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If Gillian Leng, the Prof’ who has just published her report into the future of physician assistants, associates, or whatever we are supposed to call them, were to be cast in a role in history it might be Hans Brinker
Hans was the little Dutch boy who, finding a leak in a dike, used his finger to plug it, preventing a flood and saving his town.
He spends the night in the cold, enduring until morning when he is found and the dike is repaired.
Hurrah!
The again... perhaps more accurately it should be King Canute, who in the 11th century sat on his throne by the sea, commanding the tide not to rise...
... demonstrating that even a king cannot control the forces of nature… any more than our Prof can command the forces of progress to halt.
Just as when in 1476, a group of scribes in Paris attacked and destroyed a printing press…
…fearing the new technology endangered their livelihood and status and felt threatened by its potential to undermine their role as custodians of knowledge and culture…
… so the BMA, in its opposition to PAs will be unable to hold on to their role as the exclusive custodians and knowledge of matters medical.
And yes… I do know about the dreadful mistakes some PAs have made and I do know about the deception some have practiced.
So does Leng… … and I suspect she knows better than me of the mistakes doctors make and the cruel deceptions some of their fraternity have devised.
Leng is well aware of the complaints and dangers that the lack of knowledge and experience can bring to the work place.
Rightly, she suggests; clearer local roles, smarter workforce planning, training and better safety reporting.
The subtext; corral PAs into someplace they can do no harm and if they do, we’ll know about it.
It is a clearly written review (when is a review not a report) but it is confused in the telling…
… because Leng also says PAs should have; a clear career progression, develop an advanced role, get closer to the Royal Colleges for further training and credentialing, and develop faculties, to ensure professional leadership, accountability and standards.
Either PAs are to be parked in a place ‘where they can do no harm’, or they are going to have career progression where they can do a lot more good.
If you expected Leng to decide, PAs are dodgy, dangerous, exploitative and best kept out of the NHS…
Or…
Should have a supporting role developed into a significant place in the future of the NHS like they do in Canada, Germany, Australia, the US, Netherlands, Singapore…
… you’ll be disappointed. The Leng Review, if it were a flavour, it would be vanilla…
… and I sympathise. Leng cannot say what needs to be said. I don’t want to say it. Partly because when I have said it in the past I know I am in for a welter of abuse…
… but it needs to be said.
The NHS and the jobs in it are no more immune to change than the 19th-century textile mills, when Luddites smashed looms in fear of a future they couldn't control.
Today, it’s not looms but digital diagnostics, AI, and physician associates that challenge the old order.
The BMA can stand in the way, or stand at the front, shaping how technology and new roles like PAs can improve care, close gaps, and make healthcare safer and smarter.
History teaches us that you can’t halt progress by breaking the machinery or driving new careers into a cul-de-sac.
The challenge now is to lead the transformation or be left behind by it.
Their story is today’s story.
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