Professor Dame Caroline MacEwen
Chair – General Medical Council
3 Hardman Street Manchester M3 3AW
Dear Professor MacEwen
We the undersigned are writing to you regarding the proposals to regulate Anaesthesia Associates (AAs) and Physician Associates (PAs). We are concerned that taking on this role may conflict with your charitable objects. We further believe that the previous enabling work carried out pursuing this activity in the past may have breached your obligations to spend funds exclusively on those charitable objects.
We ask that you consider the arguments listed below. You will be aware that a charity not operating within its charitable purpose may raise issues with the Charity Commission, and we ask for reassurance that you have considered the matter and taken appropriate advice.
The purpose of the General Medical Council (GMC) charity is outlined in the following paragraphs:
- The registration of medical practitioners
- The promotion of high standards of medical education and the coordination of all stages of medical education
- The regulation of the professional conduct, fitness to practise and professional performance of medical practitioners
- The provision of advice for medical practitioners on standards of professional conduct and performance and on medical ethics
There can be no doubt to anyone reading these that the overarching aim of the GMC is reserved solely for medical practitioners – the phrase is used three times in these four objects. Nothing contained in this governing document even hints at the charity having any involvement with non-medical practitioners.
Charities are advised to keep their focus on their respective governing purposes and to keep these under constant review. Drifting into activities that your charity is not set up to do can happen should you:
… want to deliver a new service, but trustees have not checked that this new work fits the charity’s purposes … have applied for a grant, which must be spent on activities that do not match the charity’s purposes …. Using charity funds or resources on other purposes is very serious. Trustees may have to repay the charity from their own money.
In the 2021 Charity Report you mentioned that there were fundamental changes on the horizon for medical regulation. You wrote
“….we expect legislative reforms to empower us to … streamline our registration processes to sustain a steady flow of new doctors into the UK’s healthcare systems. We will have new powers linked to education and training, so we can support medical professionals through their studies and career… In a historic move for medical regulation, legislative reforms will also bring two new professional groups under our regulatory umbrella: physician associates (PAs) and anaesthesia associates (AAs).”
Nothing in this report makes it clear to the casual reader that PAs and AAs are not themselves medical practitioners. They are, slightly misleadingly, described merely as ‘groups’. The final sentence carries the clear implication that AAs and PAs are subject to ‘medical regulation’. There is ambiguity in the term ‘Associates’ – a phrase used in legal and other spheres to describe a fully-trained professional and widely used in medicine to refer to non-Consultant Staff and Associate Specialist (SAS) doctors. A charity may have a duty to clearly set out within these reports the full implications of these fundamental changes.
In the 2022 report you describe that “… we are reflecting a further £2.5 million of restricted income in our accounts from the UK Government’s Department of Health and Social Care (DHSC) to cover the cost of implementation work to bring physician associates and anaesthesia associates under our regulation. These funds were fully spent in 2022, and, as with 2021, some funding was used to develop IT systems…”
We cannot find mention in the report that this could deviate from the charity’s objects. The charitable objects relate only to medical practitioners (i.e. those already registered and regulated) and the report does not suggest any changes in the objects were under consideration at that time.
On your website you do some valuable self-reflection on who you are.
“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’.”
Your founding members were correct. It is very much in the public interest that persons requiring medical aid are able to recognise who is treating them. Put simply, members of the public expect a ‘registered medical practitioner’ to be what it says on the tin – a medical doctor.
The undersigned, along with what we believe would be the majority of UK doctors, oppose any attempts to change the charitable objects of the GMC which we think would undermine and unravel 165 years of progress. Being able to recognise medical practitioners is of paramount importance in maintaining the confidence of our patients.
Yours sincerely
Dr Chris Day MBBS
Dr Daniel Wilson MBBS
Dr James Haddock MBChB
Dr Jennifer Haugh MB BCh BAO
Dr Joseph Pick FRCA
Dr Luke Mordecai FRCA
Dr Ramey Assaf MBBS
Dr Richard Marks FRCA
Dr Siddhant Parashar MBChB
TOGETHER WITH
963 Doctors
104 Other healthcare workers
247 Patients/Members of the Public