The GMC’s response to our Letter Before Action is a disgrace – a blatant evasion of responsibility. What AAs and PAs can safely do, whether patients are to be told they are not being treated by doctors and the specifics of supervision are, in their view, nothing to do with them. This is just unacceptable.

Our lawyers think we have a solid case to challenge this.  It remains vital for promoting patient safety, and may be the last chance the country gets to define the lines separating doctors from Associates.  But the harsh reality is that we need to raise £200,000 immediately to continue this battle. We’re asking for your help – right now – through CrowdJustice. 

The GMC’s response to our Letter Before Action is infuriating, for both what it says and its silence on so many of the important issues we have raised.

To start with, it says nothing about patient care even in the face of concerns raised by a coroner  following a patient death involving PA care.  Instead, it starts with nitpicking details from the Human Rights Act, argues about the timing of the claim (despite the fact that regulation hasn’t actually started and their own consultation on it remains unpublished) and then attempts to justify their refusal to set scope of practice for Associates by playing word games with ‘standards’.

What are we asking for?

There should be standards defining what Associates can and cannot do; safe and legal practice measures. To us that seems very obvious.

Other bodies, especially the Medical Royal Colleges, can of course issue their own guidance on scope of practice. But these are meaningless because they have no regulatory or statutory authority. Many hospitals are openly and brazenly overriding College guidance. And the Royal Colleges have no real disciplinary powers over them.

The law that introduced regulation for Associates places a duty on the GMC to set standards, including standards for performance. Only the GMC doesn’t want to do that, because their paymasters – the Department of Health and Social Care (DHSC) – want to blur the distinction between doctors and Associates as much as they can.

The GMCs defence

Their defence hinges on twisting words. The law requires the GMC to set standards for Associates. They have decided that ‘standards’ means ‘a standard’. A standard is something reached for and then attained, after which AAs and PAs have free reign. They say that prohibiting an AA or PA from undertaking certain kinds of work, however unsafe that might be for patients, would be a ‘limit’ rather than a ‘standard’, and so nothing to do with them.

They continue “The fact that ‘standards’ …refers to expected level of attainment and conduct is evident from the word itself”.

This is, of course, an artificial distinction. There are plenty of other limits that are set; a standard and a limit are simply two sides of the same coin. ‘Setting a standard’ means setting a pattern or model that is generally accepted, a level of quality. The legal duty for the GMC to set standards of performance for AAs and PAs means what it says on the tin.

Evading their responsibility

At the heart of the problem is the worrying conclusion that if the GMC does not set limits on Associate practice then there is nobody else with the authority to do so. And they are failing to address this situation in any way.

Patient Consent to treatment

On the issue of  patient consent, they write “There is no duty on a healthcare professional to give the patient details of their own qualifications or experience.” This neatly ignores their own advice on informed consent stating that patients “should be told the roles of key people involved in their care.”

Specific aspects of patient care

In a presentation to the House of Lords, the GMC and DHSC claimed that Associates deliver “specific aspects of patient care”. We asked them what those were. They refused to answer because they claimed it was a trick question; forcing them to admit that these ‘specific aspects’ actually exist.

Ensuring that AAs and PAs are properly supervised

They now say that supervision is, in fact, the doctor’s problem.  Nothing to do with regulation of PAs. The doctors can be the fall-guys here. How convenient for the GMC that will be.

The expectation of what Regulation would mean

Regulation has been under development for a long time, and various assurances were given during the consultations as to what it would involve.  The GMC now claims that this information should not be admissible in court.

The coroners case

Recently a coroner asked the GMC about a national scope of practice. We asked them what their response was going to be. They refused to answer, saying it would be inappropriate to pre-empt their own reply.

But it comes down to money

We think their arguments are no answer to our claim. 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 – if anything.  

But now we have to raise the funds to make that happen.  We are incredibly grateful to those that have given so far. But we cannot get to the next stage without £200,000, and we need it soon. 

We have spent almost £78,000 so far to prepare our case. We need, in addition, an estimated £60,000 towards potential adverse costs up to the permission stage, a £25,000 cushion for contingencies, and then VAT on top – bringing the total to £200,000. 

If we proceed to a court hearing we will need to raise more funds after that, and we estimate that will be around £500,000. We could reach that easily if just 5000 doctors donated £100 today. And more smaller donations will really help.

The legal costs could be significantly reduced if the GMC agreed to ADR (mediation). But they have stubbornly refused to do this. The only way our concerns can now be resolved conclusively is by putting them to a judge. 

This is everybody’s struggle. All of us that work in healthcare, and all of those that receive care, have a stake in this. Our case is strong;  please help us protect the standards of UK medicine.