"Since retiring I've had more time to follow what’s going on in the NHS and can comment more freely, as I have no allegiance to any one or any organisation. Two recent announcements in particular will have an impact on Primary Care; here are my thoughts," writes our Retired Practice Manager correspondent.

🔍 The Leng Review: A Reset for Physician Assistants in the NHS or not?

The publication of the Leng Review on 16 July 2025 marks a pivotal moment in the ongoing debate around the role of Physician Associates—now to be renamed Physician Assistants (PAs)—within the NHS. Commissioned by the Secretary of State for Health and led by Professor Gillian Leng CBE, the review offers, clarity, accountability, and a renewed focus on patient safety.

As someone who has spent years navigating the complexities of NHS staffing, governance, and public trust, I welcome this reset.

But it must be more than a rebrand—it must be a cultural and operational shift, with lessons learnt on past processes to ensure staff have the knowledge and backing to carry out their duties diligently.

In my view, PAs in the past were valuable, if they were used with care and within certain parameters. However, it was clear some were used instead of doctors as cost cutting measure and did not have GP support when in clinics. I accept mistakes were made, but in the real world even doctors and nurses can and do make mistakes. The reset is as follows:

🆕 For New Physician Assistants

The message is clear: newly qualified PAs will no longer walk straight into general practice or mental health trusts. They must first complete two years in secondary care, gaining experience under structured supervision. This is a sensible move.

It acknowledges the reality that a two-year postgraduate course, however intensive, cannot be a substitute for the breadth of clinical exposure required to safely assess undifferentiated patients.

Moreover, PAs will be prohibited from diagnosing patients who present with new or unclear symptoms—a safeguard that aligns with longstanding concerns from doctors, patients and coroners alike.

👥 For PAs Already in Post

Those already working in GP practices will not be removed, but their roles will be redefined and restricted. They may continue to support care delivery, but only:

• Within clear clinical pathways
• Under the oversight of a named supervising GP
• With no authority to triage or diagnose undifferentiated patients

This strikes a balance between continuity and reform. It avoids abrupt disruption while ensuring that patient safety and professional boundaries are restored.

🧭 Why This Matters

The review is not just about job titles and protocols. It’s about public trust. Patients must know who is treating them, and clinicians must know who they are supervising. The introduction of standardised uniforms, lanyards, and badges is a small but symbolic step toward transparency.

The creation of a new tier—Advanced Physician Assistant—offers a career pathway for those who wish to develop further, but only through credentialled training and formal oversight.

With statutory regulation of PAs set to begin in December 2026, the landscape is changing. PAs will soon benefit from:

• Fitness-to-practise protections
• A formal complaints and appeals process
• Clearer scope-of-practice definitions, which may reduce ambiguity in employment disputes

For NHS employers, this means greater clarity—but also greater responsibility. Dismissals must be justified through fair process, not professional prejudice. For PAs, it offers a pathway to legitimacy, though not without scrutiny.

Final Thoughts

Professor Leng’s report is pragmatic. It doesn’t abolish the PA role, nor does it ignore the contributions many have made. But it does draw a line under the confusion, the substitution, and the risks that have emerged from rapid, unregulated expansion. Regulation will be rolled out from December 2026.

As we move forward, I hope this marks the beginning of a more respectful, collaborative, and safe model of multidisciplinary care—one that values every role, but never compromises on clarity or competence.

However, on the negative side I wonder how cost effective a PA is going to be for practices, as they were well paid, and with a reduction in authority, will they be worth the money?

Why Are Resident Doctors Striking?

Once again, the NHS is facing a strike from junior doctors, now renamed “resident doctors”

The issues and their claims are:

• Pay Dispute: The British Medical Association (BMA) is demanding a 29% pay rise, arguing that real-terms pay has fallen by over 20% since 2008.
• Government Offer: The government offered a 5.4% pay increase this year, following a 28.9% cumulative rise over the past three years, but refused further negotiations on pay.
• Non-Pay Issues: Doctors also cite high student debt, costs of mandatory training, and limited career progression opportunities as key concerns.

It is clear that the majority of the public are not behind the doctors in this case. Although the doctors claim pay has been eroded over many years, that is the case for most workers in the NHS and most industries, and after last year’s settlement I personally feel they should accept that their claim is unreasonable. 

These strikes will affect GP training practices, as in some cases the resident doctors will not work there shifts in general practice. It will be interesting to see how this pans out and how long the strikes will go on for.