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 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

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.

Physician associates

DAUK is actively involved in the national discourse around the roles of physician associates (PAs) and anaesthesia associates (AAs). Our committee members have been vocal in the media, raising concerns about the roles and the regulation of PAs and AAs by the General Medical Council (GMC). We briefed politicians in the House of Commons and House of Lords on the draft Anaesthesia Associates and Physician Associates Order 2024, the legislation for the regulation of non-doctors by the GMC, as it passed through Parliament.

Leng review

DAUK also briefed Peers ahead of a Lords debate on the Leng Review, which we welcomed when it was announced in November. We responded to the GMC consultation on their regulation, highlighting the widespread concern on the lack of scope and standards in what is being proposing. The GMC has now begun regulating PAs and AAs, despite a lot of concern around it, with our chair Ms Helen Fernandes saying it will not protect patients or doctors. We have given our support and contributed financially to a legal challenge by Anaesthetists United to the GMC regulation of PAs and AAs. DAUK will not let up on the issue of PAs and AAs. We firmly believe the future of the medical profession and the patients it looks after are at risk.

Dr Jenny Vaughan

We were deeply saddened by the death our dearest friend and colleague Dr Jenny Vaughan. Jenny was a founding member of DAUK, a past chair, and absolutely lived and breathed the Association. There were touching obituaries in the Guardian, the BMJ, and on BBC Radio 4’s Last Word. We are holding a FREE conference in memory of Jenny on 17 May (10am to 4pm) which will feature panels, discussions, and presentations on the causes she was passionate about, as well as some of the challenges facing the NHS.

GP crisis

Our GP committee has been extremely busy highlighting the issues that face general practice. Dr Ellen Welch’s book, Why Can’t I See My GP?, has been a cornerstone of our work with a copy sent to every MP before the general election to help them understand general practice and to make it a key issue. Since the election, copies have been sent to members of the Health Select Committee and to MPs who are also doctors, and we have relaunched our GP manifesto. Dr Welch featured in the Daily Mail, the Sunday Times, i News and the Daily Express, and was interviewed on Sky News, BBC Radio 5Live and BBC Radio Cumbria – among others. Her book prompted debate on ITV’s Good Morning Britain about which types of ailments people should see their GP with, and whether children should be taught in schools how to use and access the NHS.

Manifesto

The GP committee hosted an election briefing during which it unveiled its manifesto for saving general practice. Since the election our GP committee continues to hold the new government to account on issues around general practice. We warned that the increase in employer National Insurance contributions could put financial pressure on already struggling general practices. And while we cautiously welcomed an announcement by the Health Secretary, Wes Streeting, for an extra £889m for general practice, we stressed that a huge amount of the money will be swallowed up meeting those National Insurance obligations. DAUK continues to call for funding to help solve the GP crisis. Indeed, we welcomed the findings of the Darzi Review, which advised the government to invest in general practice.

Work with government

We have offered to work with the government on solutions to the issues facing primary care. Our research has found that the equivalent of 3,000 doctors are currently unemployed or underemployed stand ready to work in general practice with the right investment. Committee members have been incredibly busy speaking to the media to highlight the issues facing general practice, not least Dr Sarah Jacques who shared her powerful story of burning out as a GP on BBC Breakfast and in the Telegraph. GP spokesperson Dr Steve Taylor has produced an astonishing wealth of data and statistics on the NHS and general practice, which he shares in his social media network. It’s helped Dr Taylor build an extensive following, including with health journalists, and insert him and DAUK into social media conversations.

NHS Practitioner Health

We highlighted a move by NHS England to stop the funding for hospital doctors referred for help to NHS Practitioner Health. Those who support doctors through Practitioner Health were also told just the week before it was due to be closed. One of our members, at that meeting, anonymously tipped us off. A social media campaign highlighted the NHS England plans in the media and the decision was reversed less than a week later.

Dr Sarah Benn

We were ‘shocked and saddened’ by the sanction handed down to Dr Sarah Benn following her Medical Practitioners Tribunal Service hearing. Dr Benn, a GP for 32 years, was suspended from the medical register following her participation in peaceful climate protests. DAUK’s Dr Steve Taylor wrote a letter to the Times on the case and the discussions around it, saying that protesting would not affect clinical judgement or trustworthiness.

Climate crisis

We joined Plant-Based Health Professionals UK (PBHP UK) to highlight serious concerns from the medical profession over the Government-backed Let’s Eat Balanced campaign. Dr Matt Lee, DAUK’s sustainability lead, and Dr Shireen Kassam, director of PBHP UK, co-wrote an open letter to the Agriculture and Horticulture Development Board (AHDB) and the Department for Environment, Food and Rural Affairs (DEFRA) to express their deep concerns at the high level of misinformation within the campaign, and ask for the campaign to be retracted. The letter was reported in a number of publications including the Independent and openDemocracy. A series of guest blogs have been published on our website, including this by Dr Marnie Sethi on the health impact of the climate crisis.

NHS Whistleblowing

DAUK supports the proposal for the Office of the Whistleblower and is working with not for profit organisation Whistleblowers UK to change how society thinks about whistleblowing. Dr David Nicholl is at the forefront of our work in this area to enable healthcare professionals to raise concerns without fear. Dr Nicholl highlighted our work to protect NHS whistleblowers at the Medical Journalists’ Association’s (MJA) symposium on Building Trust in Health Journalism. The symposium was supported by DAUK and gave our committee members the chance to hear presentations on a range of issues, and to make contact and build relationships with key health and medical journalists.

Overseas NHS Workers Day

The NHS came together for our fourth annual Overseas NHS Workers Day on Friday 1 March. Overseas NHS Workers Day is now a firm fixture in the calendar and provides a chance to celebrate the incredible contribution they make to the NHS and the health of our nation. Social media was full of videos, photos and the stories of our international colleagues, using the hashtag #OverseasNHSWorkersDay. Trusts displayed flags representing the countries of birth of overseas staff; colleagues wore blue and green, the colours of the day, and some even had an international-themed lunch. Overseas NHS Workers Day takes place this year on Friday 7 March. Join in the celebrations.

Academic Foundation Jobs

An open letter was sent to all medical school deans urging them to unite in opposition to changes to the allocation of academic foundation jobs. We believe UKFPO’s announcement that all Specialised Foundation Programme (SFP) applications will fall under the Preference Information Allocation system posed serious issues. The frustrations of the many medical students who were allocated to foundation schools outside of their top choices were shared by our student committee. And we requested a formal review of the UKFPO system by the Department of Health.

DAUK in the media

DAUK and our committee members regularly contributed to articles and broadcasts, and provided briefings and background material to journalists working on more in-depth pieces. We are proactive in putting out comment on our website and social media, and sending it direct to journalists. Our members are working hard to build good working relationships with reporers, including though networking at events such as the Medical Journalists’ Association annual awards. Our work to oppose the expansion of PA and AA roles has had real cut through and been highlighted in the national media, and medical websites and publications. And we have had some stunning media coverage for our GP committee, with members regularly invited to comment in health publications such as GP Online and Pulse Online. We look forward to continuing to advocate for doctors, patients, and the profession in 2025. And, if you can, please support our work by becoming a member or donating to our Go Fund Me.