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.

Unregulated

“For 18 months, we’ve worked with other medical organisations, the media, and politicians to bring accountability and awareness to a previously unregulated landscape. “The review needs to address concerns that the scope of medical associates should be nationally standardised, led by the regulator and not delegated to NHS trusts that have consistently failed to engage medical associate professionals (MAPs) safely. “We’re mindful there are many MAPs already in posts and respect the work they do. “This process may be unsettling to many PAs and AAs, their teams, and the patients they’re seeing. Which is why we want to see it conducted and concluded in a timely manner without affecting the quality and depth of the review. “On the point of regulation, we recognise that PAs and AAs need to be regulated. However, the GMC is not the right body for that.

Patient safety

“GMC regulation will only blur the lines between doctors and non-doctors, confuse the public, and compromise patient safety.” Ms Fernandes said DAUK was ready to submit evidence to the review. “We hope it will bring much-needed clarity and consistency,” she said. “And delivers meaningful safeguards for patient safety, transparency, and a clear national framework.” Professor Gillian Leng CBE will independently lead the review. She is an experienced leader in the UK health care system, has championed patient safety, and has a deep understanding of the British medical system. Announcing the review, Mr Streeting said: “Many physician associates are providing great care and freeing up doctors to do the things only doctors can do. “But there are legitimate concerns over transparency for patients, scope of practice, and the substituting of doctors. These concerns have been ignored for too long, leading to a toxic debate where physicians feel ignored and PAs feel demoralised.

Independent review

“This independent review, led by one of the UK’s most experienced healthcare leaders will establish the facts, take the heat out of the issue, and make sure that we get the right people, in the right place, doing the right thing.”

Professor Leng said: “To promote patient safety and strengthen the NHS workforce, it’s crucial we have a comprehensive review of the role of PAs and AAs. This will cover recruitment and training, scope of practice, supervision and professional regulation.

“As I conduct this review, I am looking forward to speaking to a broad range of stakeholders and to gathering evidence from the UK and abroad so that we can reach a shared understanding of these roles and their place in wider healthcare teams.”

Support our work by becoming a member or donating to our Go Fund Me.

Anaesthetists United (AU) has announced it has filed its claim against the GMC in the High Court.

The challenge is regarding the regulation of PAs and AAs by the GMC, which the Doctors’ Association UK (DAUK) believes puts patient safety at risk.

DAUK has been an early and consistent supporter of this crucial legal action, and contributed £30,000 to AU’s crowdfunding efforts.

AU has received financial support from medical professionals and the public, and last week the British Medical Association (BMA) agreed to provide indemnity support for the case.

It has also received the support of the parents of Emily Chesterton, Marion and Brendon. Emily was aged 30 when she died after two appointments with a PA she believed was a GP.

Legal challenge

Ms Fernandes said: “It’s heartening to see doctors from all specialities standing together to support this legal challenge.

“We thank AU for taking on this vital action and everyone who has contributed towards funding it.

“It’s clear that doctors feel very strongly about the regulation of PAs and AAs by the GMC and the blurring of lines which is putting patients at risk.

“It’s really quite incredible the GMC is being taken to court by doctors over concerns it is not regulating strongly enough and is encouraging the blurring of those lines.”

For more information on how to support the legal challenge, please visit the Anaesthetists United website.

Become a member of DAUK and support our work.

Meanwhile, GMC chief executive Charlie Massey has issued an update on its preparation for the regulation of PAs and AAs.

The challenge by Anaesthetists United addresses critical issues surrounding the regulation of PAs and AAs, including the GMC’s failure to set scope of practice or levels of supervision, or to empower anyone else to do it.

The group has raised £117,000 so far, but needs £200,000 to get the next stage and may need more after that.

The Doctors’ Association UK (DAUK) has given its support for Anaesthetists United including a £30,000 contribution to their crowdfunding efforts.

Now Anaesthetists United and DAUK are renewing their calls for doctors to donate to the legal challenge.

