In March we wrote to the GMC to say that it should cease referring to AAs and PAs as ‘members of the medical professions’, ‘medical professionals’, and in ‘medical practice’. We also called for:

• The replacement of Good Medical Practice (GMP) 2024 with two partner sets of standards, Good Medical Practice (for doctors) and Good Associate Practice (for AAs and PAs)
• Changes in the way the online registers for doctors and Associates are displayed.
• Associates to follow a specified and explicit scope of practice, as set by a professional body with appropriate expertise.
• And that Associates must, without being asked, tell patients their professional title, the name of the doctor supervising them and how they are meaningfully different to a doctor.

The GMC sent us a prompt, lengthy and detailed reply, written by Charlie Massey and which is available here to download, but which misses our key points. It starts by acknowledging that

… Patients must always be clear about who is treating them and every healthcare professional has a duty to clearly explain their role. PAs and AAs are two relatively new professional groups in healthcare so it is even more important that they are always clear about their roles and responsibilities with the patients they treat. They do not have the same knowledge, skills and expertise as doctors. They are not doctors, and they can’t replace them.

But this means patients, the public, associates and colleagues need a clear answer to the question: ‘What can or can’t an Associate safely do?’ Or to put it another way, what powers and benefits are derived from being on the Associate Register? This is why we think the GMC must set and enforce a duty for Associates to follow a specified and explicit scope of practice (set by a professional body with expertise).

The letter then addresses the use of terminology.

As you’ll know, the term ‘medical associate professions’, which includes PAs AAs, has been used for many years now by organisations across the UK including employers, statutory education bodies and the Department of Health and Social Care. This is in recognition that there are professionals in addition to doctors that are trained in, and work to, the medical model.
Our legislation sets out the legally protected title that only registered and licensed doctors can use. That term is ‘registered medical practitioner’ .

….

The use of any other terminology is a linguistic rather than a legal issue but language is always important in terms of being clear about roles and responsibilities

We think this is wrong. Section 49 of the Medical Act is the relevant legislation and states (with our emphasis):

“any person who wilfully and falsely pretends to be or takes or uses the name or title of physician, doctor of medicine, licentiate in medicine and surgery, bachelor of medicine, surgeon, general practitioner or apothecary or any name, title, addition or description implying that he is registered under any provision of this Act or that he is recognised by law as a physician or surgeon or licentiate in medicine and surgery or a practitioner in medicine or an apothecary”

Their letter is emphatic that ‘registered medical practitioner’ and ‘medical practitioner’ are “legally protected”, But we suggest that ‘registered in medical practice’ is synonymous with ‘registered medical practitioner’ and ‘in medical practice’ is synonymous with ‘medical practitioner’. It logically and necessarily follows that these terms are protected on the same basis.  

The same applies to ‘registered medical professional’, ‘registered member of the medical professions’ and derivatives, who are necessarily different to “the anaesthesia associate and physician associate professions” defined under the AAPAO.

The letter makes some other comments about the term ‘medical professionals’.

On occasion we use ‘medical professionals’ as an umbrella term to collectively describe all the professionals we will regulate in future. This is in preference to always separately listing out each individual role. The alternative term we considered was ‘registrants’, which we felt was cold and impersonal .

And we will only use the term ‘medical professionals’ sparingly and when appropriate to the circumstances, for example when referring to the collective professionals we regulate.

It gives no reason for preferring the term ‘medical professionals’ to the much clearer ‘Doctors, AAs and PAs’ other than a bizarre need to be warm and personal. The term ‘medical professional'(s) is used 29 times in Good Medical Practice which is hardly sparing.

Good medical practice and the proposal to create two separate sets of core standards

We asserted that Good Medical Practice (GMP) could not apply to Associates since Associates are not in medical practice.

In their reply to us the GMC wrote:

Where professional regulators set standards of professional behaviour for more than one group of registrants, they generally do this through shared standards…. Throughout there has been strong agreement that PAs and AAs should be held to the same high professional standards as doctors …. There has been no significant objection to the terminology used in Good medical practice until very recently .

This is a slightly ‘straw man’ argument since we specifically proposed that Good Associate Practice should mirror the same high professional standards in GMP, save for those which must be amended or removed as they cannot apply to Associates.

They then added:

In the introduction to Good medical practice, we say “You must use your professional judgement to apply the standards in Good medical practice to your day-to-day practice. This means working out which of the professional standards are relevant to the specific circumstances you are facing, and using your knowledge, skills and experience to follow them in that context.” The position is no different for PAs and AAs

We reject this assertion, since neither Doctors nor Associates can really pick and choose which of the standards they wish to adhere to.

Their reply to this section concluded;

Given the extensive engagement already undertaken prior to the publication of Good medical practice 2024, and the departure from multi-profession regulatory norms that this would represent, I do not agree that creating two separate sets of standards is the right answer. I do agree, however, that we should ensure that any guidance published on our website in future makes it as clear as possible that it applies to three distinct professions.

We think this is an important concession and statement by the GMC acknowledging that there are, indeed, three distinct professions.

Display of online registers

We were concerned with the way that the online registers were presented, with the possibility that the public could be confused into thinking Associates were in some way on the Medical Register. The reply from the GMC stated that

The images we shared in March were prototypes designed to demonstrate that we’ll ensure the prominent labelling of profession type on our online registers to ensure that when anyone conducts a search in future it will be very clear whether an individual is a doctor, a PA or an AA.

We are reassured by this statement and look forward to seeing the next iteration.

In conclusion

While we are reassured by some of the replies to our letter, overall we are not happy that the major points have been unaddressed. In particular, we feel that Good Medical Practice cannot apply to someone in Associate practice, that the term ‘medical professionals’ cannot apply to those that are not medical practitioners and, perhaps most importantly, that the Scope of Practice for Associates needs to be clarified before regulation can begin.

We have written back to the GMC with a longer and more detailed copy of the post to say that these matters cannot be unaddressed. And we will be looking to see whether a legal approach could achieve what mere words have failed to do.