Doctors’ Association UK (DAUK) has responded to reports that NHS England chief executive Sir Jim Mackey intends to accelerate work on clinical models less reliant on doctors in response to ongoing industrial action by resident doctors.
The comments, reported by HSJ, represent the clearest statement yet that NHS leadership views workforce substitution not as a patient safety measure but as a strategic response to doctors exercising their legal right to strike.
This approach contradicts the findings of the government’s own Leng Review, published in July 2025, which found no compelling evidence that substituting doctors with physician associates is safe – particularly in primary care and in settings involving undifferentiated patients.
The Leng Review identified that only one study of four physician associates had involved any direct observation of clinical competence by a doctor. No studies had examined safety incidents.
OECD data shows that the UK already has fewer practising doctors per head of population than almost all comparable countries. Rather than addressing this shortfall, NHS England’s strategy would widen it further.
A BMA survey of patients found that the public ranked physician associates as more senior than resident doctors, demonstrating deep confusion about who is providing their care.
DAUK has consistently argued that deliberate policy choices – caps on medical school places, failure to expand training posts, real-terms pay erosion and a hostile environment for international medical graduates – have created the doctor shortage driving both the industrial dispute and the push for substitution.
Dr Matt Kneale, DAUK co-chair, said: “Sir Jim Mackey’s comments confirm what frontline doctors have long suspected: that the drive to replace doctors with less qualified staff is not about improving patient care – it is about reducing the bargaining power of the medical workforce.
“You cannot simultaneously argue that doctors are so essential that their strikes cause unacceptable harm, and that the solution is to design them out of clinical care. These positions are mutually exclusive.
“The Leng Review found no evidence that doctor substitution is safe. The NHS Long-Term Workforce Plan set a target of 10,000 physician assistants before that evidence review was even commissioned. This is policy-based evidence, not evidence-based policy.”
Dr Steve Taylor, DAUK GP lead, said: “In the private sector, you see a doctor. In the NHS, the plan is for you to see anyone but a doctor. That is a political choice, and it is putting lives at risk.
“The UK already has fewer doctors per head than almost every comparable country. No other nation is responding to that gap by designing doctors out of patient care. They are training more of them.
“In general practice, patients present with undifferentiated symptoms that require the diagnostic expertise only medical training provides. The Leng Review itself found no compelling evidence that physician assistants are safe to work as doctor substitutes in primary care. GPs and their patients deserve better than a workforce strategy built on replacing expertise with cost savings.”
DAUK is a grassroots organisation of volunteers representing doctors and medical students in the NHS, campaigning for patient safety, fair working conditions and evidence-based workforce policy. For more information visit https://dauk.org
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