The Role of the Physician Assistant in Primary Care Following the Leng Review

Jul 23
4 min read

Here at THC Primary Care, we provide resources for PCN leaders, and this blog will focus on the recent guidance relating to Physician Associates following the Leng Review.

Introduction

Following the publication of the Leng Review in July 2025, important changes and clarifications have been made to how PAs will function within primary care settings.

This blog provides:

1️⃣ An updated overview of the PA role in primary care, incorporating the latest guidance and recommendations,

2️⃣ An infographic

3️⃣ A checklist to support you in implementing these changes

Let's jump in!

The Role of the Physician Assistant at a Glance

PCN Members can access this editable infographic

PCN members, head over to the infographic section to access and amend this infographic to suit your needs

Infographic titled "The role of the Physician Assistant (2025)" with key points listed. Diagonal text: "Available for download in the PCN Members Club."

Key Changes from the Leng Review

1. Name Change: From Associate to Assistant

The role of the physician associate should be renamed as 'physician assistant', reflecting the role as a supportive, complementary member of the medical team. This change aims to provide greater clarity for patients and reduce confusion about the role.

2. Mandatory Secondary Care Experience

Newly qualified physician assistants should gain at least 2 years of experience in secondary care before taking a role in primary care or a mental health trust. This ensures PAs have appropriate supervised experience before working in primary care settings.

3. Clear Limitations on Patient Care

Physician assistants should not see undifferentiated patients except within clearly defined national clinical protocols. In primary care, this means that PAs can only see adult patients with minor ailments within clear clinical pathways, as agreed upon by the Royal College of General Practitioners.

The Role of Physician Assistants in Primary Care

Core Responsibilities

Based on the Leng Review recommendations and template job descriptions, PAs in primary care will:

Act as the first point of contact for suspected minor or common conditions in adults, within clear clinical pathways
Perform annual NHS health checks (excluding patients with learning disabilities or severe mental health issues)
Provide lifestyle support and health promotion advice - a key strength identified in the review
Administer referrals to secondary care on behalf of a GP
Order agreed diagnostic tests as instructed by a GP
Support practice clinical audits, research and service development
Perform basic therapeutic procedures, including immunisations (excluding steroid or intra-articular injections)

What PAs Cannot Do

See undifferentiated patients (except within specific protocols)
Prescribe medications (though this may change with future credentialing)
See patients for a second time if their first consultation didn't result in a successful diagnosis and management
Work without appropriate supervision from a named GP

Supervision and Team Structure

The physician assistant role should form part of a clear team structure, led by a senior clinician, where all are aware of their roles, responsibilities and accountability.

A named doctor should take overall responsibility for each physician assistant as their formal line manager ('named supervisor').

The supervision framework includes:

Clinical supervision with immediate oversight
Real-time advice availability
Clear escalation processes
Maintenance of professional standards

Career Development Opportunities

The Leng Review introduces a structured career pathway:

Credentialing Programme

Physician assistants should have the opportunity for ongoing training and development within the context of a formal certification and credentialing programme. This includes the potential future ability to prescribe and order non-ionising radiation.

Advanced Physician Assistant Role

Physician assistants should have the opportunity to become an 'advanced physician assistant', which should be one Agenda for Change band higher and developed in line with national job profiles.

Supporting Patient Understanding

Clear Identification

Standardised measures, including national clothing, badges, lanyards and staff information, should be employed to distinguish physician assistants from doctors.

Patient Communication

Practices should provide clear information about:

The PA role and qualifications
What conditions PAs can manage
When patients will need to see a GP instead
How supervision works in practice

Benefits for Primary Care

The review recognises several positive contributions PAs can make:

Improved access to care for minor conditions
Continuity of care through permanent team presence
Focus on prevention and health promotion
Support for practice administration and quality improvement
Freeing GP capacity for more complex cases

Moving Forward

The implementation of these recommendations aims to:

Provide clarity about the PA role
Ensure patient safety through appropriate supervision
Create sustainable career pathways
Support effective teamwork in primary care

Conclusion

The Leng Review provides a framework for the safe and effective deployment of Physician Assistants in primary care. While the role offers valuable support for GP practices, particularly in managing minor conditions and preventive care, clear boundaries and supervision structures are essential.

As these recommendations are implemented, primary care teams will need support to integrate PAs effectively while maintaining high standards of patient care.

For practices considering employing PAs, careful attention to the supervision framework, clear communication with patients, and adherence to the defined scope of practice will be crucial for success.

We have created a checklist to help you implement these changes.

Teal checklist titled "Implementing PA Changes" with tasks like updating job titles, assigning supervisors, and planning team communication.

About Us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network Management and the creator of the Business of Healthcare Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.

Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blogs sharing insights about primary care networks.