Increasing the GMC’s scope of regulation but at what cost?

Background: reforms to regulatory frameworks

The UK’s healthcare regulatory landscape is currently undergoing significant change, with various reforms expected to improve how healthcare professionals are regulated. Central to these reforms is the inclusion of additional roles, such as Physician Associates (PAs) and Anaesthesia Associates (AAs), into the General Medical Council (GMC)’s scope of regulation.

This shift aims to streamline the regulatory process, improve accountability, and ensure patient safety across the healthcare sector. However, as the GMC prepares to assume regulatory responsibility for these new roles from December 2024 onwards, questions are being raised about whether the framework is ready to undergo such a change, and whether it will bring the improvements intended to professional regulation.

Why are there concerns about patient safety?

PAs are medically trained, generalist healthcare professionals who work alongside other healthcare professionals under the supervision of a doctor to diagnose illnesses, develop treatment plans, and perform physical examinations and some clinical procedures.  PAs must complete a two-year post-graduate training programme which usually requires a bioscience related first degree, but there are exceptions, for example, a registered healthcare professional such as a nurse or midwife can also apply to become a PA. While PAs work across various medical departments, AAs focus exclusively on perioperative and anaesthetic care. AAs also undergo a two-year training programme after completing a related degree, and so have a similar level of training. 

Since the role was first introduced in 2003, the number of PAs has drastically increased, and according to the NHS Long Term Plan, numbers are planned to reach 10,000 PAs by 2036, from current numbers of around 3,000. The number of AAs has not increased at the same rate with approximately 75 currently practising, but a rise to 2,000 AAs is planned by 2036.

The increase in the number of PAs particularly, has caused widespread concern about the scope of their role and potential risk to patient safety following a number of high-profile cases where it is reported that a lack of transparency and clarity about the role of PAs is said to have compromised patient safety. On 20 November 2024, the Health Secretary, Wes Streeting, announced a review to clarify the role of PAs and AAs and ensure transparency for patients, stating that, “there are legitimate concerns over transparency for patients, scope of practice, and the substituting of doctors”. The outcome of the review and recommendations are scheduled to be published in Spring next year, which is after these roles come under the GMC’s scope of regulation.

GMC regulation of PAs and AAs

The GMC has confirmed that the regulation of PAs and AAs will proceed as scheduled, despite the ongoing government review, with registration officially opening on 16 December 2024. Currently, neither PAs nor AAs are subject to statutory regulation, with their practice governed by voluntary registration and oversight by local employers. Under the new statutory framework, the GMC will:

• Maintain a PA and AA register: ensuring only qualified associates are allowed to practise.
• Oversee Fitness to Practise (FtP): investigate allegations of misconduct or incompetence.
• Set standards and outcomes: that student PAs and AAs must meet to achieve registration and approve the curricula that courses must deliver. They set the standards of patient care and professional behaviour that PAs and AAs need to meet.
• Revalidate: similar to the process of doctors’ appraisal process, the GMC is to introduce periodic assessments to ensure continued competence of associates.

The inclusion of PAs and AAs under the GMC’s regulation is intended to strengthen public confidence in the profession and provide a more robust system for managing concerns about patient safety. 

Will GMC regulation address concerns?

Despite the intended benefits, the inclusion of PAs and AAs under the GMC’s regulatory framework continues to spark debate.

Critics argue that the inclusion of associates may blur the lines between their roles and those of doctors. This could cause safety concerns if it is unclear how supervision and accountability will operate within the new framework. Similarly, there is concern that regulation by the GMC may perpetuate patients mistaking PAs for doctors, and hinder assuring associates do not undertake work beyond their scope and competencies, unless effective measures are implemented to ensure clarity for patients, which is a key aim of the government’s review.

This concern is further highlighted in the British Medical Association’s (BMA) recent legal action against the GMC. The GMC has been using the term “medical professionals” to refer to all its future registrants, namely doctors and associates. However, the BMA has launched a judicial review against the GMC over its use of the term, which it argues, should only ever be used to refer to fully qualified doctors. The BMA believes that while associates should be regulated, the GMC is the wrong body for this as “it will only undermine and devalue the medical profession”.

In relation to disciplinary action, in our experience the GMC already faces criticism for significant delays in its FtP processes for doctors. Adding thousands of PAs and AAs to its remit raises questions about whether the system has the capacity to cope with the increased work which may accompany the inclusion of such a large volume of professionals. There is a question as to whether the increase in the GMC’s regulatory scope may cause further delays to the FtP process, which is not in the public interest and prolongs a stressful process for the practitioner.

Will regulatory reform deliver better regulation of healthcare professionals?

Ultimately, the success of this regulatory expansion depends on whether the GMC can adapt its systems to accommodate the growing number of professionals under its oversight and embed sufficient distinction in its approach to associates to ensure patient safety and public confidence in its professional regulation. While statutory regulation is a step forward in terms of standardisation and accountability, there are risks that the GMC’s current challenges – particularly delays in the FtP process and clarity on the roles soon to be under its remit – could be magnified.

In response to these concerns, the GMC has stated its commitment to ensuring a “proportionate and efficient regulatory framework” for all professionals. It remains to be seen whether this promise will be upheld as the regulatory burden increases or how the position will be reported by the government’s independent review.

We will be monitoring the position regularly and our team is on hand to deal with your regulatory queries.

Co-authored by Areesha Qureshi