In recent years, more and more patients across the UK have been seen by physician associates — or PAs — as the NHS has leaned on them to help ease staff shortages.
But now, a major review says the system needs a serious rethink, warning that patients could be exposed to “catastrophic” harm if urgent changes aren’t made.
Calls for a Name Change and Stricter Limits
One of the boldest recommendations from the review? Stop calling them physician associates and start calling them physician assistants — a title that makes it clear they’re there to support doctors, not replace them.
The government-commissioned report also calls for a strict rule: PAs must not be allowed to see patients unless a doctor has already assessed them.
This, the review argues, is the only way to avoid dangerous errors in diagnosis, particularly when patients first show up with new or unclear symptoms.
Too Much Responsibility, Too Little Training
There are now over 3,500 PAs working in the NHS — a number that has grown rapidly in recent years.
But critics have long warned that their limited training (just a two-year postgraduate course, compared to a full medical degree for doctors) means they’re being pushed into roles they’re not prepared for.
And when Health Secretary Wes Streeting ordered this review last November, it came after several tragic deaths, including that of 30-year-old Emily Chesterton, who was misdiagnosed twice by a PA and later died of a pulmonary embolism.
A Heated Debate Within the Medical Profession
The review, led by Professor Gillian Leng of the Royal Society of Medicine, aimed to calm growing tensions.
Many doctors — especially those still in training — are angry.
Not only do some PAs earn more and work easier hours, but they’re also taking clinical opportunities away from junior doctors.
Professor Leng acknowledged the resentment, but insisted her goal was to bring clarity and better structure.
She’s urging the NHS to change how PAs are used and supervised — starting with a rule that they must spend at least two years in hospital settings before working in GP clinics or mental health services.
Visibility, Supervision and Clear Boundaries
To avoid patient confusion, Professor Leng recommends PAs wear distinct uniforms, badges, and lanyards to make sure people know they’re not doctors.
She also wants every PA to be supervised directly by a named senior doctor, ensuring accountability.
Interestingly, she’s not entirely against expanding their role — suggesting that some PAs could train to prescribe medications, order MRIs, and eventually move into better-paid advanced positions.
But only under strict conditions and oversight.
Tragedies Highlight Need for Better Protocols
One of the key issues flagged was how PAs are used when patients first present at A&E or GP clinics.
The report stresses that this is the most dangerous point for misdiagnosis — and that this is where a doctor’s broader training across multiple specialties is vital.
Professor Leng was clear: it’s not that PAs should be scrapped altogether, but that their use must be carefully structured.
Without proper planning, the report says, patients are left vulnerable — and some local NHS trusts have been using PAs as a quick fix to plug staff gaps, often without thinking through the risks.
Confusing Job Roles and Lack of Regulation
The evidence around how safe or cost-effective PAs actually are is, according to the review, very weak.
Some PA courses even accept students from non-medical backgrounds — like English literature or geography — raising questions about the rigour of their training.
Dr Tom Dolphin of the British Medical Association didn’t hold back in his response.
He slammed NHS leadership for creating an environment where patient safety is put at risk and criticised the report for not going far enough.
He said the failure to introduce nationally agreed scopes of practice — defining what PAs can and can’t do — means local NHS bosses are still free to make their own rules.
That, he warns, leaves patients exposed to a “postcode lottery” of care.
What Happens Next?
The government is expected to respond to the review today with a written statement in Parliament.
There’s pressure to move quickly, especially with growing public concern and mounting calls for reform from the medical community.
For now, the conversation around physician associates remains heated — and at the heart of it is one key question: how do we balance innovation and support in healthcare without compromising patient safety?