How we’ve responded to feedback

We received wide-ranging feedback across the areas we consulted on. We've made a variety of changes to the final rules, standards and guidance as a result.

These include:

• Revising policies: We originally proposed using one case examiner to make decisions in fitness to practise cases. We’ve updated our fitness to practise rules to require two case examiners for certain types of decisions instead.

• Clarifying processes: We’ve introduced a new provision that confirms we can’t ask PAs and AAs to provide evidence of reflective practice when applying to join, leave or re-join the register.

• Updating standards: We’ve redrafted the proposed course and curricula standards to clarify our expectations of organisations delivering PA and AA education and training. This includes a new requirement for course providers to make sure that student PAs and AAs inform patients when they’re involved in their care.

• Strengthening principles to inform guidance: We’ve expanded the list of behaviours in the guidance for decision makers that indicate a high level of seriousness. The list now includes cases where a PA or AA has deliberately misled patients or others about their registered status.

We’ve included a summary of the key changes we’ve made in the executive summary of the report. You can also read a more comprehensive breakdown of the feedback we received for each question and how we acted on it, in Part 4 of the report.

More detail on the updated fitness to practise decision-making guidance

Based on the feedback we received, we’ve made several changes to the principles of fitness to practise decision-making guidance. This guidance supports GMC decision-makers and independent tribunals in making fair, transparent, and proportionate decisions.

Changes include:

• confirming that warnings can be issued to maintain public confidence. To uphold professional standards, and signal to registrants and the public that certain behaviour or poor performance is unacceptable

• clarifying how time spent under an interim order or an interim measure should be considered when determining the length of any final measure or sanction

• confirming that certain issues are not sufficiently serious to pose any current and ongoing risk to public protection. And so will not meet the threshold for investigation.

The updated guidance has applied to PAs and AAs since 13 December 2024 and will apply to doctors from spring 2025.