DAUK has given its strong support to a formal complaint made by Anaesthetists United (AU) to the Professional Standards Authority (PSA) over the GMC’s regulation of physician associates (PAs) and anaesthesia associates (AAs).

AU’s lawyers have written to the PSA – the statutory body that oversees the GMC – presenting evidence that the GMC failed to meet at least six of the PSA’s own standards of good regulation when it introduced regulation for PAs and AAs.

The PSA is being asked to carry out an urgent formal review of the GMC’s compliance with its standards.

DAUK has been an early and consistent supporter of Anaesthetists United’s work, including a £30,000 contribution to AU’s crowdfunding campaign.

Regulatory failure

The complaint sets out how the GMC breached multiple PSA standards, including failing to consult stakeholders on scope of practice, failing to ensure patients understand who is treating them, and applying doctor-designed regulation to non-doctors.

It also highlights the GMC’s failure to act on concerns raised by coroners and its failure to implement any of the recommendations made by the Leng Review.

The PSA’s own performance review of the GMC in December concluded that it had met all 18 standards of good regulation. AU describes that review as “astonishingly superficial”.

Dr Matt Kneale, DAUK co-chair, said: “The evidence Anaesthetists United has compiled is significant. The GMC refused to consult on the most important question of all – whether there should be enforceable limits on what PAs and AAs can do.

“It applied frameworks designed for doctors to non-doctors. It ignored warnings from coroners, royal colleges, and frontline clinicians.

“And despite the Leng Review’s clear recommendations, the GMC has not implemented a single one of them.

“The PSA exists for precisely this moment – when a regulator has lost sight of its primary purpose of protecting patients.”

Patient safety

DAUK has long-standing concerns that GMC regulation blurs the lines between doctors and non-doctors, creating a misunderstanding of the role of PAs and presenting a significant risk to patient safety.

The GMC’s own chief executive, Charlie Massey, has apologised to the Health Select Committee for not being clearer about distinguishing between doctors and associates.

Much of the evidence now available only came to light because AU’s judicial review forced the disclosure of documents that the GMC had previously kept from public view.

Dr Kneale added: “We have been consistent in raising these concerns. We called for a pause on recruitment. We opposed GMC regulation. We backed the fatal motion in the House of Lords. We supported the BMA’s legal action.

“At every stage, patient safety has been our paramount concern and at every stage the GMC has failed to act.

“We need the PSA to do its job and hold the GMC to the standards it is supposed to meet.”

Support

DAUK acknowledges the contribution of PAs and AAs to the care of patients. But these roles must be properly bounded, transparently communicated to patients, and subject to enforceable national scopes of practice with proper supervision.

The current regulatory framework fails patients, fails doctors, and fails the associates themselves.

AU relies on donations to fund its legal work. For more information on how to support the challenge, visit the Anaesthetists United donations page.

Dr Steve Taylor was speaking to GP Online on the findings of the latest Health Survey for England.

GP Online reported that the survey reveals rising pressure on general practice as a growing proportion of the population lives with poor health and long-term illness.

He said: “The lack of investment in health has created this.

“We are reaping what we sowed over 15 years of austerity.

“There’s also an element of an ageing population, more long-term issues because of the huge waiting list, more people who are ill and overstretched GPs with not enough time to spend on prevention, so the problems increase again.”

DAUK in the media

Read the GP Online article on what the Health Survey for England shows about pressure on GPs.

Meanwhile, Dr Taylor spoke to Pulse on a survey by United Medical Associate Professionals (UMAPs).

The survey found that 76% of PAs said their scope of practice has been restricted since the publication of the Leng review.

Dr Taylor said: ‘I would say their scope has been reduced rightly, because I think there was significant risk for patients with somebody that’s had such limited training to be seeing undifferentiated patients.”

Read the Pulse article in full.

DAUK’s committee members are all volunteers. They campaign and speak in the media about issues facing doctors in their own time. Please support our work by joining DAUK or donating to our GoFundMe.

Physician assistants

It challenges the GMC’s decision not to set out a defined scope of practice for PAs and PAAs. AU is still short of funds and is asking for support to continue its appeal. DAUK has been an early and consistent supporter of this crucial legal action, and contributed £30,000 to AU’s crowdfunding efforts. Our co-chair Dr Matt Kneale said the appeal represented an important step in ensuring patient safety.

