Independent review of physician associates and anaesthesia associates: survey of healthcare professionals
Updated 14 March 2025
Applies to England
There has been a minor change to the wording of one question. Survey responses given before 10 March will still be considered in the Leng review.
Background
The Secretary of State for Health and Social Care has established an independent review of the physician associate (PA) and anaesthesia associate (AA) professions to make recommendations to inform future government policy, led by Professor Gillian Leng CBE.
The areas the review will consider include the safety of the roles and their contribution to multidisciplinary healthcare teams. The conclusions of the review will help to inform the workforce plan to deliver the 10 Year Health Plan.
The Leng review will take an open and transparent approach to gathering evidence from all stakeholders and will be based on the best available evidence and data.
This survey of healthcare professionals is targeted at AAs, PAs and those that work with them. The 2 roles are considered separately, and respondents will be asked to choose the role most relevant to them when responding. This survey is one part of a multi-method approach to evidence gathering.
In line with the review’s commitment to be collaborative and inclusive, there will be other ways for relevant groups and organisations to share their views. This will include, but is not limited to:
- a call for evidence, requesting data analysis or unpublished research from organisations and individuals
- review of published research
- site visits
- webinars for healthcare professionals
- focus groups for patients
Who we want to hear from
The Leng review is keen to understand the day-to-day practice of AAs and PAs, and the development of these roles.
The survey is open to all healthcare professionals, but we particularly want to hear the views of:
- people currently or previously working as AAs
- people currently or previously working as PAs
- doctors working or previously working with AAs or PAs in multidisciplinary teams
The survey will ask questions appropriate to your role - including separate questions for the AA and PA roles. While the questions are tailored to the respecitve role, they can also be answered by all healthcare professionals.
For the purposes of this review, analysis will focus primarily on the responses from AAs, PAs and those that have experience working alongside them in multidisciplinary teams. However, the review commits to assessing and analysing all feedback received through the surveys.
How to respond
Respond using the online survey. You’ll be asked whether you are a PA, AA or another healthcare professional.
The deadline for completing the survey is 11:59pm on 30 March 2025.
If you have any questions about the review, contact leng.review@dhsc.gov.uk.
Survey questions
In the online survey, respondents will be asked if they want to answer questions about either the:
- AA role
- PA role
The questions they see will therefore only refer to either AAs or PAs (not both).
The survey questions are also listed below. To avoid writing some questions twice, on this page we use the phrase ‘AAs or PAs’. This indicates that a particular question was asked about both the AA and PA role.
Question
Which survey would you like to complete?
- PA survey
- AA survey
About you
Question for those answering the AA survey only
Question
Do you work (currently or previously) as one of the following? (Select the most relevant)
- AA
- Resident doctor, including foundation years
- Specialty and associate specialist doctor
- Consultant
- Other (Please specify)
Question for those answering the PA survey only
Question
Do you work (currently or previously) as one of the following? (Select the most relevant)
- PA
- Resident doctor, including foundation years
- GP (including GP speciality trainees)
- Consultant
- Specialty and associate specialist doctor
- Other (Please specify)
Background questions for AAs or PAs
Question
Which organisation do you work for? (Please specify the trust or primary care network)
(Maximum 150 characters)
Question for AAs only
Question
In which healthcare setting do you work?
- Secondary care
- Other (Please specify)
Question for PAs only
Question
In which healthcare setting do you work?
- Primary care
- Secondary care
- Mental health trust
- Other (Please specify)
Question for AAs or PAs
Question
In which region is the service where you most recently worked as a PA or AA based? (Select all that apply)
- East Midlands
- East of England
- London
- North East England
- North West England
- Northern Ireland
- Scotland
- South East England
- South West England
- Wales
- West Midlands
- Yorkshire and the Humber
Background questions for those who work with AAs or PAs
Question
When did you last work in a healthcare setting where AAs or PAs were part of the multidisciplinary team?
