The GMC’s interim perceptions survey also found that more than three-quarters (77 per cent) of doctors were not confident in how the GMC regulates physician assistants and physician assistants in anaesthesia.

Dr Steve Taylor, Doctors Association UK (DAUK) GP co-lead, said he was not surprised by the survey results.

GMC

He said: “The GMC was set up by doctors for doctors to provide a safety check and regulation of safe patient care. 

“Given the well publicised disregard of doctors views on PAs and AAs, and ongoing concerns about the way the GMC investigates doctors, it is not at all surprising that confidence in the GMC has been falling. 

“Doctors have been an afterthought despite the fact that they are the ones paying for the GMC’s existence and are the vast majority of registrants.

Wake-up call

“The current board is failing and has failed to listen to the voices of the majority of doctors, and this survey confirms this. Hopefully this will be a wake-up call.”

Read the Doctors.Net article.

Download the GMC interim perceptions survey.

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Doctors Association UK (DAUK) has co-signed a letter to health minister Karin Smyth.

In the letter, led by the Medical Protection Society, the coalition of 32 organisations describe the proposal to remove the health category as a ‘significant step backwards’.

The proposal was put forward by the previous government in its consultation on reform of the Medical Act.

Health category

Currently, in cases where doctors are investigated under the health category of impairment, the GMC can use language which acknowledges the health concerns about the doctor without having to use pejorative terminology around misconduct.

It is able to put in place measures to protect the doctor such as some, or all of the hearings, being held in private and the focus is on aiding recovery and return to practice in addition to patient safety.

Under the new plans, concerns about doctors with a health issue would have to be investigated on the grounds of ‘inability to provide care to a sufficient standard’ and/or ‘misconduct’.

This is language the group claim is inappropriate and could deter doctors from seeking early help.

GMC concerns

The GMC has also outlined similar concerns.

GMC data shows that it recorded health as a category of impairment in nearly 1,000 of the investigations it conducted over the last six years.

This amounts to almost one in five (17%) of all investigations. In half of these cases (49%) the doctor self-referred to the GMC.

The letter, said: “Our intention is to highlight one small but important step that the Government could take to protect the most vulnerable doctors during a regulatory investigation.

“Our focus on this area, is based on a shared view that supporting the wellbeing of doctors is an essential component of maintaining high quality, safe patient care.

“The impact of a GMC investigation on doctors’ mental wellbeing is well documented.”

In an MPS survey of nearly 200 doctors who have been investigated, 78% said it harmed their mental health and almost 31% reported experiencing suicidal thoughts during the process.

This impact will be even greater for doctors who have existing health concerns.

“Significant progress has been made by the GMC to reduce the impact on doctors facing a fitness to practise investigation, and reduce the number of suicides during the process.

Investigate doctors

“Current provisions within the Medical Act, particularly the ability to investigate doctors under the health category, have been central to this progress.

“It was therefore a significant step backwards when proposals for reform were put forward by the previous government that would have the effect of removing it.

“We strongly urge you to retain health as a distinct category. This would protect doctors at one of the most challenging moments of their lives, improve their retention in the workforce, while safeguarding patients. Crucially, it would help towards ensuring that doctors who are unwell feel supported rather than driven out.”

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Not fit for purpose

Ms Fernandes said huge concerns still remained about the proposed regulation framework for physician associates. 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. “We’ve always said that PAs and AAs are and can be valuable members of the healthcare team, but only when their role is compatible with their non-medical training and knowledge, and when appropriately placed by their employer. “Their employer should ensure they are supervised and those that are supervising and responsible have full knowledge of the same.”

Physician associates

Ms Fernandes also responded to ‘misleading information’ about the historic role of PAs in the NHS She said: “PAs in their current form have not been in the NHS for 20 years. “Misleading information about this and belittling concerns about the roles of PAs and AAs by alleging that doctors are being protectionist or outwardly toxic in the social media space is disingenuous. “It does not address the real concerns that we will continue to voice in the name of patient safety.” Support our work by becoming a member or donating to our Go Fund Me.

In our written response DAUK raised concerns around the oversight of post-graduate qualifications, training, and scope of practice as well as concerns around fitness to practice and supervision.

In submitting our response, DAUK Co-chair Helen Fernandes said: “The current GMC proposal for PA/AA generates concern that most doctors have, and the wider public would likely have should they come to know, that the GMC as the PA/AA regulator will not be overseeing their post-graduate qualifications or training or scope limits.

“Currently PAs and AAs are occupying roles traditionally carried out by doctors, the public probably assuming they are qualified and trained to do so. PA/AAs can switch, and do, between primary and secondary care, and different specialities without limitation. Doctors cannot do this. There are increasing numbers of job adverts for PA posts in roles that would be deemed only suitable for specialist registrar level and above doctors. PA /AAs may be capable of these roles and responsibilities but in the proposed model this is not your role as their regulator to oversee this. 

Public trust

“We believe these issues are not clear to the public and they should be. The GMC is an organisation, as the regulator of doctors, that is widely recognised. The public will reasonably assume that the GMC regulating PA/AA means they are equivalent to doctors in training and expertise.

