An evidence-led tracker of patient safety, workforce roles, supervision, regulation, spending, coroners’ findings and official action across the NHS.
Right First Time UK is examining whether NHS workforce policies are being implemented with appropriate evidence, safeguards, supervision, public understanding and accountability.
The status below separates established official findings from matters that remain under implementation, scrutiny or further investigation.
The 2025 Leng Review found the research evidence on physician associates and anaesthesia associates limited, generally low quality, inconclusive or mixed. It did not conclude that the roles should be abolished, but it found that continuing them unchanged was not justified.
Leng Recommendation 4 says physician assistants should not see undifferentiated patients except within clearly defined national clinical protocols.
Leng recommends clear team structures, senior clinical leadership and a named doctor with overall responsibility for each physician assistant. National implementation remains an area RFTUK is tracking.
The review found that patients want clear information about who is providing care and recommended nationally standardised measures to distinguish physician assistants from doctors.
NHS England operates the Learn from Patient Safety Events service (LFPSE), which records and analyses patient-safety events nationally. The key transparency question is whether staff group and professional role are recorded consistently enough to analyse workforce-related risks.
The Leng Review said accurate assessment of cost effectiveness was not possible because of weaknesses in effectiveness data. Looking only at staff cost does not capture supervision, outcomes, reattendance or wider system costs.
The GMC maintains separate routes and register entries for doctors, physician associates and anaesthesia associates. The GP and Specialist Register application route is for doctors.
From 13 December 2026, physician associates and anaesthesia associates must be registered with the GMC to practise in the UK.
The Department of Health and Social Care published Professor Gillian Leng’s independent review on 16 July 2025. The Government accepted all 18 recommendations.
Recommendation 4 says physician assistants should not see undifferentiated patients except under clearly defined national clinical protocols. The review identified initial diagnosis and treatment decisions as a key area of concern.
Recommendation 5 says newly qualified physician assistants should gain at least two years’ experience in secondary care before taking a role in primary care or a mental-health trust.
Recommendation 6 calls for a clear team structure led by a senior clinician and a named doctor taking overall responsibility for each physician assistant as formal line manager.
Recommendation 7 calls for standardised measures such as national clothing, lanyards, badges and staff information to distinguish physician assistants from doctors.
Recommendation 15 says GMC regulatory requirements for physician assistants and physician assistants in anaesthesia should be presented separately to reinforce the differences between their roles and doctors.
Recommendation 18 says safety systems should routinely collect staff-group information so national data can be interrogated for system-level issues in multidisciplinary team working.
DHSC and the Scottish Government consulted on a new legal framework for the GMC from 24 March to 21 July 2026. The consultation is now closed.
Article 28 of the draft Order says the regulator may certify that, in its opinion, “a person” has successfully completed an approved course of postgraduate education or postgraduate training.
That broad wording has prompted questions which RFTUK considers legitimate to put to DHSC and the GMC.
RFTUK has not found evidence that Article 28, read with the rest of the framework, currently allows a physician associate or anaesthesia associate simply to become a GP or medical consultant. GMC public registration routes continue to distinguish doctors from associates, and the GP/Specialist Register application route is for doctors.
Why does Article 28 use the general term “a person”, how will certification operate separately for each regulated profession, and what explicit safeguards prevent postgraduate certification from being applied across professional boundaries?
This timeline focuses on official government, NHS, parliamentary, regulatory and statutory actions rather than social-media commentary.
| Date | Body | Action / event | Why it matters | Source |
|---|---|---|---|---|
| 20 Nov 2024 | DHSC | Independent PA/AA review commissioned. | Review tasked with examining safety, effectiveness, scope, supervision, regulation, workforce and related evidence. | GOV.UK |
| 16 Jul 2025 | DHSC / Government | Leng Review published. | Government accepted all 18 recommendations. | Review |
| 16 Jul–15 Aug 2025 | NHS England | Implementation response issued and updated. | Instructions and FAQs were issued to trusts, ICBs and primary-care networks following the review. | NHS England |
| 21 Jan 2026 | Health & Social Care Committee | Evidence session on the work of the GMC. | Parliamentary scrutiny included PA/AA regulation and the GMC’s wider responsibilities. | Committee |
| 24 Mar 2026 | DHSC + Scottish Government | Draft GMC Order consultation opened. | Proposed UK-wide reform of the legal framework governing GMC regulation. | Consultation |
| 6 Jul 2026 | DHSC / Parliament | Government confirmed active implementation programme. | Parliamentary answer confirmed a joint DHSC/NHS England programme, an Implementation Oversight Group chaired by Professor Gillian Leng, and work on national clinical protocols. | Written answer |
| 21 Jul 2026 | DHSC + Scottish Government | GMC reform consultation closed. | The next stages are the consultation outcome, any revised Order and parliamentary scrutiny. | GOV.UK |
| 13 Dec 2026 | GMC | Mandatory PA/AA registration begins. | From this date it becomes an offence to practise as a PA or AA in the UK without GMC registration. | GMC |
RFTUK will separate headline salary comparisons from full system costs and will seek evidence about what workforce decisions actually cost.
The Leng Review concluded that accurate cost-effectiveness assessment was not possible because reliable effectiveness evidence was insufficient. It warned that salary-only comparisons omit wider costs and outcomes.
