How we make decisions about a PA or AA’s fitness to practise

These explanatory publications outline the key concepts and principles that underpin our decision making in respect of a PA or AA’s fitness to practise.

• What we mean by fitness to practise (physician associates and anaesthesia associates)
  Describes what decisions are made about a PA or AA’s fitness to practise, how we assess fitness to practise and what might be a concern and why.
• Decision making principles in fitness to practise (physician associates and anaesthesia associates)
  Describes our legal role to protect the public and explains the principles of being proportionate, transparent and fair when making decisions about a PA or AA’s fitness to practice.

• Deciding whether to refer a matter to the GMC (physician associates and anaesthesia associates) – Guidance for employers
  Supports employers to decide whether fitness to practise concerns about a PA or AA need to be referred and to make accurate referrals when appropriate

The decision-making guidance below is used to inform decisions made at specific stages of the fitness to practise process.

• Decision on whether regulatory action is required (physician associates and anaesthesia associates)
  Supports decision-making on whether there’s a legal basis for considering a PA or AA’s fitness to practise and whether they pose any current and ongoing risk to public protection.
• Decisions at the pre-initial assessment stage
  Supports decision-making on whether we can, and should, carry out an assessment of a PA or AA’s fitness to practise.
• Decisions at the initial assessment stage
  Supports decision-making on how to approach evidence collection when assessing a PA or AA’s fitness to practise and on whether the test for onward referral is met.
• Decisions on failure to comply with a direction to undergo an assessment and / or a requirement to supply information or produce a document (physician associates and anaesthesia associates) 
  Supports decision-making on whether a PA or AA has failed to comply with an assessment or requirement to supply information and where they have, how to respond.
• Decisions at the case examiner stage (physician associates and anaesthesia associates) 
  Supports decision-making on assessing impairment, making a proposed outcome, referring a case to a hearing and on procedural issues and other matters that arise at the case examiner stage.
• Decision on whether a warning is required (physician associates and anaesthesia associates)
  Supports decision-making on when it is appropriate to impose a warning following a decision that a PA or AA’s fitness to practise is not impaired.
• Decision on what restrictive action is required (physician associates and anaesthesia associates)
  Supports decision-making on what restrictive action is required to protect the public following a decision that a PA or AA’s fitness to practise is impaired.

Associate tribunals have their own guidance to support decision-making in relation to physician associates and anaesthesia associates. This is published on the MPTS website Hearing resources for PAs and AAs – MPTS. 

This decision-making guidance informs our approach to restricting a PA or AA's registration on an interim basis.

• Decisions on interim measures
  Supports decision-making on whether it may be necessary to restrict a PA or AA’s registration on an interim basis and the approach to take when reviewing interim measures.

• Deciding voluntary removal applications and advising on other removals where there is an unresolved concern (PAs and AAs)
  Supports decision-making on whether it is appropriate to grant an application for voluntary removal from the register where there are outstanding concerns about a PA or AA’s fitness to practise.

• Decisions on removal for a listed offence (physician associates and anaesthesia associates)
  Supports decision-making about the approach to take when there’s information that indicates a PA or AA’s entry on the registers must be removed following their conviction for a listed offence.
• Policy on publication and disclosure of fitness to practise information for physician associates and anaesthesia associates
  Sets out our general policy on the publication and disclosure of information relating to a PA or AA’s fitness to practise.
• Using personal information in the fitness to practise process for physician associates and anaesthesia associates
  Sets out the guiding principles informing our approach to using personal information in the fitness to practise process and supports decision-making about disclosing or obtaining personal information in specific circumstances.
• Decisions on redacting case examiner decisions (physician associates and anaesthesia associates)
  Supports decision-making about what information should be redacted when preparing certain case examiner decisions for publication on the GMC website.
• Drafting allegations guidance (physician associates and anaesthesia associates)
  Operational guidance for GMC staff and legal representatives on the approach to take to drafting allegations of impaired fitness to practise.

• Decision making guidance for case examiners on using powers delegated to them to revise certain decisions relating to a PA or AA
  Sets out our policy to revising relevant decisions that relate to a PA or AA’s fitness to practise. 
• Decisions on internal appeals (physician associates and anaesthesia associates)
  Supports decision-making in relation to internal appeals against specific decisions made by the Regulator or case examiners during the fitness to practise process. 
• Decision making guidance for authorised decision makers in the Corporate Review team on using powers delegated to them to revise certain decisions relating to a PA or AA
  Sets out our policy to revising relevant decisions that relate to a PA or AA during the fitness to practise process or in relation to their registration.

• Guidance on referral to Disclosure Scotland
  Explains the relevant legal framework, the approach we take and criteria we apply when deciding whether to refer a PA or AA to Disclosure Scotland.
• Guidance on referral to the Disclosure Barring Service
  Explains the relevant legal framework, the approach we take and criteria we apply when deciding whether to refer a PA or AA to the DBS.
• Guidance on disclosure to Disclosure Scotland and the Disclosure & Barring Service under the Medical Act 1983 (Section 35B(2)) or the Anaesthesia Associates and Physician Associates Order 2024 (Schedule 3, paragraph 1(2))
  Explains the relevant legal framework, the approach we take and criteria we apply when deciding whether to make a disclosure about a PA or AA to DS and the DBS.
• Decisions on sharing information related to a physician associate or anaesthesia associate with the police
  Supports staff identifying information that may amount to criminal conduct and may need to be shared with the police and supports related decision-making on whether that information should be shared.
• Decisions on sharing information related to a physician associate or anaesthesia associate with the police – supplementary guidance for decision makers
  Supplementary guidance to help GMC staff identify information that may amount to criminal conduct and need to be shared with the police and supports decision-making on whether that information should be shared.