Official minutes from multiple Royal Colleges appear to show that organisations opposed to the physician associate role were given ongoing, privileged access to the Leng Review process, including advance sight of potential recommendations and weekly reports – while UMAPs, the union representing over half of all PAs in England, received no comparable access. When UMAPs challenged the review’s implementation in the High Court, NHS England’s legal team made no reference to any of this, instead characterising the review as a fair and open consultative process in which UMAPs had fully participated.
These minutes raise serious questions about whether the review process afforded equal and fair engagement to all stakeholders, as UMAPs and its members were repeatedly assured it would, and whether the court was given a complete and accurate picture of how the review was actually conducted. The Leng Review has since been used to justify mass redundancies, scope-of-practice restrictions, and upheaval across a profession that was designed to improve patients’ access to care and reduce NHS waiting times.
The RCoA: invited to review potential recommendations
The published minutes of the Royal College of Anaesthetists’ Council meeting on 14 May 2025 – approved by the College for publication on its website on 2 July 2025, go further still. Under item 6.1.6, discussing anaesthesia associates, the minutes record:
“…the Leng Review team was nearing the end of their process and had invited anaesthetic representation to review their potential recommendations. Dr [REDACTED] and Dr [REDACTED] were invited to represent the College and the Association, and they expected to hear about the output soon.”
The Leng Review team seemingly invited an RCoA Council member who chaired the College’s own restrictive anaesthesia associate oversight structures, and President of the Association of Anaesthetists to represent their organisations before the review team and “expected to hear about the output soon.” A formal Leng Review stakeholders’ meeting was also confirmed for 22 May 2025, with the Association of Anaesthetists included as a stakeholder. We are concerned that the RCoA was not the only college consulted as part of this process.
This was not a case of a neutral professional body being consulted for technical expertise. By its own contemporaneous records, the RCoA had already paused anaesthesia associate recruitment following an extraordinary general meeting in early 2024 and had withdrawn its draft anaesthesia associate curriculum from GMC approval leading to a significant number of AAs as they qualified. Council members were actively debating whether to produce a “proactive position statement” against the current scope of practice for anaesthesia associates. These are the actions of an organisation that had already reached a settled view on the future of the role, and yet it was this organisation, rather than the union representing the workers whose careers hung in the balance, that was given advance sight of the potential recommendations.
UMAPs was excluded
At no stage was UMAPs offered comparable access. UMAPs was not invited to review potential recommendations. UMAPs was not given advance notice of the review’s emerging findings. UMAPs submitted 66 pieces of audited data to the Leng Review, none of which was referenced in the final report. Throughout the process, UMAPs and its members were assured that all stakeholders would be engaged fairly and on equal terms. The minutes described above suggest that assurance was not honoured.
Prof Leng herself acknowledged the importance of sharing findings with those most affected. In a public statement on 6 June 2025, she wrote that she would share the findings and recommendations “with the impacted organisations first as promised.” It is difficult to reconcile that promise with a process in which selected Royal Colleges were given advance access to potential recommendations while UMAPs, indisputably the organisation representing those most “impacted”, was not.
These facts sit in stark contrast with the position taken by NHS England’s legal team before Mr Justice Dove at the injunction hearing on 15 August 2025. NHS England argued that there had been no breach of any duty to consult UMAPs because the Leng Review was itself “a deeply consultative exercise that the claimant engaged in closely” as “a core stakeholder.” The evidence now emerging reinforces UMAPs’ concern that this characterisation did not reflect the full picture.
Indeed, it now appears clear that the Leng Review did not treat all stakeholders equally. Groups intent on eliminating Associate roles, including the BMA and RCoA, were seemingly given special access and weekly reports. Their views and submissions were given pride of place in the Review. Meanwhile, UMAPs was kept at arm’s length, and none of the evidence it gathered and submitted from doctors and Associates alike were even mentioned in the Review.
What this means for UMAPs members
For our members, this is not an abstract question of process or governance. The Leng Review has been used by employers to justify decisions that are having a devastating effect on careers and, in turn, on patient care, and the scale of that damage is now becoming clear.
Since the review was published, UMAPs has received over 348 employment cases from a total membership of 1,700. That means roughly one in five of our members has needed union support to deal with the fallout. Since the BMA and Royal Colleges started publishing erosive guidance in 2024, 1 in 3 UMAPs members have needed representation. According to Pulse, the number of PAs working in primary care fell from 1,116 in June 2025 to 1,046 by September 2025. By August 2025, one in five PCNs had already cut the number of PAs they employed in the previous twelve months, acting on RCGP and BMA guidance that the Leng Review endorsed.
UMAPs’ own impact survey, published in January 2026, found that 76% of PAs have had their scope of practice restricted since the review, making their roles increasingly vulnerable to redundancy. PAs have reported seeing dramatically fewer patients per shift. Two in five reported worsening waiting times in their departments. Over half said their supervising consultant’s workload had increased as a direct result, with doctors now doing work that PAs were trained, qualified, and competent to perform. One PA described a sepsis patient who waited more than three hours for clinical review because no doctor was available, even though the PA was free to help.
All of this flows from a review that, on the evidence of the Royal Colleges’ own published minutes, appears to have given privileged, behind-closed-doors access to organisations that had already declared their opposition to the PA role, while the professionals whose livelihoods depended on those recommendations were kept entirely in the dark. It also flows from a review that, as UMAPs contends, proceeded to formulate recommendations with the potential to reshape the healthcare workforce despite finding no empirical evidence that such changes were necessary on grounds of patient safety.
The Secretary of State for Health and Social Care accepted Prof Leng’s recommendations on the same day the Review was published. Those recommendations were presented to the public, to Parliament, and to the courts as the product of an independent review.
The evidence now emerging reinforces UMAPs’ concerns that the process may not have been as independent or even-handed as it was presented to be.
What happens next
UMAPs’ judicial review proceedings are ongoing. It would not be appropriate for us to comment on those proceedings in detail, but our members should know that UMAPs will continue to pursue every available avenue, in the courts, in Parliament, and in the public debate, to ensure that the process by which these decisions were made receives the scrutiny it warrants.
Stephen Nash, General Secretary of UMAPs, says:
“What the Royal Colleges’ own published minutes reveal is deeply concerning. It appears that the Leng Review team gave advance access to its potential recommendations to organisations that had already publicly declared their opposition to the physician associate role, while the workers whose livelihoods depended on those recommendations were kept entirely in the dark.
This reinforces our concern that selected organisations were given a preferential opportunity to shape the findings of a review that was supposed to be independent, while UMAPs, the body representing the people most affected, was excluded from any comparable engagement. NHS England described the Leng Review process as entirely even-handed. The evidence emerging from these minutes makes that characterisation increasingly difficult to sustain.
Our members deserve to know that the review being used to reshape, and in many cases end, their careers was conducted with integrity. Patients and taxpayers deserve the same assurance. These are questions that merit careful examination, and we look forward to them receiving the scrutiny they deserve.”
UMAPs will shortly be issuing a formal response to the DHSC consultation on the proposed renaming of “Physician Associate” to “Physician Assistant.”
At this critical moment for the profession, collective action matters more than ever. If you are not yet a member, we urge all physician associates and anaesthesia associates to join UMAPs today. A stronger union means a stronger voice – join us here and stand with your colleagues.
