Update on Council's consideration of the Leng Review recommendations

Published: 01/10/2025

Following the publication of the Leng Review in July, we shared our initial response with members ahead of a full discussion at our Council meeting in September. This update sets out Council’s current position. 

Summary 

Several Leng Review recommendations are directed at the College and have significant implications for our specialty and its workforce. Council requires further information and dialogue in relation to these recommendations before we can confirm a definitive position. 

The government’s decision to accept the Leng Review’s recommendations is currently subject to legal action brought by United Medical Associate Professionals (UMAPs). This appears to have disrupted the government and NHS England’s implementation plans and created uncertainty for other stakeholders. 

The College has also received a letter before action from UMAPs’ lawyers stating an intention to pursue judicial review of our decision-making post-Leng Review and insisting that we maintain the status quo until the legal proceedings are resolved. We have responded robustly, but Council must carefully consider its next steps in an increasingly litigious landscape.

Subject to the resolution of current and potential legal challenges and pending any further guidance from NHSE / DHSC, Council has agreed the following position. 

  • Council supports recommendations 9,12 and 13 (nomenclature and scope of practice, workforce planning and ongoing monitoring of safety), with support for recommendation 13 conditional on the national audit being anaesthetist-led and clarity on how it will be funded.  
  • Council requires further information from and discussion with national stakeholders (NHSE, GMC, DHSC) relating to recommendation 10 (credentialling) and 11 (career development). While Council supports the principle of career development for AAs, it does not support the terminology, particularly in relation to ‘credentialling.’ Council expects to be involved in further detailed discussion on these points and will bring the outcomes of those discussions back for further consideration before confirming its position.
  • Council requires more detail on the proposed faculty’s funding models, structure and governance before reaching a position on recommendation 14 (professional standards). Recognising that this decision affects the entire anaesthetic community, Council and the wider membership will need to be convinced that creating a faculty offers benefits over and above those provided by the current governance model for AA representation within the specialty and College.  

Our rationale for our position 

Recommendation 9:overarching 
  • Anaesthesia associates should be renamed as ‘physician assistants in anaesthesia’ or PAA and should continue working within the boundaries set in the interim scope of practice published by the Royal College of Anaesthetists.

Council supports this recommendation to provide greater clarity for patients and the public. Implementation is, however, subject to legal challenge. Because of this, we will continue using the Interim AA Scope of Practice until legal proceedings are resolved, after which we will update the terminology as required.   

We welcome the clear endorsement from Professor Leng and the Secretary of State for Health and Social Care of the College’s Interim AA Scope of Practice as a safe and appropriate framework for the contribution of AAs to high-quality anaesthetic care in the NHS. We expect all departments to continue implementing the Interim AA Scope of Practice, which is endorsed by the Association of Anaesthetists.   

Recommendations 10 (credentialling) and 11 (career development)
  • Physician assistants in anaesthesia should have the opportunity for ongoing training and development in the context of a formal certification and credentialling programme, with the ability to take on added responsibilities that are commensurate with that training, including the potential to prescribe.
  • Physician assistants in anaesthesia should have the opportunity to become an ‘advanced physician assistant in anaesthesia’, which should be one Agenda for Change band higher and developed in line with national job profiles.

Council supports the principle of career development and the sentiment behind these recommendations. However, we do not support the specific terminology used, particularly in relation to credentialling. Although common across professions, the term’s use in this context could cause confusion and concern, since the GMC already employs it to recognise doctors’ expertise in specific areas of practice. 

Our Interim AA Scope of Practice clearly sets out the extent of practice for AAs, established through consultation with our members, and provides a framework for progression in the five years post-qualification. It does not allow for AA roles beyond the three phases outlined. 

Career development is not confined to the clinical sphere and although we are committed to reviewing the scope of practice on a three-yearly cycle, we do not intend to make changes before then. 

Council expects to be involved in further detailed discussion with stakeholders on these recommendations and will bring the outcomes of those discussions back for further consideration before confirming its position. 

Recommendation 12: workforce planning
  • Any expansion in the deployment of physician assistants in anaesthesia should be taken forward in conjunction with the Royal College of Anaesthetists to build safe and effective models of anaesthesia delivery that are supported by the consultant community.

Council supports this recommendation. It is essential that the College plays a central role in defining the structure of the anaesthetic workforce, as recommended by both Professor Leng and the Secretary of State for Health and Social Care. Anaesthetists must be directly involved in workforce planning if care models are to be safe, sustainable and professionally supported.  

The most pressing workforce priority remains a sustained expansion in the ability to train more anaesthetists. This is essential to address workforce shortages, reduce patient waiting times and ensure sufficient educator and leadership capacity in the specialty. Demand for anaesthetic training far exceeds supply – in August 2025 there were 6,770 applications for 539 core anaesthetic training posts in England and Wales, a ratio of 12.6 applicants per post. This imbalance requires urgent action.    

Recommendation 13: ongoing monitoring of safety 
  • There should be an ongoing national audit of safety outcomes in anaesthesia practice in conjunction with the Healthcare Quality Improvement Partnership to provide assurance of the safety of the physician assistant in anaesthesia role, in teams with and without physician assistants in anaesthesia.

Council supports this recommendation, conditional on the national audit being anaesthetist-led and with further clarification on how it will be funded.   

The Leng Review concluded that it was difficult to draw generalisable conclusions about the safety and effectiveness of AAs. Our own evidence review also found the existing literature insufficient to help answer questions about the AA role in relation to patient safety. A national audit would therefore be beneficial. 

Recommendation 14: professional standards 
  • A permanent faculty should be established to provide professional leadership and set postgraduate standards for physician assistants in anaesthesia, under the auspices of the Royal College of Anaesthetists (RCoA).

It is positive that the Leng Review endorses the role of the College in providing leadership and guidance on the education, training and professional development of AAs. Currently, Council undertakes this role, advised by an AA Committee. We remain fully supportive of AAs who are currently training or working in the NHS, and we welcome them as affiliate members of the College. 

Council requires more detail on the proposed faculty’s funding models, structure and governance before reaching a position. A faculty would require additional resources (not drawn from membership subscriptions) and does not currently have member support. 

Recognising that this decision affects the entire anaesthetic community, Council and the wider membership will need to be convinced that creating a faculty offers benefits over and above those provided by the current governance model for AA representation within the specialty and College.  

Pause in the recruitment of new student AAs 

We ask that the pause in recruitment of new student AAs remains in place while we seek clarity on legal action threatened by UMAPs. Council and the Board of Trustees will review this issue again once the legal challenges are resolved.

Next steps

Council is committed to active engagement with NHSE, DHSC, the GMC, the Association of Anaesthetists, the Association of Anaesthesia Associates and our members as these matters progress. We will continue to update members and ensure that their views are central as we work to deliver the best route forward for our specialty.