The GMC chose to continue designating doctors and PAs/AAs as ‘medical professionals’ despite internally acknowledging the risk of confusion this caused, a court has heard.

The UK medical regulator decided to continue applying the umbrella term ‘medical professional’ to both doctors and physician and anaesthetist assistants in its GMP (Good Medical Practice) guidance, despite warning its own staff to avoid doing so. 

The revelation comes as the BMA appealed a High Court judgment, which last year ruled against the association’s legal challenge to the way the GMC has regulated assistant professionals.

In that case, the BMA had argued that the GMC had acted unlawfully and irrationally and gone against its own statutory functions and objectives by labelling doctors and PAs/AAs as medical professionals.

However, in a judgment handed down in April last year, Mrs Justice Lambert dismissed the BMA’s challenge on all grounds.

Representing the BMA at the Court of Appeal on 3 February, Jenni Richards KC argued that the GMC’s claim it had used the term ‘medical professional’ for the purposes of ‘clarity’ and in a way that was consistent with its own statutory objectives, had been undermined by material that had not been brought to light at the previous hearing.

She told the court, which was heard before Lord Justice Coulson, Lord Justice Jeremy Baker and Lord Justice Cobb, that an internal GMC terminology guide produced in June 2024 made repeated warnings about avoiding the use of the term ‘medical professional’ when referring to PAs and AAs.

This included not using the word ‘medical’ to refer to or include PAs and AAs when talking about education or practice and urging caution when using the term ‘medical’ to refer to registrants or the GMC’s role as a regulator.

She said: ‘What the GMC said to the judge and what the judge found was the justification for using medical professionals in GMP, was to promote clarity, readability and accessibility.

‘When one sees what the GMC is saying internally here about the scope of the confusion, the fact that medical profession cannot encompass associates, the fact that the term “medical” should be avoided when being attached to various aspects of associates’ education and practice and the instruction “don’t use medical professionals” to patients, social media or public-facing documents.

‘We say completely undermines the key reason the GMC put before the judge … that this was both rational and consistent with the GMC’s statutory objectives in section one of the [Medical] act.’    

As well as arguing the GMC’s position in the original hearing had been undermined, Ms Richards further reiterated the BMA’s contention that the regulator’s decision making around applying the term ‘medical professional’ had been inconsistent and in conflict with the GMC’s own statutory framework.

She told the court the GMC had opted to use the term ‘medical professional’ to encompass doctors and assistants in the August 2023 iteration of its GMP guidance.

She said this decision stemmed from the GMC's anticipation that the then forthcoming legislation for PAs and AAs known as the Anaesthesia Associates and Physician Associates Order would apply the same terminology.

She said: ‘The GMC’s decision-making as a matter of fact was tied to the statutory language. It wanted to have terminology that reflected what it thought the legislation was going to say.

‘Because the legislation never changed and the 2024 order went down a different route, the GMC never revisited its initial reason.

‘When it became apparent to the GMC that the legislation was not going to be [changed] it should have realised that that fundamentally undermined the sole, or at least principal, basis upon which it had adopted that terminology in the first place.’

She added: ‘It’s [the GMC] belief that it was not in its gift to change the term is simply wrong.’

Alongside many other organisations, the BMA has long-standing concerns and objections to the regulation and use of PA and AA staff in the NHS.

These include fears that failure to distinguish between doctors and assistant professionals properly will lead to confusion among patients and jeopardise safety.

As well as independently seeking a judicial review, the association last year supported the advocacy group Anaesthetists United as part of their ultimately unsuccessful legal challenge on the use of PAs/AAs.

Representing the GMC at yesterday’s appeal, Ivan Hare KC rejected claims that the GMC had misdirected itself or acted contrary to its statutory obligations in using the term medical professional within the GMP.

He added that GMP guidance was an ethical, not legal, code and one that was not directed to 'a public authority about the exercise of legal powers', while stressing that the term medical professional was used in only a limited nature within the guidance.

He said: ‘My learned friend [Ms Richards] went as far as to say the GMC’s use of the term medical professionals gives PAs and AAs carte blanche to describe themselves as medical practitioners.

‘That’s flatly contradicted when you look at Good Medical Practice itself [which says] you have to be clear about who you are, and [that] you have to introduce yourself to patients.’

He added: ‘It’s simply not arguable, we say, that anyone reading Good Medical Practice as a whole would think that, by the GMC’s use of the term medical professionals in those limited areas, that they were entitled to describe themselves as either a registered medical practitioner or as a practitioner registered under the Medical Act.’

The court of appeal is expected to deliver his judgment on the appeal later this year.