- Within the last 2 years
- Between 2 and 5 years ago
- More than 5 years ago
- Never
Question
In which organisation did you most recently work with AAs or PAs? (Please specify the trust or primary care network)
(Maximum 150 characters)
Question for those who work with AAs only
Question
In which healthcare setting did you most recently work in a team with AAs? (If not relevant, please enter your current setting)
- Secondary care
- Other (Please specify)
Question for those who work with PAs only
Question
In which healthcare setting did you most recently work in a team with PAs? (If not relevant, please enter your current setting)
- Primary care
- Secondary care
- Mental health trust
- Other (Please specify)
Question for those who work with AAs or PAs
Question
In which region is the service where you most recently worked with AAs or PAs based? (Select all that apply)
- East Midlands
- East of England
- London
- North East England
- North West England
- Northern Ireland
- Scotland
- South East England
- South West England
- Wales
- West Midlands
- Yorkshire and the Humber
Initial training and development (questions for AAs or PAs)
Question
When did you qualify as a PA or AA?
- Within the last 2 years
- Between 2 and 5 years ago
- More than 5 years ago
Question
Where did you complete your course in AA or PA studies? (Please provide the name and location of the institution)
(Maximum 150 characters)
Question
Before becoming a PA or AA, did you have any experience working in a health or care role or setting?
- Yes
- No
If yes, what other roles in a health or care setting did you hold before training to become a PA or AA?
(Maximum 500 characters)
Day-to-day practice of PAs
Taking medical histories from patients
Question
How often do PAs in your service take medical histories from patients?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for physician associates to take medical histories from patients?
- Yes
- No
- Unsure
Providing clinical assessments on patients
Question
How often do PAs in your service provide clinical assessments on patients?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to provide clinical assessments on patients?
- Yes
- No
- Unsure
Performing physical examinations on patients
Question
How often do PAs in your service perform physical examinations on patients?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to perform physical examinations on patients?
- Yes
- No
- Unsure
Diagnosing illnesses
Question
How often do PAs in your service diagnose illnesses?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to diagnose illnesses?
- Yes
- No
- Unsure
Developing management plans
Question
How often do PAs in your service develop management plans?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to develop management plans?
- Yes
- No
- Unsure
Managing care for patients with long-term chronic conditions
Question
How often do PAs in your service manage care for patients with long-term chronic conditions?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to manage care for patients with long-term chronic conditions?
- Yes
- No
- Unsure
Performing diagnostic and therapeutic procedures
Question
How often do PAs in your service perform diagnostic and therapeutic procedures?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to perform diagnostic and therapeutic procedures?
- Yes
- No
- Unsure
Reviewing test results
Question
How often do PAs in your service review test results?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to review test results?
- Yes
- No
- Unsure
Providing health promotion and disease prevention advice to patients
Question
How often do PAs in your service provide health promotion and disease prevention advice to patients?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to provide health promotion and disease prevention advice to patients?
- Yes
- No
- Unsure
Supporting innovation, audit and research
Question
How often do PAs in your service support innovation, audit and research?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to support innovation, audit and research?
- Yes
- No
- Unsure
Teaching, supervising and assessing other team members
Question
How often do PAs in your service teach, supervise and assess other team members?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to teach, supervise and assess other team members?
- Yes
- No
- Unsure
Interpreting, monitoring and responding to clinical readings and patients’ parameters
Question
How often do PAs in your service interpret, monitor and respond to clinical readings and patients’ parameters?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to interpret, monitor and respond to clinical readings and patients’ parameters?
- Yes
- No
- Unsure
Providing contraceptive services
Question
How often do PAs in your service provide contraceptive services?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to provide contraceptive services?
- Yes
- No
- Unsure
Delivering antenatal care
Question
How often do PAs in your service deliver antenatal care?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to deliver antenatal care?
- Yes
- No
- Unsure
Prescribing medications
Question
How often do PAs in your service prescribe medications?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to prescribe medications?
- Yes
- No
- Unsure
Ordering ionising radiation
Question
How often do PAs in your service order ionising radiation?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to order ionising radiation?
- Yes
- No
- Unsure
Delivering immunisations
Question
How often do PAs in your service deliver immunisations?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for PAs to deliver immunisations?
- Yes
- No
- Unsure
Day-to-day practice of AAs
Reviewing patients prior to surgery and assessing them for anaesthesia
Question
How often do AAs in your service review patients prior to surgery and assess them for anaesthesia?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to review patients prior to surgery and assess them for anaesthesia?
