The BMA says the NHS must stop gambling with patient safety in its use of physician associates and anaesthesia associates, amid a scandal that has plunged the NHS and the medical regulator, the General Medical Council (GMC), into disrepute. 

The BMA will be putting more than 30 recommendations to the UK Government’s Leng Review¹ that seek to finally end the growing patient safety scandal surrounding the education, training, deployment and regulation of physician and anaesthesia associates, which has tragically led to multiple preventable patient deaths. 

The BMA is calling for physician associates and anaesthesia associates to be renamed as part of evidence to be submitted later this week to the first-ever national review of the roles. 

The Association says that doing this, alongside introducing a national scope of practice, will help avoid patient confusion and prevent further tragic safety incidents in which patients thought they were being treated by a doctor when they were not. 

The BMA’s submission to the Government’s Leng Review, due to be submitted by the end of the week, also includes new data from one of the largest surveys of the medical profession on the topic of PAs and AAs, with more than 16,000 doctors and medical students taking part.

The findings of the latest survey include²:

• 95% of respondents want a national scope of practice to clarify what PAs can and can’t do
• 77% of respondents think NHS leaders can't make the PA role safe
• 83% of respondents don't think PAs should be able to provide initial care to patients in general practice and the emergency department
• Only 20% of respondents think GMC regulation will improve patient safety

This survey follows another last year of almost 19,000 doctors, which found that almost 9 in 10 said the way PAs and AAs were working in the NHS was always or sometimes a risk to patient safety.

Taken together, this evidence shows that the medical profession is deeply concerned with the way the PA experiment has so far progressed.

The BMA has repeatedly called for interim safety measures while Professor Gillian Leng undertakes her review, including introducing a mandatory scope of practice for these roles until the Leng Review is able to report.

The BMA’s submission follows allegations that Trusts hosting visits by the Leng Review team have misled the national review by excluding resident doctors from the visits, preventing them from raising legitimate concerns around patient safety.

Meanwhile, the chief executive of the GMC, Charlie Massey, was discovered to have been writing to medical bodies to ask them to water-down crucial safety guidance. NHS England’s own National Medical Director cited evidence of the safety of these roles to justify their rapid expansion which has now been roundly debunked in a systematic review published in the BMJ.

BMA chair of council Professor Philip Banfield said:

“Patients deserve to know who is treating them and what they can do. This is not just good for patient confidence: it can be a matter of life and death. In the tragic cases of Pamela Marking and Emily Chesterton, the patients who lost their lives did so while they and their families were under the mistaken belief they had seen a doctor. In the case of Pamela Marking, the hospital hadn’t even recorded her death as a safety incident.

“This has to stop. We are presenting evidence today representing the clear settled opinion of the medical profession: we need a scope of practice for PAs and AAs, a proper regulatory system that draws the line between them and doctors, and the clear naming of the roles so that patients can be in no doubt of their relative responsibilities in comparison to the expertise of doctors.  

“The term ‘physician associate’ was never appropriate because it mistakenly implied some sort of parity between the two years of training a PA receives and the many years of education and training a doctor undertakes. We have even had to take the GMC to court for continuing to refer to PAs as ‘medical professionals’. Despite that, still the GMC is confused when it recently called PAs ‘medical practitioners’, the legally protected title that should only ever be used for describing a qualified doctor. Yet it continues to fight the case against the BMA, wasting public money to defend the indefensible.  

“Instead, much as with ‘teaching assistant’ in schools, a title such as ‘physician’s assistant’ is much more effective for patients in setting out where in a healthcare team the PA sits. By making clear that the PA assists but does not go beyond their training in looking after patients, the title helps them carry out their work as an effective member of the team while reassuring patients they know what level of care they are receiving at all times.

"Included in our submission to the review is a report of the safety concerns raised with the BMA through our safety reporting portal. It includes first-hand accounts that demonstrate just why it is so important that NHS England immediately introduces interim safety measures, including a mandatory scope of practice for these roles. The NHS must stop gambling with patient safety. You don’t fly a plane under safety review, you ground it.

“We urge Professor Leng to think carefully about the evidence we have presented – this has been a total system failure where the stakes for the future safety of the health service could not be higher.”

Ends 

Notes to editors

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

1. The full submission will be made available once it has been submitted.

Top recommendations set to be submitted in the BMA’s evidence to the Leng Review are: 
•    The regulated titles of associates must change.
•    Associates must not be described as medical practitioners, medical professionals or being medically trained 
•    Training opportunities of medical students and doctors must be prioritised over the provision of training opportunities of doctor’s assistants.
•    Nationally agreed safe scopes of practice for associates must be established which set ceilings of practice for these dependent non-medical roles.  
•    Regular monitoring and enforcement of nationally agreed safe working parameters must be undertaken by healthcare regulators.
•    In each healthcare setting (private or public), PAs and AAs must have an immediately available senior doctor as their named supervisor.
•    Employers must ensure that where associates are employed there is adequate time allocated each working day for every patient to be fully discussed with the supervising senior doctor and reviewed in person if necessary. 
•    An investigation into the unsafe substitution of doctors by associates must be instigated to examine the full extent of the problem across the NHS. 
•    Staff rostering systems must ensure the complete separation of doctor and non-doctor roles with dedicated doctor-only rosters, which prevent non-doctors being assigned to duties that can only be undertaken by doctors 
•    All NHS hospitals and trusts must undertake an urgent review of all electronic prescribing systems, and ionising radiation requesting systems, to ensure associates are prevented from accessing them.

2. The survey of doctors and medical students ran from Feb 19 - March 4th 2025, with 16,106 responses. 
Survey questions included: 
There should be nationally determined scopes of practice for PAs and AAs 
Answered: 13,924 
Strongly agree: 10,712 (76.9%)  
Agree: 2,516 (18.1%)  
Neither agree or disagree: 365 (2.6%)  
Disagree: 184 (1.3%) 
Strongly disagree: 147 (1.1%)  

I am confident that GMC regulation will improve the safety of PA and AA roles 
Answered: 14,131  
Strongly agree: 1,117 (7.9%)  
Agree: 1,765 (12.5%)  
Neither agree nor disagree: 3,454 (24.4%) 
Disagree: 2,973 (21.0%) 
Strongly disagree: 4,822 (34.1%) 

PAs should be able to provide initial care to undifferentiated, untriaged patients in general practice and the emergency department 
Answered: 13,923 
Strongly agree: 321 (2.3%)  
Agree: 966 (6.9%)  
Neither agree nor disagree: 1,142 (8.2%)  
Disagree: 2,319 (16.7%)  
Strongly disagree: 9,175 (65.9%)  
 
I am confident that senior NHS leaders can ensure that PA and AA roles are used safely in the NHS 
Answered: 13,895 
Strongly agree: 447 (3.2%)  
Agree: 1,029 (7.4%)  
Neither agree nor disagree: 1,675 (12.1%)  
Disagree:  3,357 (24.2%)  
Strongly disagree:  7,387 (53.2%)