Why wait? Why community settings should be a good starting place for physician assistant careers

The recent Leng review into physician associates, accepted in full by the government, has sparked many important conversations, including whether physician associates (renamed assistants in the Leng review) have any role to play in primary care. But one recommendation that might have escaped people’s notice caused me concern, because it suggests a much wider constraint on the government’s ability to shift the focus of care into the community.

Recommendation 5 of the review says: Newly qualified physician assistants should gain at least 2 years’ experience in secondary care prior to taking a role in primary care or a mental health trust.

The rationale offered for this is that secondary care provides an environment which is better supervised, allowing for closer oversight and safer development. And it is this rationale which concerns me, as it reinforces outdated hierarchies in health care training, where hospitals are seen as the ‘proper’ place to start a career and community settings are something you graduate into later. It sends a damaging message: that primary and community care are less safe, less structured and less suitable for early-career professionals, and that as a result resources for training and supervision will flow into hospitals rather than other settings. In The King’s Fund report Making care closer to home a reality, we argued that training for both managers and clinicians needs rebalancing to reflect the growing importance of care outside hospital settings. If we want to build a workforce that is confident, competent and committed to working in these settings, we need to embed exposure and experience early, not delay it.

The real issue isn’t where someone works but how well they are supported. With the right scope of practice, supervision, mentorship and structured development, there is no reason why newly qualified professionals can’t thrive in community roles from the outset. In fact, early exposure to the complexities and rewards of primary and community care can be a powerful motivator for long-term retention.

If the system is unable to provide adequate supervision for early-career professionals outside of hospitals, then there’s a lot to worry about. Rather than restrict deployment, it’s surely a reason to invest in better supervision and support for staff working in primary and community care, something that we have long argued for.

To build a workforce fit for the future, we need to start by trusting and equipping our early-career professionals to work where they are most needed, not just where it’s most familiar. This means designing flexible, supportive career routes that value community settings – not as a second step, but as a foundational part of training and early career development.

If the government is serious about delivering a shift in the focus of care this time, then the lack of confidence in the support and supervision outside hospitals will need to be urgently addressed.