Preparing for the regulation of PAs and AAs: the importance of effective clinical governance

Published 13 November 2024

Dear colleagues,
 As we move towards the start of regulation of physician associates (PAs) and anaesthesia associates (AAs), it’s important that we work together to provide clarity and assurance for patients, doctors, PAs and AAs about the way forward. We recognise the impact that ongoing discussions about these professions are having on individuals and the wider healthcare system. I appreciate your continued support in ensuring that all interactions—whether online or in person—remain respectful and professional, with local systems reinforcing this message to support colleagues.

Regulation will strengthen patient safety and public trust in PAs and AAs. It’ll help provide assurance to patients, employers and colleagues that PAs and AAs have the right level of education and training to meet our registration requirements, meet the standards that we expect of the professions we regulate, and can be held to account if serious concerns are raised.

Key to regulation being implemented effectively is robust clinical governance and our outreach teams are continuing to engage with employers about the importance of having appropriate processes in place. I’ve provided more about our guidance on this area below, along with an update on how we’re finalising the rules, standards and guidance for the start of regulation, following our consultation.

The role of employers in ensuring effective clinical governance and safe patient care

Effective clinical governance arrangements are vital for maintaining high standards of patient care and safety. To support those responsible for managing these processes, we updated our handbook on effective clinical governance in January, providing guidance to help organisations prepare for the regulation of PAs and AAs.

It emphasises that PAs and AAs must be supervised, supported by robust local governance structures. Organisations should have a designated individual at board level to oversee PAs and AAs and establish clear processes for their deployment and supervision. This approach helps ensure they’re appropriately trained and competent to carry out the activities they’re tasked with. Competence varies by individual, determined by their training, and experience. It’s essential that PAs and AAs, like all healthcare professionals, work within their competence and don’t undertake tasks beyond what their employer has approved.

Healthcare providers also need to ensure that PAs and AAs have access to annual appraisals, can actively participate in their organisation’s clinical governance systems, and are able to gather the supporting information they’ll need for future revalidation once they register with us. The handbook provides guidance on how to deliver appraisals in line with our revalidation requirements. We’re currently 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. We’ll provide more information as this work develops throughout 2025. 

Finalising the rules, standards and guidance for regulation to begin

Earlier this year the UK and Scottish Parliaments passed the Anaesthesia Associates and Physician Associates Order, which confirmed the GMC as the regulator of PAs and AAs, and set out our future responsibilities in law to:

  • maintain a register of qualified PAs and AAs and ensure only those meeting our standards can join
  • investigate concerns about fitness to practise and take appropriate action when necessary
  • set and review professional standards for education, training, and practice.

We subsequently held a detailed consultation covering the proposed rules, standards and guidance for delivering these new responsibilities and the requirement that we regulate PAs and AAs from the end of this year. We sought feedback on whether our proposals to implement the legislation were clear, fair and proportionate. We also asked for feedback on draft principles that will inform the content of fitness to practise decision-making guidance that will apply to doctors as well as to PAs and AAs.

We received over 3,000 responses from individuals and organisations across the four countries of the UK. Since the consultation closed, we’ve read and carefully considered every response we received. This includes those which reference broader issues related to the roles and regulation of PAs and AAs, rather than our proposed rules, standards and guidance.

In December, before regulation begins, we’ll publish a detailed report on the outcome of the consultation. It’ll include quantitative data for each question we asked, a summary of responses to our proposals and an explanation of how they, along with insights from research carried out with members of the public, have shaped our final approach. We’ll also share information about the broader issues raised with us and, where relevant, we’ll explain how we, or other bodies are addressing these, outside the scope of this consultation.

I hope this update has been helpful. We’ll continue to provide regular updates to ensure everyone is fully informed and prepared for the start of regulation.

Thank you again for your continued support.

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