GMC Updates Fitness to Practise Rules Amid PA Criticism

The General Medical Council (GMC) has published updated fitness to practise guidance aimed at providing greater clarity and consistency in handling concerns about medical professionals in the UK. 

The changes follow long-standing criticisms of the GMC’s approach to fitness to practise (FtP) investigations and its promises to introduce more compassionate procedures. 

However, the updated guidance drew immediate criticism for treating doctors under the same regulatory framework as physician associates (PAs) and anaesthesia associates (AAs).

Key Changes to Assessment Process

The updates to FtP guidance provide case examiners with a framework for assessing whether concerns received by the GMC should be interpreted as meaning that a doctor may pose a risk to the public. This follows changes made last year by the regulator to investigations involving violence and dishonesty. These gave decision-makers more discretion in minor cases judged to represent a lower risk to public protection.

The new guidance introduces three core questions for decision-makers when assessing whether concerns should proceed to investigation:

• What is the seriousness of the concern?
• What is the impact of relevant context?
• How has the doctor responded?

Factors that may increase seriousness include repeat behaviour, abuse of position, or allegations involving vulnerable individuals. Decision-makers will also consider working environment, personal circumstances, and whether the professional has shown insight and remediation.

Investigation Triggers

Fitness to practise investigations may still be initiated for:

• Misconduct
• Poor performance
• Criminal conviction or caution
• Physical or mental ill-health affecting practice
• Determination by another regulatory body
• Insufficient knowledge of English

The thresholds for FtP concerns remain unchanged, but the assessment process will be more structured.

The Medical Protection Society (MPS) welcomed the GMC’s efforts “to deliver a fitness to practise process that is fairer and more compassionate”. Dr Rob Hendry, the society’s medical director, told Medscape News UK: “Finding out that fitness to practise is being called into question can have a significant impact on a doctor’s mental wellbeing.”

He added that the MPS had “long called for more to be done to ensure doctors are not dragged through this stressful process unnecessarily”.

Doctors’ Association Raises Concerns

The new guidance brings FtP decisions for doctors into line with how cases involving PAs and AAs are considered. 

The GMC assumed responsibility for regulation of PAs and AAs in December 2024. The move was vigorously opposed by many in the medical profession, particularly by GPs who wanted medical associates kept out of general practice altogether.

The Doctors’ Association UK (DAUK) appreciated the GMC’s attempt to clarify its guidance but expressed concern about aligning doctor regulation with PA and AA processes.

Helen Fernandes, DAUK chair, highlighted that the GMC has not set standards or scope of clinical practice for medical associates. “If there was an issue around the clinical decision-making of a PA or AA, there are no standards against which they can be judged,” she told Medscape News UK.

This contrasts with doctors’ clinical conduct being assessed against strict standards for many years. 

DAUK has expressed unease about how doctors will be held accountable for supervising PAs and AAs, noting that the GMC has attributed supervision responsibilities to anyone working with them in a team.

“This guidance seems to add more confusion to an already confused picture, which we believe doesn’t help our members – but more importantly, doesn’t help our patients or the wider public,” Fernandes said.

The updated guidance is available on the GMC’s website.

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.