A review from the United Medical Associate Professionals has found that the restriction of the use of PAs has worsened waiting times in hospitals.
The United Medical Associate Professionals (UMAPs) trade union has reopened the debate about the use of physician associates (PAs), anaesthesia associates (AAs) and surgical care practitioners (SCPs).
The long-running debate about their use appeared over after the government accepted all the recommendations of an independent review – the Leng Review – at the end of July last year, on how they are and can be used.
Launched in November 2024, a review chaired by Gillian Leng looked into the safety of the roles of PAs and AAs and how they support wider health teams. She made 18 recommendations aimed at providing clarity to patients and improving patient safety, all of which were accepted by health and social care secretary Wes Streeting.
“The terrible impact of the Leng Review recommendations should have been entirely obvious to both the government and NHS England,” said UMAP general secretary Stephen Nash.
“Effectively sidelining some 3,500 highly qualified medical professionals was clearly going to be disastrous for patients, associates, and doctors alike. Yet at no point did the health secretary make any assessment of how this would harm medical associates or restrict patients’ access to care.”
Lengthening waiting times
The survey found that PAs’ scope of practice has been drastically reduced, resulting in lengthening patient waiting times in both secondary care and general practice.
More than three-quarters (76%) of PAs say their scope of practice has been restricted since the publication of the Leng Review.
The number of PAs averaging more than 11 patient interactions (including consultations, follow-ups, results and referrals) per shift has dropped since the Leng Review, while the number of those averaging only one to five interactions has more than quadrupled.
Two in five PAs report worsening patient waiting times in their departments since the publication of the Leng Review, and according to PAs in general practice, there has been an increase in longer patient waiting times of one to four weeks and four to eight weeks, and a drop in patients being seen in a matter of days.
“Far from protecting patients, it is increasingly looking like these changes were cooked up to mollify the increasingly radical BMA, which at the time of the review was threatening major strike action. That is why we are challenging the irrational recommendations in our judicial review, ensuring that PAs and AAs can go back to caring for patients and helping our doctor colleagues to shoulder the burden,” said Nash.
UMAPs surveyed 459 PAs currently working clinically across NHS England between mid-December and mid-January, representing a 13% response rate from an estimated population of approximately 3,500 clinical PAs. The sample includes a spread across NHS England regions and departments, with 47% of respondents working in general practice and 27% in urgent and emergency care. Over half have been working as a PA for more than five years.