The Leng Review and the leadership void: A call to fill the gap

So, the Leng Review has been published. A debate that has been admittedly toxic has finished its first round. There has been bruising on both sides. Doctors believed some of their traditional work was being taken away, and with it the income it supported. At a time when competition for training in medicine has never been more severe, the fact that Physician Assistants (PAs), as they are now to be called, were taking over their roles was painful.

On the other hand, PAs who had invested their lives in the job and built commitments around it found they were existentially threatened, and their profession was at serious risk of being disbanded.

There has been a degree of acrimony and personalisation in this debate that has been unusually harsh. Anyone familiar with PAs either professionally or socially will have seen their distress at the level of public vilification they have received. Conversely, others, even those involved in the training of PAs, have had concerns that they were being asked to take on tasks without adequate guidance and training or accountability.

The Leng report is a proposal for a way forward, but one’s verdict on it will depend on one’s perspective. The report has come to the important conclusion that there are no grounds for abolishing the PA role. PAs are here to stay. However, the role is to be more defined. PAs will need to undertake more credentialed training. Supervision is to be improved, and the initial years of practice will be within the confines of secondary care. Controversially, PAs will no longer see unselected cases, which some feel will radically emasculate the role.

It’s all a bit of a mess. Prof Leng points out that it is a pretty classical case of change mismanagement. Who was responsible for leading this change? Who was responsible for communicating the vision for the PA role? And who was responsible locally for implementing it into clinical systems? The answer, it seems, is ‘Nobody’. Change in the NHS comes about, it appears, because ideas are adopted to save money or hit targets without too much regard for the effect down at the coal face.

Did anybody sit in the patient’s chair and think about how this would affect them? Somewhere, was somebody quite happy to accept the idea that the good old NHS punters would just not spot the difference between a PA and a doctor? Conversely, weren’t the great benefits of having a PA clinician who supported the team in a focused, consistent way explained? Did anyone think to help medics understand how PAs could provide real help and improve care?

The answer, it seems, is ‘no’. Things had to get to a near-explosive level before it was realised that it was all a big mess. And now people are hurt, and somehow, we have to pick up the pieces.

And where is Christ in all this? I don’t think Jesus promotes acrimony, belittling, or slander. I do know that Jesus encourages each one of us to use the gifts he has given us for his glory and the love of others. Perhaps, as we look at this debate through the lens of Christ, we should think first of all about those who come to us for help: our patients. What really is the best for them? A godly response surely seeks to maximise the benefits of all roles in the clinical team for patient benefit.

But the wisdom from above is also without partiality or insincerity, and that means there has to be integrity in the way we present each role. So, we must stand against systems that seek to put the burdens of responsibility not just on PAs but on any of us when there has not been adequate training or credentialing to provide safe care.

And faith has no partnership with greed or ambition. There’s a murky feeling that some of the ire and bitterness about this debate has been driven by people who fear a loss of their privilege or power. The spirit of Jesus puts the other first. In the clinical context, that is fundamentally the patient. One wonders if there wouldn’t have been a gentler spirit in this debacle had it been solely about the impact of the PA role on patients.

Now, what if Christians were at the forefront of redeveloping the PA role? Would they aim to maximise patient benefit, optimise the use of resources and encourage each clinician to fully use the gifts they have been given? Professor Leng highlights the absence of leadership to effect change. Perhaps the next chapter of this story might be an opportunity for godly people to lead with the wisdom that is from above?