- Yes
- No
- Unsure
Taking medical histories and clinical assessments, allowing for an anaesthesia plan to be created
Question
How often do AAs in your service take medical histories and clinical assessments, allowing for an anaesthesia plan to be created?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to take medical histories and clinical assessments, allowing for an anaesthesia plan to be created?
- Yes
- No
- Unsure
Inducing, maintaining and/or waking up patients from anaesthesia under appropriate supervision
Question
How often do AAs in your service induce, maintain and/or wake up patients from anaesthesia under appropriate supervision?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to induce, maintain and/or wake up patients from anaesthesia under appropriate supervision?
- Yes
- No
- Unsure
Initiating and managing medications, fluid and blood therapy during surgery under supervision
Question
How often do AAs in your service initiate and manage medications, fluid and blood therapy during surgery under supervision?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to initiate and manage medications, fluid and blood therapy during surgery under supervision?
- Yes
- No
- Unsure
Ensuring there is a plan for patients following their operation and that it is carried out
Question
How often do AAs in your service ensure there is a plan for patients following their operation and that it is carried out?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to ensure there is a plan for patients following their operation and that it is carried out?
- Yes
- No
- Unsure
Supporting innovation, audit and research
Question
How often do AAs in your service support innovation, audit and research?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to support innovation, audit and research?
- Yes
- No
- Unsure
Teaching, supervising and assessing other team members
Question
How often do AAs in your service teach, supervise and assess other team members?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to teach, supervise and assess other team members?
- Yes
- No
- Unsure
Interpreting and monitoring clinical readings and patients’ parameters and responding appropriately
Question
How often do AAs in your service interpret and monitor clinical readings and patients’ parameters and respond appropriately?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to interpret and monitor clinical readings and patients’ parameters and respond appropriately?
- Yes
- No
- Unsure
Identifying potential issues during surgery and anaesthesia, taking action and seeking appropriate support when required
Question
How often do AAs in your service identify potential issues during surgery and anaesthesia, take action and seek appropriate support when required?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to identify potential issues during surgery and anaesthesia, take action and seek appropriate support when required?
- Yes
- No
- Unsure
Using anaesthesia techniques and agents, medications and specialist equipment
Question
How often do AAs in your service use anaesthesia techniques and agents, medications and specialist equipment?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to use anaesthesia techniques and agents, medications and specialist equipment?
- Yes
- No
- Unsure
Prescribing medications
Question
How often do AAs in your service prescribe medications?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to prescribe medications?
- Yes
- No
- Unsure
Ordering ionising radiation
Question
How often do AAs in your service order ionising radiation?
- Daily
- Weekly
- Monthly
- Rarely
- Never
- Unsure
- Not applicable
Question
Do you believe it is appropriate for AAs to order ionising radiation?
- Yes
- No
- Unsure
Day-to-day practice of AAs or PAs
Other activities
Question
Please describe any other activities that AAs or PAs in your service carry out. (Maximum 2,000 characters)
Question
Are there additional activities that you feel your service could assign to AAs or PAs?
- Yes
- No
- Unsure
If yes, what additional activities could be assigned to AAs or PAs? (Maximum 2,000 characters)
Question for AAs or PAs only
Question
Are there any activities that you currently conduct that you feel uncomfortable about carrying out? (This could include activities you think are potentially unsafe)
- Yes
- No
- Unsure
If yes, what activities are you uncomfortable about carrying out and why? (Maximum 2,000 characters)
Question for all respondents except AAs or PAs
Question
Are there any elements of work that you feel uncomfortable about AAs or PAs carrying out? (This could include activities you think are potentially unsafe for AAs or PAs to conduct)
- Yes
- No
- Unsure
If yes, what activities are you uncomfortable about AAs or PAs carrying out and why? (Maximum 2,000 characters)
Identifying AAs or PAs
Question
At your service, are patients told when they are seeing a PA or AA?
- Always
- Usually
- Sometimes
- Rarely
- Never
- Unsure
Question
How often do AAs or PAs in your service wear the following items and/or clothing to identify their role to patients and staff?
Specific uniform or clothing?
- Always
- Usually
- Sometimes
- Rarely
- Never
- Unsure
Badges?
- Always
- Usually
- Sometimes
- Rarely
- Never
- Unsure
Lanyards?
- Always
- Usually
- Sometimes
- Rarely
- Never
- Unsure
Other identifying items and/or clothing?
