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.

The doctors have written an open letter to Layla Moran MP following the findings of an independent inquiry which found serious governance failures at the Royal College of Physicians (RCP). The letter has also been sent to the Health Secretary Wes Streeting and to several members of the House of Lords.

The King’s Fund carried out the review into the RCP’s handling of an extraordinary general meeting (EGM) called to discuss PAs.

Its report found ‘a range of collective failures in leadership’, ‘a clear lack of accountability and due process’, and ‘a pervasive lack of trust and confidence in the College’s governance’.

Parliament ‘misadvised’

Now 28 eminent doctors, including Dr Nicholl, have written to Ms Moran ‘to express our considered view that Parliament was misadvised when the Royal College of Physicians of London was cited as approving of the Anaesthesia Associates and Physicians Associates Order earlier this year’.

Their letter continues: “We, the undersigned, were in the process of highlighting our concerns about the implications of the order to the college leadership on patient safety prior to the debate on the order.

“Our attempts to do this through an EGM were delayed inappropriately. A recent Kings Fund report into the college identified a ‘collective failure in leadership’ in the college’s approach to these occupations, with the Kings Fund noting that ‘had the EGM been held before that point’ (i.e. of the statutory instrument being debated), ‘the concerns raised would have been fed into the parliamentary process and may have affected the passage of the legislation’.

“When the EGM was finally held, an overwhelming majority of Fellows of the Royal College of Physicians of London rejected the college’s previous approach to physician associates, and the college is now working on ways to ensure that the care provided by this group of healthcare workers is safe for patients.

Concerns

“Our concerns are mirrored by other professional bodies and patient groups.

“We would welcome the opportunity to set out our concerns to members of your committee, either in writing or in person, and look forward to hearing from you in due course.”

Responding to a post about the letter on X, formerly known as Twitter, Ms Moran said: “The Commons Health and Social Care Select Committee doesn’t constitute until we have members, which won’t be for at least another month – and then we need to get up to speed.

“But once we do, we will start working on our programme of works. So please have patience with us.”

Read the letter to Ms Moran in full.

Support the work of DAUK, sign up as a member.

Dr Nicholl was speaking after the publication of a damning independent review into the RCP’s handling of an extraordinary general meeting (EGM) called to discuss PAs.

A group of RCP fellows, including Dr Nicholl, had called the EGM to challenge the college’s position on PAs, concerned about scope of practice, accountability, impact on doctors’ workloads and training opportunities, and patient safety.

Significant concerns were raised by several college members following the EGM about the presentation of information at the meeting and the conduct of people taking part.

In response, the King’s Fund, a health think tank, was commissioned to examine the events leading up to the EGM, the running of the EGM, and the relevant activities after the meeting.

Failure in leadership

Its report found ‘a range of collective failures in leadership’, ‘a clear lack of accountability and due process’, and ‘a pervasive lack of trust and confidence in the College’s governance’.

Dr Nicholl, a consultant neurologist, said: “The RCP failed to listen to the concerns of fellows over issues that DAUK was raising from last summer.

“At the time it was brushed off as social media noise but we know that’s not true.

“The delays in having the EGM meant that Parliament wasn’t properly informed when it passed legislation for the GMC to regulate PAs in March – without a vote, which is crazy.

“It’s a failure of governance at the RCP, but it’s also a failure to properly inform parliamentarians before they put a law through without a vote, which has hugely let down doctors and the public. It’s a mess.”

Dr Nicholl also responded to the report in an article in the BMJ, alongside RCP fellows Martin McKee, professor of European Public Health; Trisha Greenhalgh, professor of Primary Care Health Sciences; Asif Qasim, consultant cardiologist; and Nicholas S Hopkinson, professor of Respiratory Medicine.

Serious issue

They wrote: “Crucially, delays in setting up the EGM meant that by the time it was held, the Statutory Instrument had already been passed by Parliament.

“As the inquiry found, ‘had the EGM been held before that point, the concerns raised would have been fed into the parliamentary process and may have affected the passage of the legislation’ (page 18).

“The missed opportunity to influence Parliamentary discussion on the role and regulation of physician associates in a way that reflected the concerns of its membership is among the most serious issues faced by the college in its 500-year history.”

In response, the RCP said it accepts the report and recommendations in full.

Senior censor and vice president for education and training, Dr Mumtaz Patel, who is acting as RCP president, said: “This King’s Fund report is important and sobering reading for all of us at the RCP. It shows how, as a leadership team, we must refocus on our core purpose – putting physicians first. We must review the way that we work if we want to be a high-performing and responsive membership organisation for physicians in the future.