Scope of practice

Dr Kneale said: “Questions around their regulation, scope of practice, supervision, and ultimately patient safety need to be answered. “Patients deserve to know exactly who is treating them, what their role is, and what their qualifications are. “Without a nationally defined scope of practice, the lines between doctors and non-doctors are blurred. “There is real danger that PAs and PAAs could be asked to work beyond their training.

Protecting patients

“This appeal is about protecting patients and safeguarding professional standards, and it has our full support.” AU has applied to the judge for permission to appeal the ruling. The appeal is to Mrs Justice Lambert, who heard the original case. If the appeal be rejected, AU can make a submission to the Court of Appeal. Read details of the appeal. For more information on how to support this crucial legal challenge, please visit the Anaesthetists United donations page.

Physician assistants

“While we recognise that PAs and PAAs need to be regulated, we maintain that it must be done by the most appropriate body, which is not the GMC. “Despite the High Court verdict, our concerns remain that their regulation poses significant risk to patient safety. “The fundamental issues of scope of practice, of supervision, and of who is responsible for these assistants and their work is still to be addressed. “And with the GMC still refusing to address those issues, it will fall on every single NHS institution to do so. Clearly that can’t be right. “Instead of a clear, nationally agreed framework, we will have a fragmented system with regulation of PAs and PAAs set by individual institutions.

Patient safety

“How will the GMC enforce such a system and protect patient safety and maintain public confidence? “We will review this ruling carefully and continue to work with other organisations and policymakers to press for the regulation of PAs and PAAs that puts patient safety first.” DAUK is led by frontline doctors for frontline doctors. Please support our work by joining DAUK or donating to our GoFundMe.

Physician associates

“However, that in itself does not address the fundamental issues of scope and supervision. “Patients interacting with doctors’ assistants, and doctors working alongside them need urgent clarification.” DAUK has raised significant concerns about the regulation and expansion of PA and anaesthesia associate (AA) roles in the NHS. We’ve long called for a pause in their roll out over concerns about patient safety, scope of practice, and their supervision.

Scope and supervision

Dr Ellen Welch, DAUK’s vice chair and a GP, said: “This is a start but we still need to define scope of practice. “We also need to address the doctors’ concerns around supervision and who is responsible for these assistants and their work. “Anaesthetists United returns to the High Court next week with an important court case which aims to do that. “DAUK has given our support with a £30,000 contribution but they still need help funding their crucial challenge.” For more information on how to support this crucial legal challenge, please visit the Anaesthetists United donations page.

Supervision

However, the Doctors’ Association UK is concerned that the guidance is poor and does not address issues around supervision. These issues include the supervisor retaining responsibility and accountability for patient care. This means supervising doctors will be liable for mistakes, said Dr Steve Taylor, DAUK’s GP spokesperson. Dr Taylor said: “Doctors need to be sure that the task they are delegating is within the scope of the PA. “In many cases the supervisor will not have sufficient knowledge of the PA’s training, knowledge, or capabilities.

Patient safety

“Because the supervisor retains responsibility and accountability for patient care, the supervisor will need to be confident the patient is being treated appropriately, safely, and has been thoroughly assessed. “Supervision is not straightforward and currently there are no training requirements for supervisors. “This means patients primarily, as well as PAs and doctors, are being placed in positions that are not ideal at best and unsafe at worst. “The delegating doctor retains responsibility for patient care, and therefore will be liable for mistakes. Patient safety and care needs to be paramount.

Medico-legal minefield

“This effectively places doctors in a medico-legal minefield and open to GMC referrals for mistakes, as medical defence organisations such as the MDU make clear.” Dr Taylor added: “Doctors will remain responsible for the overall management of the patient, decisions around transfer of care, and the processes in place to ensure patient safety. “Although AAs and PAs remain accountable for their actions, a doctor will retain responsibility for the overall management of the patient and the system of supervision.” Dr Taylor said the guidance lacked certainty for doctors, failed to address significant patient safety concerns, and did not provide a comprehensive framework for supervision of PAs and AAs.

Certainty and clarification

He said: “More certainty and clarification is needed, and employers need to be aware of the significant implications of supervision, including training, assessment and monitoring. “This was highlighted by Nuffield Trust in respect to general practice supervision of other roles, but can also be extended to hospitals.” Please support our work by contributing to our crowd funder or by becoming a member.

