Commercial Litigation Team Secures Permission for UMAPs to Challenge Leng Review Decisions 

Our commercial litigation team has secured permission from the High Court for United Medical Associate Professionals (UMAPs) to bring a judicial review challenging decisions made following the Leng Review into physician associates and anaesthesia associates.

Mr Justice Sheldon granted permission on three of UMAPs’ grounds against NHS England and the Secretary of State for Health and Social Care, and two against Professor Gillian Leng.

The judgment was handed down on 1 October 2026 following an oral hearing at the Royal Courts of Justice on 8 September. The application was reconsidered after permission had been refused on paper on 16 July 2026.

The claim challenges the steps taken on 16 July 2025 to make, accept and implement the recommendations of the Leng Review, including the decision to rename physician associates and anaesthesia associates as ‘assistants’.

The claim will now proceed to a substantive hearing, where the court will consider the evidence and whether the challenged actions were lawful.

UMAPs is represented by Patrick Green KC, Jack Castle, Thomas Mallon and Kate Gardiner, instructed by Sneha Nainwal and Katherine Burnett from our commercial litigation team.

Sneha Nainwal, commercial litigation partner, said: “The High Court’s decision to grant permission marks a significant step forward for UMAPs, paving the way for the lawfulness of these decisions to be scrutinised at a substantive hearing.

“Importantly, the court has recognised that UMAPs has an arguable case on several fundamental issues, including the lawfulness of the decision to rename physician associates and anaesthesia associates as ‘assistants’, whether NHS England and the Secretary of State were under a duty to consult UMAPs, and the fairness of Professor Leng’s consultation process.

“These issues extend well beyond questions of policy. They concern the legality and fairness of decisions directly affecting an entire professional workforce, the statutory framework governing those decisions, and whether UMAPs, as the recognised trade union representing those affected, was afforded a meaningful opportunity to represent its members’ interests.

“We look forward to advancing these arguments at the substantive hearing, where the court will have the opportunity to examine the evidence and decision-making processes in full.”

UMAPs argues that the grounds that will now be considered at a substantive hearing include that:

• The decision to rename physician associates and anaesthesia associates as ‘assistants’ subverted or contradicted the statutory scheme under which associates are regulated and was irrational.
• NHS England and the Secretary of State were under a duty to consult UMAPs before making the title change, and Professor Leng failed to consult fairly on her recommendations – treating UMAPs unequally with other stakeholders.
• By not giving UMAPs the opportunity to advance its members’ interests before the decisions were made, NHS England and the Secretary of State breached Article 11 of the European Convention on Human Rights.

The claim also raises issues around the decision-making process behind the implementation of the Leng Review’s recommendations. UMAPs says that, during more than a year of litigation, the government has disclosed only one substantive document relating to the decisions: a Ministerial Submission advising then Secretary of State Wes Streeting to accept all 18 recommendations of the Leng Review on the day it was published.

Stephen Nash, general secretary of UMAPs, said: “We wholeheartedly welcome Mr Justice Sheldon’s decision that key parts of our case are arguable and deserve to be heard.

“The decision to rename our members as ‘assistants’ was taken without consulting the union that represents them. The court has now decided that the government, NHS England and Professor Leng must answer to that, and for whether our right as a trade union to speak up for our members before decisions are made about them was respected.

“We look forward to arguing this further during the judicial review with a full examination of the evidence. Our members are entitled to know why the decisions affecting them were taken and who they were really taken for, and patients deserve to know why their access to care has been restricted during these past 14 months.

“UMAPs will continue to fight to hold to account those who have leveraged a dominant position within the NHS to shut out a group of workers who were trained to help patients. Our members have lost their jobs, been pushed out of roles they trained and qualified for, and been subjected to a hostile campaign against them by their colleagues, both online and in the workplace.

“This has had a profoundly damaging impact on the associate workforce, which is around 80% female and over a third from Black, Asian and minority ethnic backgrounds.

“Our message to NHS employers remains unchanged. The Leng Review and NHS England and the Department of Health and Social Care’s advice to adopt the review’s recommendations carries no legal authority and is not a mandatory instruction.

“Its lawfulness is now to be decided by the High Court, and any associate dismissed or restricted on the basis of it will be supported by UMAPs in any potential claim they wish to pursue before the employment tribunals.”

The Secretary of State for Health and Social Care, NHS England and Professor Gillian Leng are the defendants to the claim, with the British Medical Association as an interested party.

This content is provided for general informational purposes only and does not constitute legal advice. It is not intended to address the circumstances of any individual or entity, nor should it be relied upon as a substitute for specific advice from a qualified solicitor. The information reflects the legal position as at the date specified and may be subject to change. If you require advice on a specific matter, please contact us directly.