When people talk of ‘regulation’ for Anaesthesia and Physician Associates (AA’s and PA’s) they naturally assume that this regulation will define or standardise their working patterns and set their scope of practice and levels of supervision. But that is far from the case.
Instead, the GMC has made it very clear that their form of ‘regulation’
- Does not define scope of practice
- Does not define how AAs fit into the rest of the team
- Does not specify standards for training after joining the register
- And does not even specify who will actually define or set these standards.
Instead, the GMC regulation will provide a list of who is and is not an Associate. But nobody knows what clinical power, and what constraints of practice, that the regulated list confers.
We don’t think this is good enough. We think the public naturally assumes that ‘regulation’ means what it says on the tin – controlling something, especially a business activity, by means of rules and regulations.
And whilst the GMC itself does not have the knowledge to define the standards for practice in each of the many different branches of medicine, the Royal Medical Colleges and Faculties do have this expertise. Yet the GMC has not entrusted them with that role. Instead, they have left it to the employers and the Colleges to work together and figure things out. Somehow.
What sort of regulator leaves it up to the employer to make up the rules? We cannot imagine this form of ‘regulation in any other sphere of activity. Employers are likely to interpret this to mean that they now have absolute carte blanche to push as much work through the AAs as they can, with as little supervision as they can manage.
The nation is pressing ahead with ‘regulation’ without defining what that actually means. There needs to be strict clarification, for example, on:-
- Can AAs do obstetric anaesthesia or spinal blocks?
- Can AAs anaesthetise children or high-risk emergency cases?
- Can AAs start operations without an Anaesthetist in the room?
It is an overarching necessity that the public has confidence in who will deliver their care.
We call on the GMC to clarify unambiguously that scope of practice, levels of supervision and training should be set by the Royal Colleges and Faculties, and not by the employers. To protect the public, and to protect the Associates themselves, this needs to be crystal clear.
We call on politicians of all parties to adapt the legislation governing Associates to ensure that this happens; and
We urge the public not to accept a form of regulation that fails to define what Associates are allowed to do.
Because at the moment this is regulation without regulation.