The following content discusses suicide, self-harm, bullying, and severe mental health impacts. It contains first-hand accounts from Physician Associates describing suicidal thoughts, experiences of harassment, and significant psychological distress. Reader discretion is advised.
If you are affected by any of the issues raised, please seek support from a trusted individual or a mental health professional. Should you struggle to access personal medical care, we have set up a service you can get alternative access through you need to be logged into your account to access the page): https://umaps.org.uk/associates-access-to-personal-medical-care/. In the UK, you can contact Samaritans on 116 123 (free, 24/7) or visit www.samaritans.org. If you are in immediate danger, please dial 999. For more advice, please visit the CMAPs wellbeing page: https://cmaps.org.uk/wellbeing-recources/
A quarter of Physician Associates say they have felt they would be ‘better off dead’ since a Government-commissioned review which proposed severe restrictions on their work and down-graded their status was immediately adopted by the Government and NHS England.
A survey by United Medical Associate Professionals (UMAPs), the trade union for Physician Associates, shows that nearly all PAs say the Leng Review has had a detrimental effect on their mental health, with several associates reporting that they have considered suicide.
The survey polled 695 Physician Associates, roughly a fifth of PAs working in the NHS.
Key findings:
- 95% of respondents said the Leng Review had negatively affected their mental health.
- 26% of PAs said they have felt they would be ‘better off dead’, with 7% saying they feel this way every day.
- 86% showed some degree of depression based on Patient Health Questionnaire-9 (PHQ-9) questions used to assess mental health. 21% qualified as ‘severe’ meaning they would likely meet the criteria for referral to specialist mental health services.
- Several PAs say they have considered or attempted suicide.
A significant number of Respondents saw the BMA as being used as a vehicle by activists within the BMA to support a campaign by anti-PA activists.
As part of the survey, one PA responded:
“Since the Leng Review outcome, I have had sleepless nights. I took a mortgage out two years ago based on my circumstances. I love my job and I never thought it could be taken away just like that. I have even contemplated suicide.”
Another reported:
“The day after the Leng Review came out, I had a PV [per vaginal] bleed (I was 11 weeks pregnant at the time) which resulted in an admission to A&E… I should be avoiding stress, and now is the most stressed I’ve been in years.”
In July, the Leng Review recommended sweeping changes to Physician Associates’ job roles, reducing their status and permitted scope of practice, including barring them from treating undiagnosed patients. These recommendations were immediately accepted by NHS England, despite the review showing no hard evidence that PAs were unsafe or ineffective and relying on survey results which were recognised to be likely to be affected by bias against PAs.
UMAPs has initiated judicial review proceedings against the Health Secretary, NHS England, and the report’s author Professor Gillian Leng, including for failing to consult the trade union on the changes to PAs’ job roles, which are likely to result in redundancies and, in a significant number of cases, already have.
The union also accuses the Government of implementing the changes to placate the Resident Doctors Committee of the British Medical Association, which was threatening strike action at the time, whilst claiming that the decision to implement the changes was based on safety concerns.
Many survey respondents said they had felt victimised by anti-PA doctors and activists within the BMA, both before and after the Leng Review was published.
One PA said:
“The gloating the anti-PA doctors have done online should be an indication to [Professor] Leng that, far from drawing a line under this ‘toxic debate’, it has instead loaded the bullies’ gun with bullets and stripped the bullied of any protection they had.”
Another PA commented on their own experience, echoing this sentiment:
“The instant rolling out of the recommendations has allowed the blatant and unwarranted bullying by the [activists within the] BMA and [anti-PA] resident doctors to continue and given them license to be even more negative without due cause.”
A third PA commented that the blame lay squarely at the door of the doctors’ union:
“The [activists in the] BMA constantly belittle us and target us with no one to support us. I wake up everyday feeling hopeless and not knowing where to apply since a career as a PA looks unlikely.”
Yet a further PA highlighted the extent of the damage that the BMA’s rhetoric is having:
“I have thoughts of life not worth living every single day. I have always had a background of low-level anxiety, however since the Leng review I don’t even recognize myself anymore. In fact, this has been the case since all of the online bullying and hate towards the profession was started by the [activists in the] BMA 18 months ago.”
Commenting on the survey results, UMAPs General Secretary Stephen Nash said:
“These heartbreaking responses should be a wake-up call for NHS England, Wes Streeting and Professor Gillian Leng. The Leng Review has left Medical Associate Professionals with a complete lack of certainty about their futures and exposed them to even greater hostility from anti-MAP groups within BMA.
By publishing this data and pursuing judicial review, we are taking a stand against the bullying and hostility faced by PAs from anti-MAP groups within the medical establishment as well as any entity that enables and shields them.
Since Leng was published, our efforts have already prompted NHS England to clarify that it is up to individual employers when and how to implement the recommendations. We urge all trusts and primary care networks to await the outcome of our judicial review or risk legal action from UMAPs.”
After UMAPs first publicised the survey data, the union was contacted by lawyers for the BMA, who attempted to block elements of Mr Nash’s statement, alleging that they were ‘potentially defamatory and damaging’. So, rather than expressing any sympathy for the associates affected, the doctors’ union asked UMAPs to retract elements that potentially implicated activists within the BMA. Given the volume and nature of the opinions expressed by associates that referenced victimisation by anti-MAP groups within the BMA, UMAPs considered that its statement was justified and fairly reflected the opinions of those who had responded to the survey. Mr Nash therefore declined to retract the survey report and the heartfelt responses of so many PAs, as requested by the BMA. UMAPs has received no further correspondence from the BMA since then.
– ENDS –
Notes to editors:
- The Survey was conducted over 24 hours from Friday 8 to Saturday 9 August 2025 by UMAPs, with 695 verified PA responses, representing approximately one fifth of all UK Physician Associates.
- The Leng Review was published on 16 July 2025
- On the same day, the Secretary of State for Health, Wes Streeting, announced that he would instructed NHS England to implement the recommendations in the Review immediately.
- Also on the same day, NHS England issued instructions to NHS bodies to take ‘immediate actions’ to implement the recommendations, although it later changed the original announcement in the face of the judicial review challenge by UMAPs.
- Physician Associates are commonly referred to as PAs. Anaesthetist Associates are commonly referred to as AAs. PAs and AAs are together commonly referred to as medical associate professionals or MAPs.
About UMAPs
- United Medical Associate Professionals Trade Union (UMAPs TU) was formally recognised as a trade union in December 2024, and represent medical associate professionals and students, providing advocacy, legal support, and professional development advice to MAPs at every stage in their careers.
Contact
George Chichester
Email: george.chichester@sabistrategy.com
Phone: +44 7446 858 882