Physician associates

DAUK’s key recommendations are:

• Enforce strict supervision. Prohibit unsupervised PA practice and limit their involvement in critical areas like resuscitation and prescribing.
• Reassign PA/AA regulation to the Health and Care Professions Council (HCPC) to ensure independent oversight.
• Pause MAP expansion pending a full independent impact assessment on medical training and patient safety.
• Mandate adverse incident reporting for PAs/AAs to improve transparency and accountability.
• Consider an independent inquiry should this review find systematic patient safety risks, a formal national inquiry may be required to investigate institutional failings.

DAUK’s submission is based on an extensive survey of doctors and real-world case evidence. The findings highlight significant risks to patient safety, medical training, and NHS governance, said DAUK committee member and past chair Dr Matt Kneale.

Key findings

The key findings include:

• Widespread reports of direct patient harm and near misses due to PA misdiagnosis, inappropriate prescribing, and unsupervised practice.
• The GMC’s regulation of PAs creates a conflict of interest, undermining transparency in coroner’s investigations and fitness-to-practise cases.
• PA/AA expansion is displacing doctors from essential training, jeopardising workforce development.
• Despite claims of cost-effectiveness, PAs require substantial supervision, reducing efficiency rather than relieving workforce pressures.

Dr Kneale said: “The Leng Review presents a critical opportunity to address the serious concerns raised by frontline doctors regarding the deployment of medical associate professionals within the NHS. “If this review finds patients were systematically put at risk, a formal independent inquiry must follow. “This goes beyond individual PAs—it’s about institutional accountability.

Patient safety

“Patient safety has to come first. If systemic risks have been ignored, concealed, or allowed to escalate, the public deserves full transparency and action. “Anything less would be a failure of duty at the highest level.” Read our submission in full. Please support our work by contributing to our crowd funder or by becoming a member.

Physician associates

Ms Fernandes said there had been a failure to address the ‘scope and limitation’ of PAs. She added: “That leaves the PAs themselves, the doctors supervising them and, more importantly, the patients they care for in unsafe and uncharted territory. “The proposal that the scope will be determined locally, by the employer, seems ridiculous given that is not what trusts are for in being able to define what a professional can do.” Ms Fernandes also questioned whether there was actually a role for PAs in the NHS.

What do PAs bring to medical teams?

She said: “If they work with the more admin side of patient care and carried out limited amount of patient care, like blood pressure checks and blood tests… but there are already people who do these things all of whom are trained in these things, so what does a PA bring to a medical team? “What unique skills do they bring? Well, the answer is none. There is no single college that supports the role.” Read the article in full on the i News website. Please support our work by contributing to our crowd funder or by becoming a member.

Judicial review

In seeking a judicial review, Anaesthetists United argued in the High Court that PAs and AAs, who are not doctors, are performing roles beyond their competence and training. It was also argued that by not setting their scope of practice, the GMC was putting patients at risk. The case has been heard by Mr Justice Chamberlain, the lead High Court Judge dealing with judicial review cases. It has passed its first legal hurdle and has been granted permission to proceed to a full High Court hearing, which is set to be held before Easter. In reaching his decision, Mr Justice Chamberlain, said: “The claim raises serious issues of importance to the relevant professions and to patients which should be determined on a reasonably expedited basis.”

Legal ruling welcomed

The ruling was today welcomed by our chair Ms Helen Fernandes. She said: “We have been consistent supporters of this crucial legal challenge and provided substantial financial backing. “We are delighted with the ruling and that it will now go to a full judicial review. “With this ruling, as well as the independent Leng Review, we feel even more strongly that the roll out of PAs and AAs now needs to be paused. “Questions around the appropriate regulation, scope of practice, supervision, and ultimately patient safety need to be answered. It’s too important to blindly carry on. “It’s also unsettling for the many PAs and AAs who are already in post, and their teams and their patients.

Patient safety

“We recognise PAs and AAs need to be regulated. However, it must be done by the most appropriate body, which is not the GMC. “GMC regulation only blurs the lines between doctors and non-doctors, confuses the public, and risks patient safety.” Anaesthetists United is aiming to raise another £150,000 to cover its costs in the next stage of the case. For more information on how to support this crucial legal challenge, please visit the Anaesthetists United donations page. And please support the work of DAUK.