Supporting Our Physician Associate Colleagues in the United Kingdom 

AAPA Responds to the Leng Review’s Misrepresentation of UK Physician Associates 

October 31, 2025 

By Todd Pickard, DMSc, PA-C, DFAAPA
President and Chair of the Board, American Academy of Physician Associates

As physician associates (PAs) in the United States, our profession is rooted in one mission: expanding access to safe, high-quality, patient-centered care. Across the Atlantic, our physician associate colleagues in the United Kingdom (UK) share that same mission—but unfortunately, their 20-year history of expanding access and providing safe care is being distorted and misrepresented.  

The American Academy of Physician Associates (AAPA) has been in close contact with UMAPs—the recognized trade union for UK Medical Associate Professionals—and has stayed carefully apprised of the concerning situation unfolding abroad. We were disappointed to learn about efforts to strip UK physician associates of their title, as well as implement sweeping changes that could undermine their clinical expertise, limit their ability to care for patients, and put thousands of their jobs at risk. These actions threaten not only the livelihoods of dedicated providers, but more importantly, the continuity, accessibility, and safety of patient care across the UK.   

UMAPs estimates that the implementation of these changes could cause thousands of physician associates to lose their jobs overnight due to unilateral contract changes, thereby delaying critical care and reducing access to appointments. The potential loss of experienced physician associates from the workforce would further strain an already overburdened healthcare system. Compounding these concerns, several UK universities have announced that they are suspending or no longer admitting students to physician associate programs, citing uncertainty about the profession’s future.  

Serving as the basis for these proposed changes is a recent report known as the Leng Review, accepted in full by the UK government. Given the far-reaching implications this report holds for the PA profession and patient access to care, AAPA undertook a thorough and independent evaluation of the Leng Review. As the leading organization representing physician associates in the United States, the birthplace of the profession, AAPA felt a responsibility to assess the report’s accuracy, fairness, and evidentiary foundation.  

Upon completion of this review, AAPA has significant concerns about not just this report’s research methodology and findings, but the rationale behind the recommendations put forth despite lack of evidence. AAPA’s research division found:  

• No significant safety or “Never Events.” The Leng Review found no substantive differences in safety, clinical effectiveness, or “Never Events” between physician associates and comparator groups within the National Health Service (NHS).  

• Weakness in research methodology undermines the report’s recommendations. The literature review, focus groups, and survey underpinning the Leng Review’s recommendations suffer from methodological flaws, including subjective exclusion of studies, sampling bias, lack of transparency, and non-response bias. 

• Secondary data supports physician associate safety. National datasets indicate that physician associates provide care as safe as other NHS professionals. The report’s characterization of these data as “inconclusive” is challenged, and the absence of significant safety concerns should be interpreted as evidence supporting physician associate safety. 

• Restrictive recommendations lack evidence and may worsen workforce shortages. Proposals to limit physician associate scope are not supported by the data and could exacerbate existing NHS workforce shortages. Survey responses show many General Practitioners and resident doctors support expanding physician associate responsibilities, and majority of physician associates feel confident in their abilities to manage patients adequately and effectively.  

• Policy changes should prioritize evidence-based strategies. The Leng Review advocates for NHS and General Medical Council (GMC) professional changes including clearer role definition, structured credentialing, and enhanced career development for physician associates within multidisciplinary teams. Future policy efforts should focus on enhancing these aspects for the profession, rather than imposing unnecessary and non-evidence-based constraints.  

It is clear that the Leng Review authors dismissed the robust, real-world data demonstrating the safety and effectiveness of physician associate-led care. This singular assessment not only endangers the patient and public perception of physician associates in the UK, but around the world—and most critically, it poses a substantial risk to patients’ access to high-quality care under an already strained healthcare system.  

As AAPA continues to modernize physician associate practice in the United States, we stand in solidarity with our UK colleagues to ensure that physician associates everywhere can continue providing high-quality, patient-centered care.   

Read AAPA’s full response to the Leng Review