“3 - Standards (1) The Regulator must determine standards applicable to associates. (2) The standards must relate to (a) education and training, (b) knowledge and skills, (c) experience and performance, (d) conduct and ethics, (e) proficiency in the English language, and (f) such other matters as the Regulator may prescribe in rules made under paragraph 2(2)(a) of Schedule 4. (3) Before determining a standard, the Regulator must consult such persons as the Regulator considers appropriate. (4) The Regulator – (a) must keep the standards under review, and (b) may vary or revoke a standard.” (a) education and training, (b) knowledge and skills, (c) experience and performance, (d) conduct and ethics, (e) proficiency in the English language, and (f) such other matters as the Regulator may prescribe in rules made under paragraph 2(2)(a) of Schedule 4. (a) must keep the standards under review, and (b) may vary or revoke a standard.”
“You must always be honest about your experience, qualifications and current role. You should introduce yourself to patients and explain your role in their care.”
“GMP requires….you should introduce yourself to patients and explain your role in their care. For example this includes PAs and AAs (i) Using and explaining their title in full before using any abbreviations (ii) Taking time to explain their role during clinical interactions (iii) Remembering that role titles may not always be immediately clear to others (iv) Offering patients and staff the opportunity to ask for more information about their role and taking sufficient time to explain.” (i) Using and explaining their title in full before using any abbreviations (ii) Taking time to explain their role during clinical interactions (iii) Remembering that role titles may not always be immediately clear to others (iv) Offering patients and staff the opportunity to ask for more information about their role and taking sufficient time to explain.”
“.. knowledge and skills expected at qualification… the job description which will outline what they are able to do and what knowledge, skills and experience is required for the post they undertake”
“[Ms Chesterton] attended her general practitioner surgery on the mornings of 31 October and7 November 2022 with calf pain and shortness of breath, and was seen by the same physician associate on both occasions. She should have been immediately referred to a hospital emergency unit. If she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived.”
“1. There is no regulatory body with oversight of Physician Associates. It is understood that this is currently the subject of a consultation by the General Medical Council. … 3. There is no national framework as to how Physician Associates should be trained, supervised and deemed competent. This is placing both patients, Physician Associates and their employers at risk. The court heard that since the death of Mrs Pollitt the Northern Care Alliance have put in place a local trust framework. Unlike all other clinical roles there is no national guidance save for very recent guidance issued by the British Medical Association (March 2024). 4. There remains limited understanding and awareness of the role of a Physician Associate both amongst medical colleagues, patients and their families. The lack of a distinct uniform and the title "Physician" gives rise to confusion as to whether the practitioner is a doctor. 5. In June 2022 the Physicians Associate had been signed off as competent for the insertion of ascetic drains. This sign off was completed by a liver nurse specialist using a competency form which was provided by the FPA. Whilst the competency form assessed the technical aspect of placing the drain, it did not include competency around the wider aspects of care such as taking consent, risk factors and after care.”
“1. The term ‘Physician Associate’ is misleading to the public Mrs Marking’s son was under the mistaken belief that the Physician Associate was a doctor by this title in circumstances where no steps were taken by the Emergency Department or the Physician Associate to explain or clearly differentiate their role from that of medically qualified practitioners. 2. Lack of public understanding of the role of Physician Associate Witnesses from the Trust gave evidence that a Physician Associate was clinically equivalent to a Tier 2 resident doctor without evidence to support this belief. This blurring of roles without public knowledge and understanding of the role of a Physician Associate has the potential to devalue and undermine public confidence in the medical profession whilst allowing Physician Associates to potentially undertake roles outside of their competency thereby compromising patient safety. 3. The right of patients and family to seek a second opinion The lack of public knowledge that a Physician Associate is not medically qualified has the potential to hinder requests by patients and their relatives who would wish to seek an opinion from a medical practitioner. It also raises issues of informed consent and protection of patient rights if the public are not aware or have not been properly informed that they are being treated by a Physician Associate rather than a medically qualified doctor. 4. Lack of national and local guidelines and regulation of the scope of practice for a Physician Associate A diagnosis … was made by the Physician Associate without appreciating the relevance of [Mrs Marking’s symptoms] and in the absence of understanding the need to undertake … an abdominal examination in a patient who was unable to give a proper clinical history because of short term memory loss. No evidence was presented that the management of Mrs Marking was subject to a reflective practice review. Given their limited training and in the absence of any national or local recognised hospital training for Physician Associates once appointed, this gives rise to a concern they are working outside of their capabilities. 5. Lack of guidelines for direct supervision and consideration of an appropriate level of autonomy for Physician Associates Whilst there were discussions with the ‘supervising’ consultant the Physician Associate was effectively acting independently in the diagnosis, treatment, management and discharge of Mrs Marking without independent oversight by a medical practitioner. This gives rise to a concern that inadequate supervision or excessive delegation of undifferentiated patients in the Emergency Department to Physician Associates compromises patient safety.”
“..associates are already a valued and integral part of the multi-disciplinary healthcare team but have the potential to make an even greater contribution.. The GMC is best placed to regulate the AAs and PAs as they form part of the medical team and are trained to the medical model. Regulation also paves the way for broadening their scope of practice by, for example requesting ionising radiation where local governance allows and, in the future, the possibility of being able to prescribe.”
“You must always be honest about your experience, qualifications, and current role. You should introduce yourselves to patients and explain your role in their care.”
“What regulatory approach was the Defendant going to adopt to address the various risks posed by Associates in order to safeguard public safety (and would this include the safe and lawful practice measures)?”
“Could a rational decision-maker, in this statutory context, take this decision without considering these particular facts or factors?”
“1. The obligation upon the decision-maker is only to take such steps to inform himself as are reasonable. 2. Subject to a Wednesbury challenge, it is for the public body, and not the court to decide upon the manner and intensity of inquiry to be undertaken (R(Khatun) v Newham LBC[2005] QB 37 at paragraph [35], per Laws LJ). 3. The court should not intervene merely because it considers that further inquiries would have been sensible or desirable. It should intervene only if no reasonable authority could have been satisfied on the basis of the inquiries made that it possessed the information necessary for its decision (per Neill LJ in R (Bayani) v. Kensington and Chelsea Royal LBC(1990) 22 HLR 406 ). 4. The court should establish what material was before the authority and should only strike down a decision by the authority not to make further inquiries if no reasonable council possessed of that material could suppose that the inquiries they had made were sufficient (per Schiemann J in R (Costello) v Nottingham City Council(1989) 21 HLR 301 ; cited with approval by Laws LJ in (R(Khatun) v Newham LBC (supra) at paragraph [35]). 5. The principle that the decision-maker must call his own attention to considerations relevant to his decision, a duty which in practice may require him to consult outside bodies with a particular knowledge or involvement in the case, does not spring from a duty of procedural fairness to the applicant, but from the Secretary of State's duty so to inform himself as to arrive at a rational conclusion (per Laws LJ in (R (London Borough of Southwark) v Secretary of State for Education (supra) at page 323D). 6. The wider the discretion conferred on the Secretary of State, the more important it must be that he has all relevant material to enable him properly to exercise it (R (Venables) v Secretary of State for the Home Department[1998] AC 407 at 466G).”