The Doctors’ Association UK (DAUK) has raised concerns about the significant risks to patient safety in its submission to the Leng Review.
DAUK’s evidence-based report also highlighted risks to medical training and NHS governance posed by the expansion and regulation of physician associates (PAs) and anaesthesia associates (AAs) roles.
The Leng Review is urged to prioritise evidence over expansion, ensuring that workforce changes safeguard patient safety, medical training, and professional accountability.
Physician associates
DAUK’s key recommendations are:
- Enforce strict supervision. Prohibit unsupervised PA practice and limit their involvement in critical areas like resuscitation and prescribing.
- Reassign PA/AA regulation to the Health and Care Professions Council (HCPC) to ensure independent oversight.
- Pause MAP expansion pending a full independent impact assessment on medical training and patient safety.
- Mandate adverse incident reporting for PAs/AAs to improve transparency and accountability.
- Consider an independent inquiry should this review find systematic patient safety risks, a formal national inquiry may be required to investigate institutional failings.
DAUK’s submission is based on an extensive survey of doctors and real-world case evidence.
The findings highlight significant risks to patient safety, medical training, and NHS governance, said DAUK committee member and past chair Dr Matt Kneale.
Key findings
The key findings include:
- Widespread reports of direct patient harm and near misses due to PA misdiagnosis, inappropriate prescribing, and unsupervised practice.
- The GMC’s regulation of PAs creates a conflict of interest, undermining transparency in coroner’s investigations and fitness-to-practise cases.
- PA/AA expansion is displacing doctors from essential training, jeopardising workforce development.
- Despite claims of cost-effectiveness, PAs require substantial supervision, reducing efficiency rather than relieving workforce pressures.
Dr Kneale said: “The Leng Review presents a critical opportunity to address the serious concerns raised by frontline doctors regarding the deployment of medical associate professionals within the NHS.
“If this review finds patients were systematically put at risk, a formal independent inquiry must follow.
“This goes beyond individual PAs—it’s about institutional accountability.
Patient safety
“Patient safety has to come first. If systemic risks have been ignored, concealed, or allowed to escalate, the public deserves full transparency and action.
“Anything less would be a failure of duty at the highest level.”
Please support our work by contributing to our crowd funder or by becoming a member.
