Some physician associate (PA) courses may not be approved by the GMC as they do not currently meet the necessary standards, the regulator’s submission to the Government review has revealed.
Yesterday, the GMC published its submission to the Leng review, which is looking at the safety and effectiveness of PAs and anaesthesia associates (AAs) and is expected to report in June.
Since statutory GMC regulation of PAs began in December, over 1,400 PAs and AAs have been officially registered, from over 2,500 completed registration applications.
However, the submission said that ‘a small number of PA applicants were not granted registration’ because they had not passed the Physician Associate National Exam.
Registration with the GMC is not a legal requirement until December 2026, meaning these PAs will not be barred from practising during this ‘transition period’.
The GMC clarified to Pulse that during this period it is the responsibility of employers to check that PAs have the necessary competence, and that many employers already require them to be on the Faculty of Physician Associates managed voluntary register, for which a pass in the national exam was a pre-requisite.
The regulator also revealed in its evidence to the Leng review that it will soon publish more specific guidance on doctor supervision of PAs, bringing together the relevant standards on delegation, and expanding on this with further advice.
On scope of practice, the GMC reiterated to the Leng review that its standards ‘do not impose ceilings on what individual doctors, PAs and AAs can do once registered’.
‘This is because we recognise that competence will vary by individual and is shaped by their supervised training and experience,’ the submission said.
But the GMC emphasised that PA employers have a ‘clinical governance responsibility’ to ensure employees are competent to do the activities they are tasked with, and to ‘determine which activities and specific tasks an individual can carry out and what level of supervision is required’.
‘We would expect employers to be aware of, and have regard to, relevant guidance produced by royal colleges and other specialist professional bodies when they are making decisions about deployment,’ it added.
As well as employers, the GMC also suggested to the Government review that medical royal colleges and other specialist professional bodies are well placed to set scope within their specialty areas, as they ‘have the level of clinical expertise required’.
The submission pointed to guidance from the RCGP, on which the GMC has provided feedback saying the ‘restrictive’ scope could ‘dissuade’ GP practices from employing PAs.
‘While it is not for the regulator to endorse the finalised guidance, we will have appropriate regard to it in the discharge of our regulatory functions, and will therefore consider this when assessing any concern about a PA or AA that is raised with us,’ the GMC clarified.
On education and training, the submission said the GMC had ‘worked closely with all 37 PA and AA course providers’ to prepare them for regulation.
From an initial quality assurance process, the GMC will recommend to its council that the ‘majority of courses’ meet their standards, but some do not.
The submission said: ‘There are a small number of courses where we do not have satisfactory assurance that they meet our standards in full and we will recommend attaching conditions to approval or we will not recommend them for approval. The first approval decisions will be taken by our Council in April.’
One of the areas for concern about these courses was that there was not sufficient evidence around how they teach the safe management of prescribed medicines.
This month, the BMA has also made a submission to the Leng review which details over 600 doctor concerns about PAs and patient safety, and demands a new name for the role.
The RCGP told the Government-commissioned review that PAs have ‘no role’ in general practice, a position which is based on GPs reporting ‘specific’ examples of patient safety being compromised.
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In my later years as a locum it was notable how much time was spent debriefing, supporting and measuring pur new cadre of clinicians. Having been a GP trainer and an early trainee it was evident that this vastly outweighed the benefits of extra “hands to the pump: , training more GP registrars would have been more effective.