About regulation
The GMC as regulator
In 2017 the Department of Health and Social Care (DHSC) held a public consultation on which healthcare regulator would be most suitable to regulate one, some, or all of the medical associate professions.
The majority of respondents favoured the GMC. The main reasons they gave were:
- PA and AA training, practice and supervision are more aligned to that of doctors than other health professionals,
- being regulated by the organisation responsible for doctors’ registration, would improve PA’s and AA’s professional credibility, and the public’s confidence in the role.
The DHSC considered the Health and Care Professions Council as a potential regulator but, in 2019, decided the GMC was more appropriate. Since then, we’ve been working with a wide range of individuals and organisations - representing patients, doctors, PAs, AAs, educators, supervisors and employers - to shape the model of regulation.
We agreed to regulate PAs and AAs on the condition that no additional costs would fall on doctor registrants. We invoice the DHSC for all costs arising from our work on PAs and AAs and will continue to do so until these are covered by PA and AA registration fees.
The regulatory model
As for doctors, regulation will help assure patients, employers and colleagues that PAs and AAs are safe to practise and can be held to account if serious concerns are raised.
We’ll regulate the pre-qualification education that PAs and AAs receive. Our framework sets out the knowledge, behaviour and skills that will be expected of newly qualified PAs and AAs once regulation starts. We’ve begun working with PA and AA course providers to help them understand and assess whether they’ll meet our future education standards. These measures will ensure PA and AA graduates are fit to practise. There aren’t currently any national or UK-wide frameworks for post-qualification education and training of PAs and AAs for us to regulate.
We’ll set the standards for registration, check that PAs and AAs have met them, including that that there are no outstanding concerns about their fitness to practise. You can read more about the registration processes in our guide for PAs and AAs.
We’ll also set professional standards for PAs and AAs. Once regulation begins, PAs and AAs will have to follow Good medical practice which sets out the standards of care and behaviour expected of our registrants. They’ll also have to follow more detailed guidance, which explain covers specific areas that we often receive questions about or where it’s useful to provide extra detail.
We’ll introduce revalidation to make sure PAs and AAs remain up to date. We’re developing a model that will support them to reflect on and develop their practice, give colleagues and patients confidence that they’re keeping up to date, and help drive improvements in clinical governance. We’ve already updated our Clinical governance handbook and Guidance on supporting information for revalidation to help PAs, AAs and their employers prepare.
We’ll ensure that PAs and AAs are safe to practise. As with doctors, if a serious concern is raised with us about a PA or AA, we may need to investigate to assess if they pose any current and ongoing risk to public protection. You can read more about how we do this for doctors on our fitness to practise explained webpages. These will be updated to include PAs and AAs before regulation begins.
Scope of practice
Like many other professional healthcare regulators, we don’t set a scope of practice that determines what tasks registrants can safely carry out, because that depends on their individual skills and competence, which develop over time. We don’t do this for doctors, and we won’t do this for PAs and AAs.
Regulation will support good, safe patient care in two interlinked ways: setting the outcomes that need to be achieved through education; and setting the standards required for registration. While we approve the curricula that qualifying courses must teach, we also set separate registration assessments which must be passed by new graduates, international applicants or those who have taken a prolonged break in practice.
Good medical practice sets the standards of care and professional behaviour expected of PAs and AAs once regulation begins, including only practising within their competence. We’ve also issued guidance for employers on clinical governance of PAs and AAs in our updated clinical governance handbook. This reiterates that, PAs and AAs must work under the supervision of doctors and that appropriate governance structures must be in place.
Post qualification education and training
Doctors are unusual amongst healthcare professionals in having a structured, regulated Foundation programme and a regulated framework for post-qualification development (or specialty training) for those who wish to pursue a certificate of completion of training (CCT).
Qualified doctors who are not in specialty or GP training - mainly specialty, specialist (SAS) and locally employed (LE) doctors - do not have a nationally approved training framework to extend their practice post qualification, but they are expected to work within their competence. And their practice is overseen by local systems of appraisal and clinical governance, and by periodic revalidation.
Other professionals, such as nurses, develop their skills and experience within non-statutory frameworks or local guidance, typically under the umbrella of ‘advanced practice’, which isn’t currently separately regulated. Once PAs and AAs are regulated, we will consider what role we should play in the development of post-qualification frameworks for PAs and AAs.
Fee levels
The fees that PAs and AAs will pay to be registered with us will be formally approved by our governing Council in December when regulation comes into effect. Until then, we don’t have the powers to set fees.
The DHSC is providing funding to cover the full set-up costs of bringing PAs and AAs into regulation until PAs and AAs begin paying fees. They will also provide some transitional funding while the number of PA and AA registrants remains low.