- Always
- Usually
- Sometimes
- Rarely
- Never
- Unsure
If you said ‘Always’, ‘Usually’, ‘Sometimes’ or ‘Rarely’, what other identifying items and/or clothing do AAs or PAs in your service wear to identify them to patients and staff? (Maximum 2,000 characters)
Question
Do you agree or disagree that patients in your service understand the role of AAs or PAs?
- Strongly agree
- Agree
- Neither agree nor disagree
- Disagree
- Strongly disagree
- Unsure
Please provide more detail to support your answer regarding patient understanding of the AA or PA role. (If you have suggestions for how this may be improved, please include them here)
(Maximum 2,000 characters)
Question
What changes do you think healthcare services could make to improve how the AA or PA role is implemented? (Maximum 2,000 characters)
Defining the AA or PA role
Question
Do you agree or disagree that the role and responsibilities of AAs or PAs are clearly defined within your organisation?
- Strongly agree
- Agree
- Neither agree nor disagree
- Disagree
- Strongly disagree
- Unsure
Question
Do you agree or disagree that the role and responsibilities of AAs or PAs are clearly defined at a national level?
- Strongly agree
- Agree
- Neither agree nor disagree
- Disagree
- Strongly disagree
- Unsure
Question
Do you agree or disagree that a defined scope of practice for AAs or PAs would be helpful?
- Strongly agree
- Agree
- Neither agree nor disagree
- Disagree
- Strongly disagree
- Unsure
Question
Please provide any detail to support your answer regarding a scope of practice for AAs or PAs. (If you have suggestions for how a defined scope of practice could develop over time, please include them here)
(Maximum 2,000 characters)
Question for all respondents except AAs or PAs
Question
What changes in your service (if any) have you experienced as a result of the introduction or expansion of AAs or PAs? (For example, changes to workload, skills mix or capacity)
(Maximum 2,000 characters)
Questions for all respondents
Question
What do you think could improve the effectiveness of AAs or PAs working in multidisciplinary teams? (Effectiveness can relate to any aspect of how these roles contribute to service quality and patient safety and quality as part of the multidisciplinary team)
(Maximum 2,000 characters)
Question
What do you think would reduce the effectiveness of AAs or PAs in multidisciplinary teams? (This can include factors you think already reduce the effectiveness)
(Maximum 2,000 characters)
Supervision (questions for AAs or PAs)
Question for AAs only
Question
Who most commonly acts as your day-to-day supervisor?
- Consultant
- Other (Please specify)
Question for PAs only
Question
Who most commonly acts as your day-to-day supervisor?
- Consultant
- General practitioner
- Other (Please specify)
Question for AAs or PAs
Question
How confident do you feel that there is enough supervision and support for you in your AA or PA role?
- Extremely confident
- Very confident
- Moderately confident
- Slightly confident
- Not at all confident
- Unsure
Please provide more detail regarding your confidence in supervisory support. (Maximum 2,000 characters)
Supervision (questions for those who work with AAs or PAs)
Question
Do you provide, or have you previously provided, day-to-day supervision for any AAs or PAs?
- Yes, currently
- Yes, previously
- No
Question
What other relationships, if any, do you hold with AAs or PAs in your service? (Select all that apply)
- Employer
- Training lead or trainer
- Governance lead
- Other (Please specify)
- None of the above
Question
How confident do you feel that AAs or PAs deployed in your service receive enough supervision and support?
- Extremely confident
- Very confident
- Moderately confident
- Slightly confident
- Not at all confident
- Unsure
Please provide more detail regarding your confidence in supervisory support for AAs or PAs. (Maximum 2,000 characters)
Question for those who work with AAs only
Question
What ratio of supervisor to AA do you work to in your setting?
- 1:1
- 1:2
- Unsure
- Other (Please specify)
Question for those who work with PAs only
Question
What ratio of supervisor to PA do you work to in your setting?
- 1:1
- 1:2
- 1:3 to 1:4
- 1:5 to 1:6
- 1:7 or more
- Unsure
- Other (Please specify)
Continuing professional development (questions for AAs or PAs only)
Question
Does your work schedule allow time for continuing professional development?
- Yes
- No
Question
Would you like more opportunities for career progression?
