Government accepts PA review recommendations

PAs will in future be identified as physician assistants and AAs will be renamed as physician assistants in anaesthesia, reflecting their role as supportive members of medical teams. They will not be able to treat undiagnosed patients, except within clearly defined cases.

The recommendations accepted by the government include:

1. The role of physician associate should be renamed as ‘physician assistant’.
2.  Physician assistants should have the opportunity for ongoing training and development in the context of a formal certification and credentialling programme.
3. Physician assistants should have the opportunity to become an ‘advanced’ physician assistant, which should be one Agenda for Change band higher and developed in line with national job profiles.
4. Physician assistants should not see undifferentiated patients except within clearly defined national clinical protocols.
5. Newly qualified physician assistants should gain at least 2 years’ experience in secondary care prior to taking a role in primary care or a mental health trust.
6. The physician assistant role should form part of a clear team structure, led by a senior clinician, where all are aware of their roles, responsibilities and accountability. A named doctor should take overall responsibility for each physician assistant as their formal line manager.
7. Standardised measures, including national clothing, lanyards, badges and staff information, should be employed to distinguish physician assistants from doctors.
8. A permanent faculty should be established to provide professional leadership for physician assistants, with standards for training and credentialling set by relevant medical royal colleges or the Academy of Medical Royal Colleges.
9. Anaesthesia associates should be renamed as ‘physician assistants in anaesthesia’ or PAA and should continue working within the boundaries set in the interim scope of practice published by the Royal College of Anaesthetists.
10. Physician assistants in anaesthesia should have the opportunity for ongoing training and development in the context of a formal certification and credentialling programme, with the ability to take on added responsibilities that are commensurate with that training, including the potential to prescribe and order non-ionising radiation.
11. Physician assistants in anaesthesia should have the opportunity to become an ‘advanced’ physician assistant in anaesthesia, which should be one Agenda for Change band higher and developed in line with national job profiles.
12. Any further expansion in the deployment of physician assistants in anaesthesia should be taken forward in conjunction with the Royal College of Anaesthetists to build safe and effective models of anaesthesia delivery that are supported by the consultant community.
13. There should be an ongoing national audit of safety outcomes.
14. A permanent faculty should be established to provide professional leadership and set postgraduate standards for physician assistants.
15. The General Medical Council requirements for regulation and reaccreditation of physician assistants and physician assistants in anaesthesia within Good Medical Practice should be presented separately to reinforce and clarify the differences in roles from those of doctors.
16. Doctors should receive training in line management and leadership and should be allocated additional time to ensure that they can fulfil their supervisory roles, and to ensure effective running of the health service.
17. DHSC should establish a time limited working group to set out multidisciplinary models of working in different settings. The group should include input from a small group of experienced leaders covering medicine, other relevant healthcare professionals, management, and human resources.
18. Safety systems should routinely collect information on staff group to facilitate monitoring and interrogation at a national level, against agreed patient safety standards, to determine any system-level issues in multi-disciplinary team working.

Health and Social Care Secretary Wes Streeting said: “Patients should always know who they are being treated by and should always receive appropriate care. Legitimate concerns about patient safety have been ignored for too long - that’s why I sought out the very best clinical advice to review physician associates and anaesthesia associates’ roles in the NHS. I want to thank Gillian Leng, one of the UK’s most experienced healthcare leaders, for her comprehensive, thorough report.

“We’re accepting all of the recommendations of the Leng review, which will provide clarity for the public and make sure we’ve got the right staff, in the right place, doing the right thing. Patients can be confident that those who treat them are qualified to do so.

“Physician assistants, as they will now be known, will continue to play an important role in the NHS. They should assist doctors, but they should never be used to replace doctors.”

Professor Gillian Leng said: “I’m pleased the government is implementing the recommendations in full. My review provides the opportunity of a reset, but this must be the start of the conversation, not the end.

“Now it’s time to focus on delivery: bringing clarity for patients, complementarity between doctors and assistant roles, collaboration across teams, focussed on ensuring safe and effective high-quality care.”