Public interest

Dr Richard Marks, co-founder of Anaesthetists United, said: “There is a compelling public interest for the High Court to decide what protection the public can expect from the GMC as the regulator of AAs and PAs, but we have to raise the funds to make that happen.

“This is everybody’s struggle. All of us that work in healthcare and and all of those that receive care have a stake in this.

“We’re immensely grateful to those who have donated, but we’re struggling to raise the money.

“If every consultant and SAS doctor gave us £100 we’d be well on the way to funding our action.

“Our case is strong, please help us protect the standards of UK medicine.”

The families of two patients who died following care from PAs have given their support to the legal challenge.

Patient safety

Ms Helen Fernandes, DAUK chair, said: “It is very brave of those personally affected and very telling that they are joining this legal challenge.

“This is not about PAs and AAs as individuals but it’s about patient safety.

“PAs and AAs are not doctors and there is widespread concern they are undertaking work beyond their training, experience, and competence, putting patients at risk.

“This is a vitally important legal challenge and even the smallest donation will really help.

“We are also asking the royal colleges to support this, and we would encourage you to speak to your college to ask it to back the action.”

For more information on how to support, please visit the Anaesthetists United website.

Support the work of DAUK by signing up as a member.

It follows the vote by the Royal College of General Practitioners (RCGP) to oppose the role of physician associates (PAs) working in general practice, which has been welcomed by DAUK’s GP Committee.

DAUK is proud to announce its robust support for Anaesthetists United in their legal case against the GMC, which addresses critical issues surrounding the regulation of PAs and AAs.

This backing includes a £30,000 contribution to their crowdfunding efforts, underscoring the medical profession’s deep-seated concerns over patient safety and professional standards.

Now it is calling on royal colleges to also give their support to the legal challenge.

Why DAUK supports this legal challenge

DAUK shares the grave concerns that the current regulatory framework fails to adequately safeguard patient safety and maintain the high standards of medical practice that the British public expects and deserves.

Ms Helen Fernandes, DAUK chair, said: “The GMC’s approach to regulating PAs and AAs is fundamentally flawed.

“It risks blurring the lines between fully qualified doctors and support staff, potentially misleading patients and compromising care quality.

“We categorically back Anaesthetists United in demanding clear, enforceable guidance on the scope of practice for these roles.”

United front

DAUK’s significant donation to the Anaesthetists United legal fund is not an isolated action but part of a broader united front in the medical community.

Recent events, including the Royal College of General Practitioners’ revised stance on PA regulation and the Emergency General Meeting at the Royal College of Physicians, demonstrate that concerns over these issues are widespread and deeply felt.

Dr Matt Kneale, DAUK committee member and former chair, said: “The strength of feeling across the medical profession cannot be overstated.

“These are not isolated incidents of discontent but a clear signal that the current trajectory of medical regulation and workforce planning is deeply troubling to those on the front lines of patient care.”

Call to action

In light of these developments, DAUK calls upon all royal colleges to take decisive action:

1. Contribute financially to the Anaesthetists United crowdfunding campaign.

2. Publicly back the medical profession’s stance on this critical issue.

3. Prioritise patient safety by advocating for standards to be set by the regulator, not by individual NHS trusts or GP practices.

Dr Kneale said: “The variation in standards across different healthcare settings has already led to concerning safety events.

“It’s time for our professional bodies to unite in demanding a consistent, high-quality approach to regulation that puts patient safety first.”

Dr David Nicholl, fellow of the Royal College of Physicians (RCP) and DAUK committee member, said: “As a former member of RCP Council, I would like to see the RCP backing this case.

“The RCP has already publicly stated that there should be national scope which the GMC are refusing to do.

“It’s time for all royal colleges to put their money where their mouth is and support this legal challenge against the GMC’s intransigence. This is about safe patient care.”

