The Professional Standards Authority (PSA), the body that oversees the GMC, has agreed to carefully consider the dossier we sent about Physician and Anaesthesia Assistants (PAs and AAs) regulation. Our dossier was very timely as the next review of the GMC is about to start.
Our lawyers made detailed representations to them about what we think are serious and repeated failures by the GMC to comply with standards. These include:
- Failing to identify and manage risks by properly consulting stakeholders.
- Not ensuring patients receive honest, usable information.
- Inappropriately applied policies designed for doctors to non-doctors.
- Failing to implement the Leng review in any meaningful way, and
- Failing to keep its own standards under review as risks became obvious.
We hope that the PSA will bring about change. It is equipped to boldly go into the regulatory space and demand action in a way that the courts have chosen not to. It has assured us that the representation we sent, and our evidence, will be fully taken into account.
And with this in mind, Anaesthetists United has decided to close down as a group.
What’s in a name?
Physician Associates? Or Physician Assistants?
One of the key recommendations in Professor Leng’s report was that the name of PAs was changed back to “Physician Assistant”. This is essential to make clear to the public what the role entails.
But despite their duty of protecting the public, and the government’s agreement to implement all the Leng recommendations, the GMC has dragged its heels over implementing this change of title.
It’s time for proper regulation…
The next PSA review of the GMC will be the first that properly grapples with the GMC as regulator of AAs and PAs. The review completed last December inexplicably made no findings on the issue – something our lawyers have highlighted at paragraphs 21-38 of their representations.
Thanks to AU, though, the PSA has all the evidence it needs of risk. What it must do now is demand answers from the GMC on how its ‘light touch’ approach can possibly be enough to address those risks.
The onus is now on the GMC to explain its actions and failures – in line with the PSA standard requiring them to ‘ensure its policies are being applied appropriately’. CEO Massey has already admitted to the Health Select Committee that they could have done it better.
The PSA can ask to see the risk assessments that the GMC appears so reluctant to undertake (unlike every other PSA-regulated body).
For the GMC to regulate a profession other than medical practitioners is a new situation. It needs to persuade the PSA that it has done so in a manner consistent with Parliament’s intention – that AAs and PAs have adequate guidance, direction and guardrails.
… and not doctor-replacement
Unfortunately there is ample evidence that employers are indeed using PAs as doctor substitutes – and jobs are openly advertised as such. This job description, for example, for a PA post at the spinal unit at Leicester is a good illustration.
The post holder will be trained to assess and examine patients, present them, initiate and interpret investigations, and recommend treatment.
They will be expected to liaise with other professionals and specialties as required and complete necessary documentation relating to their patients
Essential skills – to Assess and examine spinal patients, initiate and interpret investigations, formulate differential diagnoses, and recommend treatment in both inpatient and outpatient settings on behalf of the supervising consultant
The PSA must remember its statutory purpose is to prioritise patient safety. It must grab this nettle and get the GMC to act. We believe we have given them the information they will need for the task they face.
AU will now be closing
When Anaesthetists United launched, in August 2023, people seemed more interested in the AI-graphics we were using than they were in our campaign. We were told our concerns about Associates were unimportant and that we were just a ‘vocal minority’. The huge show of support at the RCoA EGM changed that view completely and confirmed the concerns.
The RCoA EGM was, in retrospect, the turning-point for the medical profession.
Following the RCoA’s lead the BMA, and several other Medical Royal Colleges, changed their own stances on the use of non-doctors. The issue has hit the press repeatedly, especially since the coroner Prevention of Future Deaths reports. Increasing awareness and concern over PAs led the Health Secretary to commission the Leng review, which will significantly change the status quo.
So although we are disappointed with the outcome of our court case we are glad we took on the challenge and believe we made a real difference.
We raised over £250k from patients and the public to cover our legal costs, as well as some institutional funding. There was a shortfall in the money we raised; our lawyers have very kindly agreed to waive the excess. We are very grateful to them for this. Their team has been outstanding in every way and at every step.
Anaesthetists United is taking a break from campaigning to catch up with our lives. We are grateful to all our supporters and donors, our solicitors and barristers, those who have contributed to AU past and present, and to everyone else who has helped us. We will remain on X and other social media as individuals.
Richard LondonAnaesth
Ramey Ramey999
Luke Shr_Nottingham