A complete comparison needs to include supervision time, training, reattendance, tests and investigations, patient outcomes, service capacity and any effect on medical training — not only basic salary.
Actual spending by role, establishment and vacancy numbers, training and supervision costs, local business cases, workforce modelling, implementation costs and evidence used to claim productivity or savings.
If a workforce policy is justified on capacity, productivity or value-for-money grounds, the public should be able to see the assumptions, costs, safeguards and measured outcomes used to support that decision.
Cases are not labelled as being “caused by doctor substitution” unless the official evidence supports that conclusion. The wording below stays close to the coroner or other primary record.
A 2023 Prevention of Future Deaths report concerned delayed diagnosis of a subarachnoid haemorrhage. The coroner recorded primary-care presentation before the condition was diagnosed and raised the need for awareness of key symptoms among doctors and other healthcare professionals.
The 2025 Prevention of Future Deaths report was sent to NHS England, DHSC, CQC, GMC, Royal Colleges and the NHS trust. It raised multiple concerns following Mrs Marking’s death and is a key primary document for examining role clarity, clinical governance and patient safety.
A February 2026 Prevention of Future Deaths report identified ambiguity in guidance following changes in responsibilities between secondary care, GPs and community pharmacists, creating a risk of potentially fatal delay in recognising methotrexate toxicity.
An April 2026 Prevention of Future Deaths report recorded a delay in Mr Roomes being seen by a qualified clinician and numerous missed opportunities for referral or contact with a qualified clinician. RFTUK does not currently classify this as a PA/advanced-practice substitution case because the published report does not establish that specific classification.
The NHS has a national reporting system. The transparency issue is whether the data structure lets the public and NHS reliably identify patterns involving different staff groups and workforce models.
NHS England describes LFPSE as the national NHS system for recording and analysing patient-safety events and says more than 2.5 million events are recorded each year.
The review specifically recommended that safety systems routinely collect information on staff group so that data can be monitored and interrogated nationally against agreed patient-safety standards.
Can national patient-safety data currently identify the professional group involved in an event consistently enough to compare risks, trends and outcomes? If not, when will Recommendation 18 be fully implemented?
Different organisations regulate professions, investigate safety, oversee services, make policy or scrutinise government. Their responsibilities should not be blurred together.
Government health policy, legislation, the Leng implementation programme and GMC reform.
National implementation, patient-safety systems, workforce guidance, standards and NHS provider instructions.
UK regulator for doctors, physician associates and anaesthesia associates, with separate register routes.
Oversees health and care professional regulators. Its 2024/25 review found the GMC met all 18 Standards of Good Regulation.
Regulates health and adult social-care providers in England and can hold relevant information about quality and safety.
Independent safety investigations into patient-safety concerns across the healthcare system in England.
Independent voice focused on the safety of medicines and medical devices and wider patient-safety advocacy within its statutory remit.
Committee scrutiny, written questions, legislation and Regulation 28 Prevention of Future Deaths reports provide important public records.
Professional organisations and patient groups can provide important evidence, but their statements are identified as stakeholder evidence rather than being presented as government or regulator findings.
The BMA has published campaigning and evidence about doctor substitution and advanced-practitioner deployment. RFTUK will link its evidence while independently checking claims against primary records wherever possible.
DAUK has raised concerns about PA/AA and other workforce policies and has called for clearer safeguards and safe scopes of practice.
RFTUK will also record statements from nursing, paramedic, allied-health and medical Royal College bodies where they address role boundaries, scope, supervision or patient identification.
This subject is contested and emotionally charged. The public page therefore uses a stricter evidence system than an ordinary campaign post.
Readers can use these links to check the underlying official record rather than relying only on RFTUK’s summary.
Independent government review of physician associate and anaesthesia associate roles.
Open GOV.UKOfficial NHS response, employer instructions and implementation information following Leng.
Open NHS EnglandDraft General Medical Council Order 2026 and consultation material.
Open consultationPublic registration information for doctors, physician associates and anaesthesia associates.
Open GMC registersNHS England LFPSE information and published patient-safety data.
Official published Regulation 28 reports and responses from the Courts and Tribunals Judiciary.
Search PFD reportsHealth and Social Care Committee work, written questions, debates and legislation.
Health CommitteeIndependent oversight of statutory health and care professional regulators.
Open PSAThese are transparency questions, not predetermined conclusions.
Which of the 18 Leng recommendations are fully implemented, partly implemented or still outstanding, and what is the timetable for each?
When will the protocols governing undifferentiated patients be published, who approved them and how will compliance be monitored?
Does LFPSE now capture staff group consistently enough to implement Recommendation 18 and permit meaningful national comparison?
What are the full costs and measured outcomes of different workforce models once supervision, training and wider system effects are included?
What are the membership, meeting dates, papers, minutes, decisions and implementation milestones of the Leng Implementation Oversight Group?
How will Article 28 certification work for each regulated profession, and what wording in the final Order will prevent confusion across professional boundaries?
RFTUK will continue following the official record, identifying gaps and asking who made each decision, what evidence supported it, what it cost, what safeguards were required and whether those safeguards were actually delivered.