RCGP vote

Meanwhile, DAUK’s GP Committee has welcomed a vote by the Royal College of General Practitioners (RCGP) to oppose a role for physician associates (PAs) from working in general practice.

The RCGP’s UK Council voted 61 per cent in favour of opposing the role of PAs working in general practice, with 31 disagreeing and eight per cent abstaining.

Dr Ellen Welch, DAUK vice chair and member of the DAUK GP committee, said: “We agree with the RCGP Council’s decision to end the further expansion of PAs in general practice.

“This is not about PAs as individuals but about patient safety.

“They should not have been allowed to consult undifferentiated patients and, in our view, it was always unsafe for patients.

“The complexity of patient care, the needs of patients, and the safety of patient care must always be a priority.

“GPs are highly-skilled clinicians who have trained for 10 years to have the depth and breadth of knowledge essential to care for the complexity of patients seen in general practice.

“It is essential that patients are able to consult with GPs, therefore we urge NHS England and the Government to make the retention and recruitment of GPs a priority.”

Looking forward

DAUK remains committed to supporting initiatives that protect patients and the integrity of the medical profession. We will continue to monitor the progress of the Anaesthetists United case closely and are ready to take further action as necessary.

For more information on how to support this crucial legal challenge, please visit the Anaesthetists United CrowdJustice page.

Support the work of DAUK by signing up as a member.

DAUK has long-standing concerns that GMC regulation will confuse the roles of doctors and non-doctors in the eyes of the public, creating a misunderstanding of the role of PAs and presenting a risk to patient safety.

We’ve also voiced concerns about the scope of practice, that doctors are responsible in law for PA care, and concerns that tasks and procedures that doctors in training need to practice repeatedly are being reallocated to PAs and AAs.

Announcing its legal action, the BMA said it had consistently made clear that physician and anaesthesia associates – who complete a two-year course rather than a five-year medical degree – need regulating, but that the GMC is not the right organisation to do this.

Physician associates

By choosing the GMC as the regulator for PAs and AAs, the BMA says the Government was undermining and devaluing the medical profession, and confusing patients.

The GMC has been using the term ‘medical professionals’ in its materials to describe all of its future registrants – both doctors and associates, the BMA says. This includes in Good Medical Practice, the key GMC guidance document for doctors, defining the standards of care and behaviour that are expected, which is used as a reference to determine fitness to practise.

The BMA is now launching a judicial review claim against the GMC over its use of this term, which the Association says should only ever be used to refer to qualified doctors.

Anaesthetists United, an independent group of grassroots anaesthetists, are planning separate but complementary legal action, which relates to the lack of any national regulation of scope of practice for PAs and AAs, a vital issue which the GMC has studiously avoided.

The BMA says it is liaising with Anaesthetists United, and the DAUK offers both our support.

Dr Ellen Welch, DAUK vice chair, said: “We do need to stand up and make people aware of the deskilling of medicine.

“I do feel for PAs within this debate, but this is not about individual clinicians. It’s about systemic flaws which are normalising doctors being replaced by staff members who haven’t done the same training and this is simply a patient safety issue.”

Open letter

The BMA has also written an open letter to party leaders ahead of the general election to try to put the issue of PAs at the top of their agendas.

In summary, it is asking for:

1.    Implementation of a national safe scope of practice for MAPs underpinned by robust evidence and regulation. 

2.    Amending the Anaesthesia Associates and Physician Associates Order 2024 so that MAPs are regulated by a more suitable regulator using titles that protect patients from being misled. 

3.    An end to widespread doctor replacement and unemployment. 

4.    An urgent review of the long-term workforce plan to determine how MAPs can be safely utilised to the benefit of patients and healthcare systems, as well as the numbers required, underpinned by evidence.  

5.    A halt to any current plans to provide MAPs with prescribing responsibilities. 

6.    An independent inquiry to determine how widespread doctor substitution has become, and how this scandal has been allowed to develop without sufficient regard for patient safety.

Sign the open letter.