The BMA has again called for immediate intervention to protect patient safety in the NHS after publishing over 600 reports of serious concerns submitted to the BMA by doctors and medical students who have witnessed unacceptable blurring of lines between the role of physician associates and anaesthesia associates (PAs and AAs), and doctors. This testimony, collected via an online reporting portal between November 2023 and February 2025, has been submitted to the ongoing government-commissioned  Leng Review¹ as  evidence that there is a clear disconnect between how PAs are meant to be working and the way they actually are showing that the NHS has failed in its duty to ensure patient safety. 

Given the seriousness of the safety concerns highlighted, and the number and spread of examples of actual and potential patient harm, the BMA has today published the full extent of the evidence collected, and is calling for the NHS to introduce urgent interim safety measures while the Leng Review is ongoing. These interim measures include: the immediate halt to recruitment and expansion of PA and AA roles; implementation of the BMA’s safe scope of practice and supervision guidance; and an immediate investigation into PAs and AAs being placed on doctor rotas. 

Testimony² includes: 

• PAs making incorrect clinical decisions in place of doctors 

• PAs introducing themselves as doctors 

• PAs dangerously prescribing medication (something they are not permitted to do) 

• PAs taking part in surgical procedures for which they were not qualified 

The full testimony, taken from across the UK and anonymised to protect the doctors and patients involved, paints an alarming picture of the postcode lottery that has resulted from an ongoing failure to put in place a national scope of practice for these roles. Many patients have either come to harm or only avoided it by the timely intervention of a doctor after being seen by a PA who was left to act well outside their competence.  

While some of the most serious examples of PAs and AAs acting outside of their competence resulting in patient safety incidents are outlined below, a large proportion of responses described PAs and AAs working in place of doctors on rotas, illustrating the widespread misuse of PAs and AAs across the NHS.³ 

BMA chair of council Professor Philip Banfield said: 

“We have long talked about ‘patient safety’, ‘scope of practice’, and competencies. Now this shocking testimony shows precisely what these words mean on the ground. Here is a chronicle of a health system that is seeing far too many near misses, with one simple cause: PAs and AAs are doing things they are neither trained or legally supposed to do. These testimonies are of critical importance to Professor Leng’s impending review which must end this dangerous free-for-all.  

“PAs inserting chest drains unsupervised, prescribing dangerous levels of opioids to patients or even those outright impersonating doctors – the sheer number of these accounts is hair-raising. This is an invaluable testimony from working doctors across the UK showing why we have been so insistent that we see a national scope of practice, right now. Immediate intervention by the NHS until this preventable dangerous mess is sorted out would seem the only way to restore public confidence that someone is taking this scandal seriously.” 

Notes to editors