The Government has accepted all of the physician associate (PA) review’s recommendations, it has announced, following its release today.
The Leng Review, published today, recommended that PAs be renamed physician assistants and work for two years in secondary care before moving to primary care.
It added that the role did not need to be scrapped, but did suggest putting in place more development opportunities for PAs.
It concluded eight recommendations for PAs, alongside an additional six for anaesthesia associates and four for the wider system.
The Government has today revealed that it has accepted all the recommendations in full, with health secretary Wes Streeting saying this would ‘provide clarity’.
Mr Streeting said: ‘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.’
Dr Claire Fuller, medical director of primary pare at NHS England, said: ‘We welcome the publication of this review and the clarity it provides on how these vital and valued roles can best support high-quality care for patients as part of multidisciplinary teams.
‘Following legitimate concerns raised, it is right this review has gathered expert insight and evidence from across the health service and internationally and we will now work with the service and government to fully consider and implement its recommendations.’
Future of the role
The review, which looked at the safety and effectiveness of the roles of PAs and AAs, said abolishing the role of PA would be a ‘significant, unprecedented intervention’, and that there was not ‘convincing’ evidence that this needed to happen.
‘Considering all the factors, there is no convincing reason to abolish the roles of AA or PA,’ the review said.
But it added that there was a ‘mixed picture’ of safety and effectiveness based on poor data, as well as a lack of satisfaction among PAs of the role, and a lack of confidence in the roles from the medical profession. The review suggested that the roles were important for future workforce planning, but that there could not be full trust from the public in the profession while there were ‘issues about lack of clarity’.
It said that while the roles should not be abolished, they also should not remain as they are.
‘There is also no case for continuing with the roles unchanged, as there are a number of significant issues that need to be addressed to effectively embed the PA and AA roles in the NHS workforce,’ it said.
It recommended the name of PA be changed in order to ‘give immediate clarity’ to PAs, patients and other healthcare professionals.
Deployment in primary care delayed
On their deployment in primary care, the review added: ‘In the same way that doctors do not immediately work in primary care after qualification, neither should newly qualified PAs.
‘Initial employment in secondary care provides an environment with much greater supervision, where any safety issues can be identified promptly and further training and development provided.’
In a proposed job description for newly qualified PAs joining general practice, it said they should ‘play a central role in all aspects of preventative care, including undertaking NHS health checks and provide lifestyle support and support the administration of basic therapeutic procedure.’
Other recommendations in the report include clearer marking of who is a doctor and who is a PA, and the requirement of a named supervisor. It added that there should be more support to the doctors taking on the supervisory role.
The chair of the review, Professor Gillian Leng, said the recommendations represent a ‘pragmatic solution that aims to bring cohesion and clarity’.
She added that they ‘would not be universally popular’, but that debate must now be closed.
In May, the GMC approved 33 PA courses after it became the regulator for the profession.
It comes as the decline in the number of PAs has slowed, according to the most recent monthly workforce statistics.
Leng recommendations in full
Physician associates
Recommendation 1: positioning of the role
The role of physician associate should be renamed as ‘physician assistant’, reflecting the role as a supportive, complementary member of the medical team.
Recommendation 2: credentialling
Physician assistants should have the opportunity for ongoing training and development in the context of a formal certification and credentialling programme. This should include the ability to take on added responsibilities that are commensurate with that training, including the potential to prescribe and order non-ionising radiation.
Recommendation 3: career development
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.
Recommendation 4: undifferentiated patients
Physician assistants should not see undifferentiated patients except within clearly defined national clinical protocols.
Recommendation 5: initial deployment in primary care
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.
Recommendation 6: teamworking and oversight
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 (‘named supervisor’).
Recommendation 7: identifying the role
Standardised measures, including national clothing, lanyards, badges and staff information, should be employed to distinguish physician assistants from doctors.
Recommendation 8: professional standards
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.
Anaesthesia associates
Recommendation 9: positioning of the role
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.
Recommendation 10: credentialling
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.
Recommendation 11: career development
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.
Recommendation 12: workforce planning
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.
Recommendation 13: ongoing monitoring of safety
There should be an ongoing national audit of safety outcomes in anaesthesia practice in conjunction with the Healthcare Quality Improvement Partnership to provide assurance of the safety of the physician assistants in anaesthesia role, in teams with and without physician assistants in anaesthesia.
Recommendation 14: professional standards
A permanent faculty should be established to provide professional leadership and set postgraduate standards for physician assistants in anaesthesia, under the auspices of the Royal College of Anaesthetists.
Wider system
Recommendation 15: regulation and accountability
The General Medical Council requirements for regulation and reaccreditation of physician assistants and physician assistants in anaesthesia in Good medical practice should be presented separately to reinforce and clarify the differences in roles from those of doctors.
Recommendation 16: supporting doctors as leaders and line managers
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.
Recommendation 17: redesigning medical and multidisciplinary teams
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.
Recommendation 18: safety reporting
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 multidisciplinary team working.
Source: Leng Review
A version of this story was first published on our sister title Pulse PCN.
