GMC framework ‘not fit for purpose’, say doctor leaders as PA regulation begins

Doctors leaders have continued to raise safety concerns, as GMC regulation of physician associates (PAs) officially began today.

The BMA said the Government’s decision to ‘press ahead’ with GMC regulation despite concerns ‘blurs the lines between doctors’ and PAs, while the Doctors’ Association UK (DAUK) said the regulator’s framework is ‘not fit for purpose’. 

Around 5,000 PAs across the UK will now be regulated by the GMC, with registration opening on Monday next week. 

However, Pulse has previously reported that PAs will be given until December 2026 to register, when it will become ‘an offence to practise as a PA’ or an anaesthesia associate (AA) in the UK without registration. 

Doctors leaders have repeatedly raised concerns about the GMC regulating PAs, with the BMA taking legal action against the regulator for its use of the term ‘medical professionals’.

The RCGP also changed its stance on PA regulation in March, arguing that the GMC is the wrong body to take on the job.

But attempts at the start of the year to block legislation failed, and bringing PAs under GMC regulation was written into law.

BMA council chair Professor Phil Banfield said that today the ‘doctors’ regulator, the GMC, starts regulating non-doctors’ without ‘any national agreement’ about what PAs can and cannot do ‘safely’ beyond ‘basic assessment at graduation’.

He said that despite the upcoming Government review into the safety and scope of PAs, there is ‘no sense of urgency’ from the GMC, NHS England and employing trusts to ‘introduce practical safety measures’ to ensure patient safety in the meantime. 

Professor Banfield added: ‘The Government’s decision to press ahead with GMC regulation further blurs the lines between doctors and these associate professionals. 

‘This undermines the founding purpose of the GMC, which is to properly distinguish who is, and who is not a medical practitioner, practising medicine to national standards set by Royal Colleges and the GMC who oversee the quality and standard of postgraduate medical training.’

Earlier this month, the GMC released a long-awaited report on findings from its consultation, which launched in March, with only minor tweaks made to its plans for PA regulation. 

The regulator has also been clear that it will not itself set out a scope of practice for these professionals, but that it will ‘have reference’ to scopes set out by other bodies, such as the RCGP and the BMA.

DAUK chair Miss Helen Fernandes criticised the GMC’s proposed framework, saying ‘huge concerns’ still remained on the eve of PA regulation. 

She said: ‘While regulation of any health professional is welcome, it is only as good as the nature of the regulation.

‘We urge the GMC to address the concerns raised by DAUK, royal colleges, BMA and swathes of the medical profession. The proposed framework for regulation is not fit for purpose and will not protect patients. 

‘Nor will it protect doctors, who the GMC hold responsible for the supervision of PAs and AAs, often when they are not necessarily able, aware, or at times appropriate.’

The RCGP said that one of the college’s ‘red lines’ on PAs is that ‘regulation must be implemented as soon as possible’, but that in their view, the GMC ‘is not the most appropriate body to do this’.

‘However, now that they have been given this responsibility, we will continue to work with them to ensure regulation is implemented as smoothly as possible in general practice,’ college chair Professor Kamila Hawthorne said.

The GMC confirmed that before the end of this month a ‘small number’ of PAs will receive an invitation to apply for registration – which requires evidence of qualifications, work history and references – while all PAs on the current voluntary register will receive an invitation by the end of January 2025.

GMC chief executive Charlie Massey recognised that there have been ‘challenges along the way’ but argued that there will now be a ‘step change in regulation’.

He continued: ‘For the first time, patients, employers and colleagues will be assured that physician associates and anaesthesia associates have the necessary education and training, meet our standards, and can be held to account if serious concerns are raised.’