United Medical Associate Professionals (UMAPs) says thousands of physician associates are considering leaving the NHS after facing hostility, tighter restrictions on their work and uncertainty following a government review that recommended changes to their roles. Their union warned this week that many are close to walking away, adding strain to stretched services.

Physician associates complete two years of postgraduate training and assist doctors in general practice and hospitals. They take histories, review long-term conditions and give vaccines. Around 5,000 work in the UK. GMC data showed 3,937 physician associates on the register as of 8 January 2026. All PAs working in the UK will need GMC registration from 13 December 2026.

A Hostile Climate Around the Leng Review

The Leng review, published on 16 July 2025, said the evidence base on physician associates was limited and recommended renaming the role physician assistants, clearer identification and restrictions on seeing undifferentiated patients. The UK government accepted all 18 recommendations the same day.⁠

United Medical Associate Professionals says thousands of members are considering leaving. John, a physician associate in Wales who asked for anonymity, shut down his social media after being called a killer, a noctor and a pretend doctor. Rosie, who works in a London GP practice, said: 'There's so much uncertainty around the profession, the role, and all the negativity and the hostile environment.'⁠

A later union survey found 76 per cent of physician associates had their scope restricted and many now see far fewer patients each shift. Polling of 695 associates found 95 per cent said the review had harmed their mental health. GMC data showed 3,937 physician associates on the register in January 2026.⁠

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Legal Challenges and a Narrower Role

UMAPs has issued group claims against some GP practices, the Royal College of General Practitioners and the British Medical Association. The first group involves 45 physician associates, with potential damages estimated at up to £7.5 million ($9.9 million).

UMAPs also sought judicial review of the decisions surrounding the Leng Review. At an oral High Court hearing on 8 September 2026, the union argued its case for permission to proceed; the judge reserved judgment.

Stephen Nash, the union's general secretary, said that when a doctor errs the response is to learn, while 'the moment something happens, it's all physician associates are bad'. On X he wrote that the risk to his health and wellbeing was too great in a clinical environment where backlash was possible.

The Department of Health and Social Care said physician assistants play important roles and the review was a chance to reset the debate. A Welsh government spokesman said the staff support doctors and are not a replacement for them.

Doctors' groups have argued that unclear boundaries between the roles can create risks, pointing to high-profile cases involving physician associates, including the death of Emily Chesterton. A coroner concluded that Chesterton should have been immediately referred to hospital after being seen by a physician associate and would likely have survived had she been referred.

Registration Deadline Approaches

From 13 December 2026 it will be an offence to practise as a physician associate without GMC registration. NHS Employers has told trusts to check the register and talk to anyone who does not apply.⁠

Restrictions have already cut the number of contacts some physician associates handle. Union officials say that capacity has not been replaced. Resident doctors still seek more training posts.

The latest warning arrives as the health service faces long waits. Whether large numbers of physician associates leave will become clearer after the registration deadline and remaining legal cases.

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