Honest and open

“The report highlights an organisation that was neither listening, nor responding quickly enough, to the questions and concerns being raised by its fellows and members. It points to the need for improvements in our culture, governance, processes and the way that we represent physicians of all generations. It calls for a more honest and open relationship with our membership, and one that welcomes constructive challenge rather than avoiding it.

“Today is a moment for review, reset and refocus in all that we do. We owe this to our fellows and members, our staff and our volunteers. We hear loud and clear how we need to lead rather than respond to others’ agendas. The entire leadership team is committed to reflecting, changing and benefiting from external support to make these improvements happen.”

Read Dr Nicholls’s article in full.

Read the King’s Fund report.

Support the work of DAUK, sign up as a member.

The fellows are concerned by the response to the vote at the RCP’s Extraordinary General Meeting in March to reject the expansion of the physician associate (PA) role.

At the EGM, the fellows voted on five motions covering scope of practice, accountability, evaluation, the impact on training opportunities, and the pace and scale of the roll-out of PAs.

At the time, Dr Nicholl, a consultant neurologist who is standing for the Liberal Democrats in his home constituency of Bromsgrove at the general election, described it as ‘a landmark result’.

Now he has put his name to the statement of concern which is being sent to the RCP.

The statement says: “The policy of the Royal College of Physicians, which is to reject the programme of uncontrolled expansion of the physician associate role without a defined scope of practice, has now been established by an overwhelming vote of fellows at the Extraordinary General Meeting in March this year. This includes limiting pace and scale of roll-out to the maximum extent that the college can, and challenging proposals by the GMC to allow scope of practice to be set locally, an approach that represents a threat to patient safety.

“As Fellows of the Royal College of Physicians we are therefore concerned by the response of the senior leadership to this clear mandate. In particular, we are concerned by delays to implementation and references to accepting the view of the fellows ‘in principle’ rather than in full.

“Failure to take action now risks further weakening the College’s reputation and influence. The leadership of Royal College of Physicians will be failing patients and the profession if it chooses not to address the motions, passed by many thousands of Fellows following the EGM, in both a timely and a comprehensive fashion.”

The Doctors’ Association UK has long been calling for a pause in the expansion of physician associates.

DAUK is also opposed to regulation of PAs by the GMC over concerns about patient safety, 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.

Fellows in good standing can join the call here.

Become a DAUK member and support our work.

In only the third EGM in the RCP’s 505-year history, fellows voted on five motions covering scope of practice, accountability, evaluation, the impact on training opportunities, and the pace and scale of the roll-out of physician associates.

The results were:

·       Motion 1 on scope of practice was passed with 96.9% of the vote.

·       Motion 2 on accountability was passed with 95.6% of the vote.

·       Motion 3 on evaluation was passed with 96.1% of the vote.

·       Motion 4 on training opportunities was passed with 95.9% of the vote.

·       Motion 5 on caution in pace and scale of roll-out was passed with 78.7% of the vote.

Dr Nicholl, RCP fellow and consultant neurologist in the West Midlands, told BBC radio listeners it was a vote to ensure the safety of patients.

Speaking on BBC Hereford and Worcester, he said: “Imagine this morning you go to your GP, you could potentially be seeing someone with two years’ experience at college or university rather than an experienced GP.

“We felt that was a real clinical risk to patients.

“So this is a landmark change, to take our foot off the accelerator and say that if we’re going to introduce this, let’s introduce this safely.”

Legislation bringing the PA role under GMC regulation passed through the House of Lords last month, despite attempts to kill it.

The Doctors’ Association UK (DAUK) has opposed regulation of PAs by the GMC and has called for a pause on the roll-out of PAs.

The association has long-standing concerns that the legislation will blur the roles of doctors and non-doctors, creating a misunderstanding of the role of PAs and presenting a significant risk to patient safety.

Dr Nicholl added: “There are many excellent PAs.

“The point is they aren’t doctors and their scope and range of practice must be defined.

“I’ve seen too many examples across the country where we’ve seen they’ve been filling in doctors’ rotas.

“The most extreme examples, which were mentioned in the House of Lords, were two cases that came to criminal court of non-accidental injury where a physician associate was acting as an expert witness and was introduced to the court as a member of the Royal College of Physicians.

“They were neither a doctor nor a member of the RCP.

“The implication was there was a huge risk of a miscarriage of justice there.”

Dr Nicholl said he hoped the vote would allow the PA roles to be defined in scope and supervision to help them work safely.

“This is all such a big change,” he said. “They do need regulating which is coming at the end of the year.

“The challenge now is making sure it’s done properly and there’s a proper timeline.

“Until yesterday, this was all going to go on a wink and a nod, whereas we’re saying we have to get the curriculum, we have to get the scope, we have to get the supervision sorted out for all 46 specialities.

“It’s not possible by the end of the year, so we need to find a way for PAs and most importantly for patients.”