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Professional Standards Authority response to GMC consultation on the AA and PA Order Rules

21 May 2024
  • Consultation Responses

We have published our response to the General Medical Council's consultation on the Anaesthesia Associates and Physician Associates Order Rules


We have several concerns about the GMC’s proposals as set out in their consultation. You can read through our response in full from the link below or through a summary here:

No information about the early stages of the fitness to practise process: the Rules do not describe any decision point before the decision about whether to refer a case to a case examiner (equivalent to the current real prospect test). We would have liked to see this detail here, to give clarity over these stages, which already lack transparency under the current fitness to practise process.

Decision to use only single case examiners: the GMC is proposing to use only single case examiners to make decisions, without the option of using them in pairs. This runs counter to our draft guidance. It is also borne out by 80% of respondents to our consultation on this draft, including members of the public and professionals – who said they were not in favour of use of single case examiners. We are concerned that this could present a public protection risk, particularly as the mechanism for challenging these decisions is not appropriate for public protection.

Interpretation of the case examiner powers to refer a case to a Tribunal is inconsistent with what is in the AAPAO Order: the GMC’s draft Rules do not provide a clear framework for case examiners to refer a case to a Tribunal if they have doubts about their own ability to reach a sound decision. This discretion is all the more important in the light of the GMC’s decision to use only single case examiners.

An imbalance between registrant appeal rights and public protection mechanisms: registrants will have ‘two bites of the cherry’ when it comes to challenging an accepted outcome – on grounds of error of fact or law, and also on grounds of injustice. In contrast, any public protection challenge will be limited to error of fact or law, with no broader test equivalent to ‘injustice’. Our power to challenge regulators’ final fitness to practise decisions was put in place to redress this kind of imbalance. This imbalance was even described as a ‘loophole’ by Minsters at the time. This is an issue with the Order itself and we plan to raise this with DHSC.