High court upholds GMC’s fitness to practise framework for physician and anaesthesia associates

The High Court upheld the GMC’s fitness to practise standards for Physician and Anaesthesia Associates, finding its framework rational, despite challenges over scope limits.

Anaesthetists United Ltd, joined by the family of Emily Chesterton, brought a judicial review against the General Medical Council (GMC) in October 2024, arguing that the regulator had failed to set national limits on the tasks associates may perform, mandate informed consent disclosures, and ensure safe supervision. They claimed these omissions breached the GMC’s statutory duties under the Medical Act and the Anaesthesia Associates and Physician Associates Order 2024.

The legal challenge centred on concerns that PAs and AAs were working beyond their competence without clear boundaries or oversight, potentially compromising patient safety. The claimants cited survey data, coroners’ reports and professional body statements to argue that the GMC’s regulatory model lacked enforceable safeguards.

However, Mrs Justice Lambert dismissed the claim, ruling that the GMC’s approach was neither procedurally nor substantively irrational. The court found that the 2024 Order did not require the GMC to impose task-specific limits, and that its adoption of a unified fitness to practise framework—anchored in the established Good Medical Practice standards—was lawful and appropriate.

Good Medical Practice for PAs and AAs: a tailored framework

The GMC’s Good Medical Practice standards form the ethical and professional backbone of regulation for all registrants, including PAs and AAs. While the core principles mirror those for doctors, the guidance is tailored to reflect the distinct roles, training, and legal scope of these associate professions.

1. Knowledge, skills and performance

• PAs and AAs must work within the limits of their competence and training.
• They are expected to maintain and update their clinical knowledge through CPD and supervision.
• They must not undertake tasks they are not qualified or legally permitted to perform (e.g. prescribing or signing death certificates).

2. Safety and quality

• Associates must raise concerns promptly if patient safety, dignity or comfort is at risk.
• They should contribute to quality improvement and follow local governance protocols.
• They must seek supervision when needed and escalate concerns about unsafe practice or unclear delegation.

3. Communication, partnership and teamwork

• PAs and AAs must explain their role clearly to patients, especially that they are not doctors.
• They must obtain valid consent before examination or treatment, ensuring patients understand who is providing care.
• They are expected to collaborate respectfully with colleagues and contribute to multidisciplinary teams.

4. Maintaining trust

• Honesty, integrity and transparency are essential — especially when things go wrong.
• Associates must protect patient confidentiality and maintain professional boundaries.
• They must be candid about their professional status and avoid misleading patients or colleagues.

How these standards guided the High Court’s decision

The High Court found that the GMC’s reliance on these high-level standards was lawful and rational. The judgment confirmed that:

• The GMC is not required to impose detailed, statutory task limits for PAs and AAs.
• The Good Medical Practice framework provides a sufficient regulatory basis for ensuring safe, ethical care.
• The standards are supported by employer-led governance, Royal College guidance, and future revalidation processes.

Rather than prescribing fixed scopes of practice, the GMC’s model places responsibility on individual registrants to exercise professional judgment, seek supervision, and work within their competence — principles embedded in Good Medical Practice.

This approach reinforces the GMC’s role as a professional regulator, not a workforce planner, and sets the tone for how PAs and AAs will be regulated as part of the UK’s evolving healthcare landscape.