Responding to the publication of the Leng Review, Dr Tom Dolphin, chair of BMA council, said:

“Today, Professor Leng has laid bare the catastrophic failures in NHS leadership that have put patients at serious risk of harm. But unfortunately this review’s recommendations do not adequately protect patients.  

“Professor Leng has succeeded in exposing how NHS England introduced these roles and encouraged their expansion without any robust evidence of their safety. The report reveals inadequate national leadership, no accountability and no attempt to listen to the concerns raised by doctors, patients and coroners. The blurring of lines between doctors and non-doctors, aided and abetted by the GMC, has been an unfolding disaster for all to see, and many doctors today will be relieved to see that they were right to raise the alarm.

“Unfortunately, while the diagnosis is strong, the prescription fails to meet the urgency of the moment. Despite the alarming way these roles were introduced and expanded unsafely there are significant gaps in the report where strong patient safety recommendations should have appeared. Most worryingly, a major opportunity has been missed to end the postcode lottery of what PAs can and can’t do. By failing to recommend authoritative, nationally-agreed scopes of practice, Professor Leng has ignored the most urgent demand of the medical profession, and left patients at the mercy of local decisions by employers who can still choose where and how assistants can work.

“This is deeply disappointing, and we call again on NHS England to act now and adopt the BMA’s safe scope of practice guidance as an interim measure until this can be properly addressed. The GMC too must urgently act on Professor Leng’s criticisms about how its decisions are blurring the lines between doctors and assistants.

“There are some helpful recommendations. It is good to see that our longstanding call to change the job title to “assistant” has been listened to. It should not have needed a report like this to tell NHS leaders that the title “physician associate” is confusing and misleading for patients. We urge Government and employers not to waste any time in making this change from associate to assistant.

“Despite correctly recommending that assistants shouldn’t be the first person seeing patients coming straight through the doors in GP practices or in A&E, the report then contradicts itself by saying that PAs can act as a first point of contact in primary care for minor and common conditions. It is not clear how these two recommendations can coexist, and this must be urgently clarified. Minor complaints are only minor in retrospect and serious conditions can present in subtle or unusual ways.”

“No doubt doctors will look back at this report as a moment when historic failures could have been addressed and patients finally protected – but sadly will see this as an inadequate response to what is a patient safety scandal. We hope that the Government will follow our advice beyond what this report has recommended, for the sake of patients.”

Notes to editors

The BMA’s submission to the Leng Review can be found here

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.