The case was brought by Anaesthetists United and the parents of Emily Chesterton, who died at the age of 30 after having two appointments with a PA in general practice who she believed was a GP.
It also had the backing of the BMA, which has previously said it would provide indemnity for any adverse legal costs Anaesthetists United incurs for certain stages of the case.
The case argued that the GMC should enforce a national scope of practice for PAs and AAs to ensure they are differentiated from doctors. It said that doing this meant it was failing in its obligation to ensure patient safety.
PA scope of practice
However, Mrs Justice Lambert dismissed the case on all grounds. In her ruling, she said there was ‘a genuine debate about whether the imposition of national limits on the practice of associates is overall in the interests of patient safety’.
‘It is not for me to enter the debate and resolve it one way or the other,’ she added. ‘That is not this court’s role: my only role is to determine whether the defendant’s decision not to impose a ceiling on practice is irrational.
‘This court is simply not equipped to weigh complex social, political and economic issues and then express a concluded view on the pros and cons of limits of practice.’
Anaesthetists United said: ‘We are hugely disappointed that Mrs Justice Lambert has dismissed our judicial review on all grounds.
‘Our lawyers will be looking next week at whether or not we can appeal the judgement. Whether or not this is practical depends on financial, as well as legal considerations. We will report on this as soon as possible.
‘Since we started this case there has been a sea-change in attitudes towards the use of physician assistants. The Leng review, and its widespread adoption, has been a key part of this change; and the public are now more aware of what PAs are and what background they have.
PA regulation
A spokesperson for the GMC said: ‘Our thoughts remain with the Chesterton family. Today our regulation of associates – supported by a robust system of registration – ensures they are safer and better equipped to carry out their duties and can be held to account if they pose a risk to patients or public confidence.
‘We welcome the decision of the High Court to dismiss the claims on all grounds and we are pleased the court found our approach when considering how we would regulate associates, and our decision not to impose limits on their practice, was “coherent and rational”.’
Dr Tom Dolphin, chair of BMA council, said: ‘This is a disappointing outcome. The case was rightly brought by Anaesthetists United and the family of Emily Chesterton following the failure by the GMC to act on the overwhelming consensus of doctors that there should be a clear scope of practice that sets safe limits on what physician assistants can and cannot do. That consensus is still correct even though the court today decided that who sets scope is not a matter for a court of law.
‘We thank Emily’s parents Marion and Brendan for their bravery in bringing this case, and the many doctors who supported AU directly by providing funds to ensure it could be heard.
‘It is important to make clear that the court has not vindicated the GMC’s refusal to set a scope or adopt scopes set by others. Instead, it has simply stated the GMC’s decision not to do so was not unlawful.’
Earlier this year the High Court also dismissed a legal challenge brought by the BMA against GMC about regulation of PAs. That case related to the GMC’s use of the term ‘medical professionals’ to describe not only doctors, but also PAs and AAs and questioned the basis for using common professional standards for groups within this umbrella term.