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RCEM publishes its response to the Leng Review on PAs

07/10/2025

The Royal College of Emergency Medicine has today (7 October 2025) published its response to The Independent review of the physician associate and anaesthesia associate roles conducted by Professor Gillian Leng.

The review, published in July 2025, made 18 recommendations covering both roles. All 18 have been accepted by the government.

RCEM’s Short Life Working Group on PAs, which was convened in September 2023, has reviewed and considered the recommendations and how they relate to PAs working in the Emergency Medicine specialty.

Following this work, the SLWG drafted a position statement which was then discussed at the College’s full Council meeting in September 2025 and subsequently accepted.

This decision was then ratified by the College’s Board of Trustees at its meeting on 25 September 2025.

The response reaffirms the College’s previous position that there should be no expansion PA Roles in EM and that:

  • PAs cannot replace EM doctors or Advanced Clinical Practitioners (ACPs)
  • Funding, resources, and learning opportunities must prioritise the training and retention of all EM doctors, and credentialling and credentialed ACPs
  • In relation to rotas, PAs should be considered a distinct workforce group and should not be used to replace EM doctors and ACPs
  • PAs should identify and explain their role as such, and their function should be explained to patients and other members of the MDT. Standardised measures, including national clothing, badges, lanyards and staff information, should be employed to distinguish PAs from doctors.
  • Direct supervision is mandatory. PAs should be directly clinically supervised in line with the RCEM Workforce Tiers document (2025), at Tier 1.
  • With Regards to PAs, undifferentiated patients must be seen by a Tier 3 clinician or above first. Patients triaged by paramedics, RATs, reception teams, triage nurses or patients referred into an ED from other clinical services remain undifferentiated until subsequently seen by a Tier 3 clinician or above who has seen, reviewed and formulated a differential diagnosis and management plan for the patient.

It also accepts the recommendation that Physician Associates should now be referred to a Physician Assistants.

The statement does not respond to the recommendations related to the establishment of a Faculty of Physician Assistants or any future development of a PA credentialling programme as any future work around these elements would not be the responsibility of the College and would have to be undertaken by a coalition of organisations.

The College has written to its PA members directly to inform them of the response and will continue to support them going forward.