Preparing for the regulation of PAs and AAs: key updates ahead of December

Dear colleagues,

As we approach the start of regulation for physician associates (PAs) and anaesthesia associates (AAs) in December 2024, I’d like to provide an update on progress and share some key upcoming milestones. This follows my last update in June, where I outlined our approach to regulation and provided guidance to support other organisations in their work.

Regulation is a vital step towards strengthening both patient safety and public trust in these professions. It will help provide assurance to patients, employers and colleagues that PAs and AAs have the right level of education and training, meet the standards that we expect of the professions we regulate and that they can be held to account if serious concerns are raised.

We recognise that the discussion about the PA and AA role and deployment continue. It’s important that we all engage to proactively address these issues and to provide clarity and assurance for patients, doctors, PAs, and AAs alike.

As always, we’re committed to working closely with our partners across the health system to ensure that regulation is implemented effectively and supports our shared goal of improving patient safety and care.

Update on our consultation

We’re grateful to everyone who took part in our consultation on the rules, standards, and guidance for the regulation of PAs and AAs. We’ve been analysing the responses and will publish a detailed report in December, before the start of regulation. The report will include quantitative data for each question we asked, showing the range of responses to our proposals. It’ll explain how the feedback, along with insights from research we conducted with members of the public, has shaped our final rules, standards, and guidance. We’ll publish these once they’ve been approved by our governing Council in December.

How we’ll regulate PAs and AAs

Regulation for PAs and AAs will come into effect on 13 December. We’re in the final stages of developing the policies and processes necessary for implementing regulation across our key functions. You can find a brief update on each area below and there’s more detailed information on our PA and AA hub. It includes a range of guidance for PAs, AAs, employers, and educators to clarify their roles and responsibilities.

A robust, effective registration process

Registration will open on 16 December 2024. We’ll invite a small number of PAs and AAs to apply for registration before the end of the year and will then invite the rest of those on the voluntary registers by the end of January.

While PAs and AAs aren’t legally required to register until December 2026, we’ll encourage everyone currently practising in the UK to apply as soon as possible and we’ll work directly with employers to promote early registration. This two-year transition period, specified in the legislation, is designed to allow PAs and AAs to complete the necessary steps for registration while continuing to work.

As with UK medical graduates and international medical graduates, before we grant registration, we’ll carry out checks to ensure PAs and AAs are fit to practise. They’ll need to declare any previous concerns and provide a reference from their most recent employer. 

Upholding professional standards

Once registered, PAs and AAs will be required to follow Good medical practice which outlines the standards of care and behaviour we expect. We’ve been actively raising awareness through webinars and via our outreach teams, and we’ll continue to provide support after regulation starts, as we do for doctors.

We’re also updating other relevant guidance to ensure PAs and AAs have the resources they need when regulation begins. They’ll need to use their professional judgement to apply the standards to their day-to-day practice. 

Setting standards for high-quality education and training

Once regulation begins, we’ll set the standards for the education and training that PAs and AAs must receive. We’ll also approve courses and curricula to ensure PAs and AAs have the knowledge and skills, and demonstrate the behaviours needed to work safely once they qualify.

Since 2021, we’ve been carrying out quality assurance checks with PA and AA course providers on a voluntary basis. This process will continue after regulation starts to ensure that standards are being met, and we’ll publish annual reports of our findings.

We’ve also been finalising learning outcomes, course standards, and curricula in collaboration with the Royal College of Anaesthetists, the Royal College of Physicians and the Faculty of Physician Associates.

Taking action when concerns arise 

As with doctors, if a serious concern is raised with us about a PA or AA, we may need to investigate to assess any current and ongoing risks to public protection. Our duty to protect the public is set out in the Medical Act 1983, which defines public protection in three key areas and requires us to act in a way that:

  • protects, promotes and maintains the health, safety and wellbeing of the public
  • promotes and maintains public confidence in the profession
  • promotes and maintains proper professional standards and conduct for members of the profession.

During the initial phase of regulation, we’re aware that we may receive concerns about PAs and AAs who are not yet registered with us. While we can’t take action in those cases, we’ll log the information for future reference and, where appropriate, refer concerns to employers or relevant bodies who may be able to take action in the interim.

Setting expectations for appraisal ahead of future revalidation

We’re developing a revalidation model that will support PAs and AAs to reflect on and develop their practice and give colleagues and patients confidence that they’re keeping up to date. Before we set revalidation dates for PAs and AAs, we need to develop and consult on the rules for how revalidation will be delivered.  We’ll provide more information as this work develops throughout 2025. 

However, from the moment PAs and AAs register with us, they should start participating in annual appraisals and collect supporting information. Our handbook on Effective clinical  governance to support revalidation provides guidance for healthcare providers on how to deliver appraisals in line with our revalidation requirements.

Working together to prepare

We appreciate everyone who’s contributed to the development of regulation for PAs and AAs. Over the coming months, we’ll provide regular updates and continue to work with you and others to ensure you’re fully informed and prepared for regulation to begin. Thank you for your continued support and input as we work towards this important milestone.

Best wishes, 

Charlie Massey

Chief Executive and Registrar
General Medical Council

Sent to:

  • Academy of Medical Royal Colleges
  • Chief Medical Officers in England, Northern Ireland, Scotland, Wales
  • Department of Health and Social Care England
  • Government officials in Northern Ireland, Scotland and Wales
  • Health Education and Improvement Wales
  • NHS Confederation
  • NHS Education for Scotland
  • NHS Employers
  • NHS England
  • NHS Providers
  • Northern Ireland Medical & Dental Training Agency