This guidance for members should be seen as an update and replacement of our Preliminary Guidance for members regarding the outcome of the Leng review (here). We have also issued an interim update for employers (here).

• Employers felt compelled to implement recommendations even where they disagreed.
• Some employers were concerned that immediate implementation could compromise patient care, potentially affecting access to healthcare.
• Many were unclear on the practical mechanics of implementation and the legal exposure to employment tribunal claims.

UMAPs acted swiftly to address these risks:

1. Blocking proposed DES amendments – July 2025, UMAPS successfully prevented NHS from introducing changes to Associate titles and scopes of practice.
2. Urgent legal action – On 11th August 2025, UMAPS filed an application for an interim injunction requiring NHS England and DHSC to clarify that the 16th July decision is not mandatory.

Whilst the injunction itself was not granted, the legal action resulted in NHS England and DHSC explicitly acknowledging in court that:

• DHSC: “We are not saying it is safer to see a resident doctor than a PA. We are not saying any medical professional is completely safe all the time.”
• NHS England: “Employers, including NHS trusts, PCNs, and GP practices, are independent and make clinician-led decisions regarding their workforce, considering local circumstances and clinical practice.”
• Dr Claire Fuller (in her witness statement for NHS England): “It is ultimately a decision for the professional judgment of employers (not NHS England) … to determine the skillset and competencies of their workforce having regard to external guidance sources.”

• Therefore, NHSE has stated that the 16th July decision is not a directive. On 15th August 2025, UMAPS’ application for an interim injunction was heard by the Administrative Court. Whilst the injunction itself was not granted, on the very same day, NHS England revised the original guidance on its website, replacing the call for “immediate action” with FAQs that unequivocally clarify that employers retain full discretion over whether and how to implement the recommendations. 
• Employers are responsible for any implementation decisions, including legal and human rights consequences. 
• Immediate or unconsidered changes risk breaching employment law, potentially exposing employers to tribunal claims. Specifically: 
  • Termination under “Some Other Significant Reason (SOSR)” or redundancy must be considered carefully. Employers relying on these measures to implement the recommendations may still face legal challenge.
• The ongoing judicial review challenges the process, outcome and legality of the Leng Review recommendations. UMAPS has now also added Prof. Leng as a defendant, challenging the recommendations themselves.

Due to NHSE’s seeming withdrawal of their initial directive, any Employer who continues with the unilateral imposition is not only doing so wilfully in the knowledge that these changes have not been mandated, but they are also acting unlawfully and therefore MUST be challenged. 

As the leading trade union for Physician Associates (PAs) and Anaesthesia Associates (AAs) in the UK now representing approximately 60% of the MAP workforce, we continue to raise our ongoing concerns about the Leng review recommendations, the subsequent guidance from NHS England (NHSE), and the implementation of changes.

We reaffirm our position that we do not agree with the widespread implementation of the recommendations, in particular precluding PA’s from seeing undifferentiated patients and attempting to change the title to ‘Assistant’, particularly in view of the harm we are seeing it cause to our individual members and our profession. The situation is exacerbated when looked at against the backdrop of the upcoming Judicial Review, in which the lawfulness of the process and decisions forming the Leng Review and the proposed implementations will be challenged.

Despite the review providing no conclusive evidence that the PA profession is unsafe or ineffective, the recommended changes fundamentally alter the nature and scope of the role, and undermine the extensive training, experience and skills that current PAs hold. We are concerned that this could result in significant detriment to patient care through reducing access to care and disabling a highly skilled workforce from doing the job they are trained to do.

We are alarmed at the scale and substance of these changes, the process by which they are being introduced, and the impact this is having. We have seen a 675% increase in employment disputes since the publication of the recommendations. Furthermore, it is deeply troubling to us that 95% of respondents to our mental health impact survey reported a negative affect on their mental health following publication of the Leng Review, with 26% of respondents reporting they have felt they would be “better off dead”.

We filed for an injunction with the aim of putting a halt to any harm whilst awaiting Judicial review, and although injunctive relief was not granted, NHS England have since removed their initial immediate actions guidance from the website, replacing it with a ‘Frequently Asked Questions’ document, and have now confirmed that employers retain discretion over whether and how to implement the recommendations. Employers remain fully responsible for their decisions and accordingly, face potential liability as a result of any breaches of employment law.

Our view is that Associates should continue to work within the scope of practice permitted by the GMC, guided by demonstrated competence, experience, and established clinical supervision. We propose employers should aim to maintain the status quo whilst legal challenges are ongoing. If there are found to be any necessary operational adjustments introduced at this stage, they should be temporary with frequent review, proportionate, in line with employment law and with adequate consultation, and should not result in substantial changes to the Associate’s role, title, or contractual terms.

1. If you are asked to sign a new contract/ job description/ framework or agreement DO NOT SIGN IT and seek advice from UMAPs.
2. Where employers maintain the status quo, you should continue to practice in line with your contract, local arrangements, training, competence and experience.
3. If your employer unilaterally implements any changes to your job role and/or job title, submit a letter of protest to formally record your disagreement with the changes and contact UMAPs. This should be done regardless of whether the changes are made formally in writing, or informal/ verbally, and regardless of how big or small the changes may be. A template protest letter is included below. Remember, working under protest preserves your legal rights and demonstrates that although you will comply with the changes and continue to fulfil your professional duties, you do so under protest and do not agree to the changes to your terms and conditions.
4. Our stance, based on the NHSE FAQ document and concurrent withdrawal of the 16th of July decision, is that any unilateral imposition of terms, including title change, is unlawful and should be challenged through a formal grievance with a view to pursue tribunal if there is failure to remediate harm. We now advise that all members facing changes should immediately contact us so that we can provide help.
5. When contacting UMAPs about any employment issues or changes to working arrangements, please use the ‘Request a Rep’ link on the website. Requests will be triaged based on urgency, and one of our reps will be in contact as soon as possible.

Your letter of protest should:

• Clearly state that you do not accept the change.
• Specify what has changed (duties, supervision, job title, etc).
• Declare that you are continuing to work under protest to protect your legal rights.

Subject: Working Under Protest – Contractual Changes

Dear [Manager/HR Representative],

I am writing to formally assert that I do not accept the recent changes made to my employment terms and conditions introduced as part of the implementation of the Leng Review. These changes include the revised job title of Physician Assistant, being prohibited from seeing undifferentiated patients, revised clinical supervision arrangements, modified duties, and a change in job role.

I consider these changes to be a repudiatory variation of my contract made without my express consent. While I will continue to carry out my responsibilities to patients and colleagues, I do so under protest and without prejudice to my legal rights. By doing so, I am expressly not affirming my contract. I reserve the right to challenge these changes and seek advice on further action.

Please acknowledge this letter and confirm that it will be placed on my personnel file.

Yours sincerely,
[Your Full Name]
[Job Title]