Zarah ChoudharyThe British Medical Association (BMA) is urgently calling on NHS England to introduce a mandatory scope of practice for physician and anaesthesia associates (PAs and AAs), following the publication of a systematic review which concluded there is a lack of evidence these roles are safe.
In November 2023, the BMA called for a national pause in the recruitment and expansion of PAs and AAs following evidence that they are working considerably beyond their competencies, taking on tasks that are usually undertaken by doctors with a decade or more of education and training.
Professor Sir Stephen Powis and Dr Navina Evans, NHS England’s national medical director and chief workforce officer respectively, wrote an open letter at the time, claiming that “the evidence tells us MAPs are safe, increase the breadth of skill, capacity and flexibility of teams, positively contribute to patient experience and flow, and reduce workload pressure on other clinicians.”
Despite a request for evidence of this claim, none was provided, according to the BMA.
In the BMA’s letter, sent on 11th March 2025, chair of BMA council Professor Phil Banfield reminded them of this claim in light of the BMJ’s rapid review, which concluded that NHSE’s “conflating absence of evidence of safety incidents in a small number of research studies with absence of safety concerns […] is an error of logic that is likely to cost lives.”
Banfield added: “By maintaining a postcode lottery in which different hospitals can decide what physician and anaesthesia associates can and can’t do in the absence of any agreed scope of practice, I fear that the NHS has created a patient safety scandal.
“It is wholly unacceptable for NHS England to continue its current course of inaction relying on evidence that cannot be provided and which this systematic review has shown does not exist.”
An increasing number of coroners are now raising concerns after several tragic deaths following misdiagnosis by PAs: Emily Chesterton died following the misdiagnosis of a blood clot in 2022 by a PA she thought was a doctor, while Pamela Marking died in February 2025 after being wrongly diagnosed with a nosebleed by a PA when she had a strangulated hernia.
While the Secretary of State for Health and Social Care has now launched a review of the role, NHS England has refused to introduce interim safety measures to protect patients.
The BMA has called upon them to review this position immediately.
A spokesperson from NHS England said: “Physician associates are trained practitioners that play an important role in supporting the NHS to provide high-quality care for patients, but this should always be with the appropriate supervision and within the scope of their practice.
“The Leng Review will gather insight from across the NHS to ensure that these roles are being used appropriately to deliver safe care for patients and we are listening carefully to legitimate concerns about these roles and we are taking action to address this.”
