UMAPs challenge to the Leng Review has been dismissed, and permission to apply for judicial review has been refused, with all grounds deemed “unarguable”. 

The long-running saga about the use of physician associates (PAs), anaesthesia associates (AAs) and surgical care practitioners (SCPs) appears to have come to an end with the High Court dismissing a challenge to the implementation of the Leng Review by United Medical Associate Professionals (UMAPs). 

Launched in November 2024, a review chaired by Gillian Leng looked into the safety of the roles of PAs and AAs and how they support wider health teams. In August last year, she made 18 recommendations, aimed at providing clarity to patients and improving patient safety, all of which were accepted by then health and social care secretary Wes Streeting.

The UMAP has refused to take the recommendations lying down. In May this year, it wrote a letter to James Murray, the new health and social care secretary. 

In it, UMAP general secretary Stephen Nash took issue with the recommendations limiting the use of PAs and AAs. He said that decisions were taken without proper consultation and following a review process that had “failed to engage fairly and meaningfully” with the associate profession and the evidence submitted on its behalf. 

He went on to express concern that “the views of certain external stakeholders, including the BMA and royal medical colleges, appear to have carried disproportionate influence within a process that should ultimately have been guided by robust and transparent evidence”.

The letter concluded by saying that there were “serious questions about whether the Leng Review process was conducted with the degree of independence and even-handedness that the profession was entitled to expect”.

The High Court refused permission to apply for judicial review, finding all grounds unarguable. The judge, Alistair MacDonald, found that the review was lawfully produced and that the allegation of bad faith on the part of Gillian Leng in appeasing the BMA was baseless.

“Every ground UMAPs brought was found to be unarguable. Importantly, the allegation that the Leng Review was somehow designed to appease the BMA and its resident doctor members was rightly found to be baseless,” said BMA deputy chair of council Emma Runswick. 

“The recommendations, while limited, were an attempt to protect patient safety. Trying to stop the implementation of safety measures on unevidenced accusations was always going to fail,” she continued. 

Nash responded to the decision by saying that UMAP was “exploring the options available to apply for reconsideration of the decision”.