Barely a day goes past without another press article condemning the unchecked and uncontrolled activities of non-medically trained ‘associates’ treating patients. With no defined scope of practice and no formal regulation, they are the sign of an NHS desperate to cover the cracks however it can.

The government’s belated attempt to regulate Anaesthesia Associates (AAs) relies on a Statutory Instrument to force the General Medical Council (GMC) – the regulator of doctors – to regulate both AAs and Physician Associates (PAs). In doing so, it is deliberately attempting to blur the distinction between doctors and non-doctors. And it is doing this through the use of a parliamentary loophole.

Using secondary legislation in this way is contrary to both the spirit of the Medical Act 1983 and of the GMC’s Charitable objects. We urge parliament to reject this attempt, and to implement regulation of Anaesthesia Associates and Physician Associates in more appropriate ways.

The GMC’s Charitable Objects

Back in 1858 the GMC came into being to protect the public against quacks and charlatans. In a recent piece of self-reflection they wrote: 

While so much in medicine and society has changed since 1858, our purpose would still be recognisable to one of our founding members. We protect the public by ensuring good standards of medical education and practice. Or as we said it back then, so that ‘Persons requiring medical aid should be enabled to distinguish qualified from unqualified practitioners’.

In 2001 the GMC became a registered charity. Its charitable objects are now expressed in these four paragraphs.

1. The registration of medical practitioners

2. The promotion of high standards of medical education and the coordination of all stages of medical education

3. The regulation of the professional conduct, fitness to practise and professional performance of medical practitioners

4. The provision of advice for medical practitioners on standards of professional conduct and performance and on medical ethics 

Anyone reading this will be left in no doubt that the scope of the GMC charity extended solely to medical practitioners – even the phrase itself is used three times in these four objects. The charity will have kept focus on its charity’s purposes and until now has avoided drifting into activities that it was not set up to do – for example delivering a new service. 

We received £2.5m
Charity Commission report 2022 p48

As a charity it has a duty to make clear in its annual reports to the Charities Commission any significant changes to these charitable objects. Receiving £2.5m of Department of Health and Social Care income to set up IT systems for non-doctors which, on the face of it, appears contrary to these objectives, might warrant further clarification.

We have written to the GMC for reassurance that they have considered the matter and taken advice. You can read our letter here.

Misusing the Law

Secondary legislation and Statutory Instruments are intended to fill in the details of primary Acts. They are intended for day-to-day changes – for example, to ban new substances in response to new information under the Misuse of Drugs Act.

These instruments are not intended to fundamentally change the purpose or vision of a law. Yet this is what Steve Barclay is apparently attempting to do. The Medical Act has a clear purpose – protecting the public from non-medically trained practitioners. Promotion of the medical profession, and maintaining public confidence in it, is an overarching objective. Asking the  GMC to register non-doctors alongside doctors goes against everything that the charity has stood for until now, and is a fundamental change to the purpose of the Medical Act.

We urge parliament to reject this proposal, if and when it finally comes to them – no date for this has yet been set. We consider the route the government has adopted is intrinsically unconstitutional. And we urge doctors, patients and everyone concerned about this fundamental change to contact their MP and ensure that they strive to maintain the easy recognition of non-medically trained practitioners. We believe there is a public interest in ensuring that as a charity, the GMC maintains its present objective of focusing on medical practitioners.

Our letter to the GMC

We are writing to the GMC about their charitable objects – you can read the letter in full