“The draft order 3(1)(b) states that the GMC may determine other standards in relation to associates, but there is no ‘must’ in the legislation. As we understand it, the GMC will require this from local employers and trainers. There is, however, no detail about how this might be obtained, standardised, controlled or regulated against. 

“The public must trust in the regulation of PA/AAs, trust that they will not be allowed to perform in a role they are not trained in and not capable of, and trust that these individuals will be expected to work towards a minimum accepted standard that the GMC, the regulator, can enforce. These tried and tested principles of regulation of doctors, we believe, are needed and missing from current GMC PA/AA regulatory proposals.

“We understand that currently, should an individual report a PA/AA to the GMC for some sort of failure in clinical care, you have no process in place of how to judge clinical competence against a to be determined accepted standard. This is of course how doctors are judged, through a wide array of expert witnesses that the GMC instructs. You will not have the same structure for fitness to practice issues for PA/AAs.

GMC regulation

“Most referrals to the GMC are from either patients or other health professionals who feel the clinical care provided by a doctor is unacceptable. This reassurance therefore does not help or inform how GMC regulation might work for PA/AAs, nor will it reassure the public again that any given PA/AA is working towards a regulatory accepted standard.

“Finally, we would like to understand how the GMC will deal with those doctors who are in some sort of supervisory capacity of PA/AAs who are reported to them as their regulator. While many PA/AAs are appointed to roles which are described as autonomous, most do nominally describe these roles as being under supervision. Is the named doctor supervisor responsible, in the view of the GMC, for issues reported to them around PA/AA behaviour, performance and care? A previous MPTS outcome suggests so.”

Frustration

Ms Fernandes also commented on the consultation questionnaire.

She said: “Completion of this questionnaire is just beyond frustration. The material referred to is voluminous, repetitive, complicated and so very generic.

“None as we can see comes back to the scope, training and accepted clinical standards that underpin the fitness to practice in any doctor. Nor the role of the supervising doctor.

“The questionnaire seems deliberately opaque and difficult.” 

The GMC has thanked us for our response and said it will ‘feed our points into their consideration of next steps following the end of the consultation process’.

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It is of concern that despite the clear and urgent need the GMC is not intending to set out any scope, education or competency standards.

You may ask what then are they proposing to regulate?

Our position remains that PAs and AAs have a role in assisting doctors provide good, safe medical care but they are not substitutes for doctors of GPs. We support their regulation, but not by the GMC, which will create further confusion for patients.

Have your say.

More than 2,800 doctors have signed a letter to the General Medical Council (GMC) over fears the proposed regulation of physician associates (PAs) will undermine healthcare standards and put patients’ safety at risk.

Published today (Tuesday 31 October), the letter from the Doctors’ Association UK (DAUK) urged the GMC to reconsider the plans, describing them as “unsafe, premature, and lacking the necessary safeguards”.

DAUK said the GMC needed to address “the inconsistency between the stringent requirements” for doctors to be regulated and the proposed transition for PAs and anaesthesia associates (AAs), which will see them “moved to a statutory GMC register without undergoing equally rigorous checks”.

In their open letter, DAUK co-chairs Dr Matt Kneale and Ms Helen Fernandes said proposals to assign PAs and AAs with a registration number similar to those used for medical doctors risked creating “unnecessary confusion” and “muddling the distinct roles of various healthcare professionals”.

“This ambiguity could inadvertently foster scope creep, putting patients at risk due to uncertainty about practitioners’ qualifications,” they said.

“Furthermore, the absence of a clearly defined scope of practice for PAs and AAs, set by the GMC, is alarming.

“Allowing local settings to establish these boundaries could lead to further confusion and possible exploitation of both doctors and PAs, as well as compromise patient safety.”

Commenting on the letter, Dr Kneale said: “The urgency and seriousness of this situation can’t be understated.“

“The rapid move to incorporate PAs and AAs into the GMC’s regulatory oversight not only jeopardises public safety but also undermines their trust in the system.“

“The resounding support of 2,870 healthcare professionals speaks volumes about the pervasive concern within the medical profession.”

“We need a complete reexamination of a flawed system that has lost the confidence of many.”

The DAUK has set out four recommendations in its letter:

• The GMC should immediately inform the Government about the growing discontent and advocate for reopening the consultation process with the Department of Health and Social Care
• If the regulation of PAs by the GMC goes ahead, distinct GMC numbers should be allocated to PAs to distinguish them from medical doctors
• All PAs transferring from the voluntary Royal College of Physicians register to the GMC’s statutory register must undergo thorough verification and checks, especially with regard to Fitness to Practise procedures
• The GMC must establish a clearly defined scope of practice for PAs and AAs, eliminating the option for these to be set locally.

Dr Kneale added: “We urge the GMC to immediately address these critical issues, maintain the high healthcare standards the public rightly demands, and request that the Department of Health and Social Care put the brakes on the issue and reopen the consultation on physician associates and anaesthesia associates regulation.”

Read the DAUK letter in full.

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Notes to editors

The Doctors’ Association UK (DAUK) is the voice of frontline doctors. It’s a non-profit professional association run by volunteer NHS doctors which advocates for the medical profession and the wider NHS.

Contact:

For more information and interview requests, please contact Andy Mann on 07399 164557 or email press@dauk.org