MAPs PMB minutes 25/07/2023

Minutes from GMC MAPs Programme Board, 25 July 2023

This is a transcript of the minutes provided by the GMC provided via FOI

Minutes and actions from the last meeting

  1. Minutes from the May Programme Board meeting were agreed as accurate. CB provided an update on the two actions from that meeting:

    • M to talk to Finance about AARA fees – completed and paper on today’s agenda.

    • DD to explore with B whether, once we have established a framework and rules, changes to fee levels will require re-consultation in the future – D has confirmed we will keep a schedule of fees separate to the rules and the rules will acknowledge the schedule. This means we can change the schedule each year without consulting, as the order only requires consultation each time the rules change.

Programme update

  1. HA reported that the programme grading remains amber. We are still preparing to begin regulation at the end of 2024, but DHSC are behind schedule on the Order so we’ve moved the target date for opening the PA/AA rules consultation from January to March 2024. Discussions are ongoing with the Regulatory Reform Programme Team on managing the implications of this, and a paper will be considered at SMT in August.

  2. She highlighted that the individual outputs currently rated amber are those that are dependent upon legislation, plus:

    • Outreach service development - HA noted she will be facilitating a workshop with NOs and Outreach Management Team at the end of August to progress this; and

    • International applications – We are making some tweaks to the original process design following advice from Legal that decisions on acceptability (or otherwise) of overseas qualifications must be appealable.

  3. There were no questions from the Board.

Fees for the AA registration assessment

  1. MG introduced her paper setting out proposed fee levels for the new AA registration assessment (AARA) and the rationale for these. [SECTION REDACTED BY GMC]

  2. The Board supported the principle of recovering costs of the WPBA element of the AARA via fees charged for the knowledge test. However, they asked that the rationale for the proposed fee levels be revisited to:

    • More clearly reference the principles underpinning our fee approach.

    • Begin from a position that AARA fees should broadly cover the costs we incur in delivering the exam, or explain why this is not our approach in this case. Members discussed the importance of avoiding cross-subsidy and the possibility of setting fees in relation to comparative salary levels.

    • Fully consider equality impacts, including the approach to clinical skills assessment for international AA applicants (which has yet to be established).

    NR asked that information on AARA fees, and the rationale for these, is incorporated into a wider paper on fees for AAs and PAs that should be authored by DD.

    ACTION: MG to review and further develop thinking on AARA fees, in consultation with Finance, so that final proposals can be incorporated into the overall schedule of AA/PA fees for approval by Executive Board.

Feedback on multi-professional regulation discussion at the Council Awayday

  1. CB summarised the outcomes from the session that she and HA ran at the recent Council Awayday. Following an initial presentation, including Dr GL talking about how PAs are deployed in his Trust, Council members carried out an ’empathy mapping’ exercise to discuss the perspectives of employers, patients and PA/AAs themselves. They also discussed what we are hearing from doctors, in particular the concerns being expressed by trainees.

  2. Council members had discussed priority actions for the GMC in relation to stakeholder management and suggestions included:

    • Being supportive of the Government’s workforce plan – which includes increasing numbers of PAs and AAs – whilst helping to manage any unintended consequences.

    • Recognising and dealing with the perceptions of doctors and helping all our registrants (and the system) to manage the transition to the new multi-disciplinary team (MDT).

    • Strengthening the narrative around the MDT, engaging employers and royal colleges in the discussion, and supporting improved public awareness of new professional roles.

    • Taking care not to stray beyond our regulatory remit: our focus should be on ensuring that education and training for PAs and AAs is appropriate and that professional guidance is available on issues such as scope of practice.

  3. NR observed that bringing PAs and AAs into regulation is fairly straightforward, but we do need to consider whether it’s appropriate to extend the wider ambitions we’ve set for the medical workforce (which stray beyond our core remit) to AAs and PAs. There will be differing views on that question; his personal opinion is we should focus narrowly and avoid being drawn into areas we don’t need to be part of.

  4. SC presented an alternative perspective, setting out that there are real risks for the GMC, and risks to patient safety and workforce sustainability, if we don’t ensure that governance is robust and teams can work effectively.

  5. FK-W supported the importance of clinical governance and also shared that colleagues in Fitness to Practise have developed ‘user personas’ to explore the journey through FtP processes, an approach that has similarities with the empathy mapping undertaken by Council.

  6. HA referenced a question raised in the Council discussion about it being part of our role to promote trust in the medical profession, and this ought therefore to extend to PAs and AAs.

  7. SMc noted this conversation is really useful, as we need to understand how the professions view our expanded role. We build trust and confidence by regulating effectively: part of that comes from years of existence and structures outside the GMC, some of which is absent for PAs and AAs. She asked if we need to be more expansive in our thinking about what regulation and being regulated means for PAs and AAs and their professional identity?

Discussion on the external environment for PAs and AAs

  1. HA and SMc talked through the slides setting out challenges in the external environment for PAs and AAs arising from the publication of NHSE’s long-term workforce plan, the PA resolution at the BMA’s recent Annual Representative Meeting, and the high-profile case of a patient death allegedly due to negligent care provided by a PA. They suggested that our current positioning and the breadth of our communication strategy needs to be reconsidered in light of wider developments since we began working on PA/AA regulation.

  2. Programme Board discussed how best we might respond to the current environment, in particular the concerns of doctors:

    • RM agreed this is tricky to navigate but we should remember it’s our role to promote regulation of PAs and AAs, rather than promoting their existence. Certainly we want to avoid being drawn into debates on scope of practice. He also noted the absence of positive voices in the current online discussion and asked whether we could potentially prevail upon the colleges or others to counter-balance some of the negativity.

    • FK-W suggested we could be more pro-active in correcting misconceptions about the role of the GMC that are being posted online and also share more information with stakeholders about the journey we’re on towards regulation of PAs and AAs, including reminding stakeholders about what has already happened and why.

    • TA asked whether we feel this is a signal or just a series of noises? Has something fundamentally changed?

    • LW agreed we need to put energy into stakeholder engagement side, including with employers, since they are in a position to address the frustrations around training. Some concerns will dissipate over time, especially once regulation starts, but uncertainty has created a lot of the fear among trainees.

    • SC agreed with LW’s points and feels we are seeing both signal and noise. We shouldn’t be overly pessimistic, not all doctors support the BMA line, but a plan for deployment of PAs and AAs is needed. She advised we can’t expect too much from colleges in this space since they are membership bodies and won’t jeopardise their relationship with doctor members to defend PAs and AAs (as we have seen in recent statements from the RCoA). We can add some clarity without promoting the roles and should also recognise there is tension between PA/AAs and other (non-doctor) healthcare professions. Socialisation of new GMP important.

    • MS noted new GMP launches next month, which does raise some challenges. He said we have a line on PAs and AAs being held to the same high professional standards as doctors. He also noted that it is a well-established duty that you should treat your colleagues with respect so we shouldn’t be shy about advising that the proper way to raise concerns is with your employer, union etc., not by attacking individuals.


  • There was no other business raised. CB noted that the next MAPs Programme Board meeting is scheduled for 19 September 2023; she will be away so HA will chair.