18 May 2026
Rt Hon James Murray
House of Commons
London
SW1A 0AA
Dear Secretary of State,
Congratulations on your appointment. I am writing on behalf of UMAPs, the recognised trade union for medical associate professionals (MAPs), including physician associates (PAs) and anaesthesia associates (AAs) in the NHS.
I am writing to you as a matter of urgency because decisions made by your predecessor have set in motion serious consequences for patient care, NHS capacity, and a clinical workforce that warrant your immediate attention.
The situation you have inherited
In July 2025, your predecessor accepted all 18 recommendations of the Leng Review on the day of its publication, without any published impact assessment regarding the consequences for patients, NHS capacity, or the associate workforce.
UMAPs’ position is that this decision was made without proper consultation and following a review process that, in our view, failed to engage fairly and meaningfully with the associate profession and the evidence submitted on its behalf. We are also concerned that the views of certain external stakeholders, including the BMA and royal medical colleges, appear to have carried disproportionate influence within a process that should ultimately have been guided by robust and transparent evidence.
We are pursuing judicial review proceedings in respect of those decisions. You have inherited those proceedings as a named defendant, and a decision on permission is expected imminently.
The consequences of your predecessor’s decisions are already being felt across the healthcare sector:
- The number of PA roles in primary and secondary care has fallen significantly since restrictions began to be imposed, undermining the work of trained, qualified, and GMC regulated clinicians. There are also thousands of trained associates who, despite qualifying in reliance on the NHS Long Term Workforce Plan and its commitment to expanding the profession, are now struggling to secure employment.
- Prior to the Leng Review, PAs undertook an estimated 20 million appointments and patient interactions across primary and secondary care annually. Current restrictions mean many PAs are seeing far fewer patients. Those appointments have not simply disappeared; at a time of unprecedented NHS pressure, they represent capacity that services are now struggling to replace.
- In responses to FOI requests made by UMAPs, some NHS Trusts have reported depleted rotas, longer waits, and experienced clinicians being replaced by unfamiliar bank staff following restrictions on PA practice within emergency departments. These are the conditions in which patients may come to serious harm.
- Over half of PAs report that their supervising consultant’s workload has increased as a result of scope restrictions, further reducing NHS capacity as doctors are required to undertake work that associates had previously been performing safely and routinely within clinical teams.
- The associate workforce is suffering immensely as a result of the rushed implementation of the Leng Review recommendations. In polling conducted by UMAPs, 95% of PAs said the Leng Review has negatively affected their mental health, with a quarter reporting thoughts they would be “better off dead”.
UMAPs has been warning for some time of the human cost that the implementation of the Leng Review recommendations may carry for both patients and associates. We remain deeply concerned that significant restrictions affecting this workforce are being implemented before any comprehensive assessment has been undertaken of the consequences for NHS capacity, patient access to care, and workforce retention.
Debate about the future of MAPs must remain grounded in evidence, patient need, and the long-term resilience of the NHS workforce. Decisions of this scale cannot safely be driven by professional tensions, public controversy, or short-term political pressure alone.
Questions about the Leng Review process
UMAPs has identified evidence which, in our view, raises serious questions about whether the Leng Review process was conducted with the degree of independence and even-handedness that the profession was entitled to expect.
Published minutes from the Royal College of Anaesthetists Council meeting of 14 May 2025 confirm that named individuals were invited to review draft recommendations prior to publication. UMAPs – representing over half of all practising physician associates – received no
equivalent access or opportunity to engage with draft proposals.
In addition, all 66 pieces of data submitted by UMAPs during the review process appear to have been discounted or omitted from the final report, including ten snap audits of associates and supervising clinicians conducted during the evidence-gathering period.
UMAPs will address these matters further within the judicial review proceedings and recognises that those issues must properly be determined by the Court.
The purpose of this open letter is not to rehearse the litigation publicly, but to urge you, irrespective of the outcome of those proceedings, to ensure that any immediate policy decisions affecting patients and the MAP workforce are taken following careful, evidence-based consideration of their consequences for NHS capacity, workforce sustainability, and patient access to care.
Our asks
We are asking you to do what your predecessor did not: address this issue on the basis of evidence, with proper regard for patient safety, NHS capacity, and the clinicians affected.
Specifically, we ask that you:
- Commission an immediate and independent impact assessment into the effect of MAP scope restrictions on patient access to care, NHS operational capacity, and workforce sustainability before any further restrictions are implemented.
- Establish an immediate structured engagement process with UMAPs, as the recognised trade union for MAPs, before any further material implementation decisions are taken affecting this workforce.
- Carefully reconsider whether further implementation of contested Leng Review recommendations should proceed before the conclusion of the judicial review proceedings and before the publication of any independent assessment of their operational impact.
- Publicly acknowledge that PAs and AAs are GMC-regulated, clinically trained professionals who continue to make a substantial contribution to NHS care and whose future forms an important part of any credible long-term workforce strategy.
We recognise that you are taking on one of the most demanding briefs in government at a moment of extraordinary pressure for the NHS. We look forward to working constructively with you to ensure that millions of patients, and the MAP workforce of more than 3,500 clinicians, are treated according to policies grounded in evidence, fairness, and the long-term needs of the health service.
Yours sincerely,
Stephen Nash
UMAPs General Secretary