- Yes
- No
- Unsure
If yes, what opportunities for career progression would you like? (Maximum 2,000 characters)
Patient safety questions for AAs or PAs
Question
How confident would you feel reporting a patient safety incident?
- Extremely confident
- Very confident
- Moderately confident
- Slightly confident
- Not at all confident
- Unsure
Question
How confident do you feel that you would be supported by your service following a patient safety incident?
- Extremely confident
- Very confident
- Moderately confident
- Slightly confident
- Not at all confident
- Unsure
Question
Please explain your answer. (Maximum 2,000 characters)
Question
Have you ever been involved in a patient safety incident?
- Yes
- No
If yes, please provide any details about how the patient safety incident might have been prevented. (Maximum 2,000 characters)
Patient safety questions for those who work with AAs or PAs
Question
Have any AAs or PAs in your team been involved in a patient safety incident?
- Yes
- No
- Unsure
If yes, please provide any details about how the patient safety incident might have been prevented. (Maximum 2,000 characters)
Patient safety: reporting incidents
Question
Have you ever reported any patient safety incidents, including incidents that did not involve AAs or PAs?
- Yes
- No
Question to AAs or PAs answering ‘yes’
Question
Who was involved in the patient safety incidents that you reported? (Select all that apply)
- Yourself
- Other AAs or PAs
- Resident doctors
- Consultants
- Speciality and associate specialist doctors, registrars or other doctors
- Nurses
- Others (Please specify)
Question to respondents other than AAs or PAs answering ‘yes’
Question
Who was involved in the patient safety incidents that you reported? (Select all that apply)
- Yourself
- AAs or PAs
- Resident doctors
- Consultants
- Speciality and associate specialist doctors, registrars or other doctors
- Nurses
- Others (Please specify)
Question to all respondents answering ‘yes’
Question
Who have you reported patient safety incidents to? (Select all that apply)
- Consultant
- General practitioner
- Organisation leadership
- Freedom to Speak Up Guardian or other whistleblowing support role
- Other (Please specify)
Question to all respondents
Question
Describe any changes to the AA or PA role - or the way this role is integrated into multidisciplinary teams - that you feel would help increase patient safety. (Maximum 2,000 characters)
Regulation
Question
What impact do you expect the General Medical Council’s regulation of AAs or PAs to have on the following:
The safety of the AA or PA role?
- Very positive impact
- Some positive impact
- Neither positive nor negative impact
- Some negative impact
- Very negative impact
- Unsure
The support that AAs or PAs receive in their roles?
- Very positive impact
- Some positive impact
- Neither positive nor negative impact
- Some negative impact
- Very negative impact
- Unsure
Perception of AAs or PAs within the medical profession?
- Very positive impact
- Some positive impact
- Neither positive nor negative impact
- Some negative impact
- Very negative impact
- Unsure
Public perception of the AA or PA role?
- Very positive impact
- Some positive impact
- Neither positive nor negative impact
- Some negative impact
- Very negative impact
- Unsure
Please provide any detail regarding your expectations on the General Medical Council’s regulation to help explain your answers. (Maximum 2,000 characters)
Other
Question
Please add any other comments that you think might be useful to the Leng review. (Maximum 2,000 characters)
Next steps
The data gathered will help to inform the conclusions and recommendations set out in the Leng review.
Privacy notice
Summary of initiative or policy
The Leng review will consider the safety of PA and AA roles and their contribution to multidisciplinary healthcare teams. The conclusions of the review will help to inform the refreshed workforce plan that the government has committed to publish in summer 2025 and wider government policy. The review’s terms of reference sets out the purpose and timing of the review.
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The Department of Health and Social Care (DHSC) is the data controller.
What personal data we collect
Through this survey we will be collecting a limited amount of personal data - this will be limited to the name of the organisation that survey respondents work for and the nature of their role.
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We will use this data to inform the deliberations of the review and support analysis of the survey. Data will also be used to ensure that the review is hearing from an appropriate range of respondents.
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No decision will be made about individuals solely based on automated decision making (where a decision is taken about them using an electronic system without human involvement) which has a significant impact on them.
Changes to this policy
We keep this privacy notice under regular review, and we will update it if necessary. All updated versions will be marked by a change note on this page. This privacy notice was last updated on 7 March 2025.