This is a transcript of the minutes provided by the GMC provided via FOI
Minutes and actions from the last meeting
- Minutes from the July Programme Board meeting were agreed as accurate. CB provided an update on the action for MG to 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. Two meetings have been held and this is progressing.
Programme update, including external environment
HA stated that the programme still reporting as amber. That is mostly due to the risk to the timescale if DHSC doesn’t achieve its target of laying the Order in Parliament by the end of the year. But there are also a few areas of policy work outstanding, including in relation to the international registration process, and these are holding up completion of IS development. HA also noted the upcoming Council webinars, which will take Council members through how the rules will operate for PAs/AAs across all our functional areas.
The main change since the last programme board has been increased challenge and volatility in the external environment. Tensions and questions around PAs and AAs have increased, not just on social media but within colleges and a formal statement by the BMA. We have reviewed the risk log, recognising that complaints and concerns from doctors may have a negative impact on programme delivery and our rules consultation. HA/CB led a discussion, with comms colleagues, on this at SMT this week.
Programme Board discussed the implications of the current external environment and reflected on the discussion at SMT earlier in the week:
a. SMT recognise it’s a difficult time for the team and they offer personal support. We should continue to speak about the quality of the work that has been done on the MAPs programme.
b. There is a limit to our role as regulator and we must look to other stakeholders, especially DHSC and NHSE, to address most of the issues being raised.
c. Regulation is a significant positive that will help relieve workforce pressures and address some of the concerns being raised.
d. We can respond to specific concerns such as PAs ‘masquerading as doctors’, we have a process for dealing with that. We can also share figures around the number of AAs/PAs compared to the number of doctors to put issues into perspective.
UL highlighted that funding for the MAPs programme is from DHSC and a lot of additional time and resource is being spent on comms at present. We should consider asking for increased funding for these functions, or encouraging them to step into this space.
SM emphasised the role of other organisations/stakeholders in speaking out; future comms activities may play a role in encouraging this, for example the GMC Symposium. We know there is unhappiness in the sector (expressed, for example, in the GMP consultation) and as an organisation we may need to respond to this. Social media is problematic and this is where most of the discussions are taking place, so we need to take a role in restoring calm without getting involved in back and forth in this space.
RM emphasised that MAPs regulation is a ‘good news story’ and we should not get blown off track - there were similar issues when revalidation and regulation of nursing associates were introduced. Note the RCoA welcomed the regulation of AAs by GMC when it was first announced, and so changes do happen.
SC said the view on the ground is that the conversation is worsening, and views are hardening amongst doctors who were previously neutral. She also highlighted wider changes in multi-disciplinary working and the tensions that exist between about PA/AAs and nurses and allied health professionals (in relation to blurred scope of practice). The system has not been well prepared for recent changes, and uncertainty in relation to post-qualification development is making people nervous. It may be worth us working with other regulators to help address concerns and inappropriate behaviour.
HA noted the recent statements from some Royal Colleges which may presage a narrowing of the activities that PAs and AAs are allowed to do. Whilst this presents a risk for existing levels of service delivery, workforce deployment isn’t a matter for the GMC .
ACTION: HA/CB to flag to DHSC the budget pressure around programme communication in the current environment
[Other actions being developed and signed off via SMT]
AAPA Order update
- TA updated the Board on the AAPA Order. We do not expect to need to provide extensive further feedback to DHSC, beyond that already noted on initial assessment, revisions and appeals. RM agreed that we need to be proportionate and avoid giving detailed feedback across the board at this time. BJ noted some new concerns about the Standards wording.
Standards for PA/AA course providers
SE outlined the work carried out to produce an interim version of Promoting Excellence specifically for PAs and AAs so we can consult on this and reference it in education rules. GL added that the existing guidance and terminology are sufficiently generic to cover these professions with minor tweaks. The guidance will be titled: Standards for the Delivery of PA and AA Pre-Qualification Education.
Programme Board were informed that the next step for this document is Education and Standards DLT, after which it will be included in the wider rules package for sign off. Members supported the draft and noted:
a. It may be worth including a sentence about giving due regard to the training needs of other professions in the multi-disciplinary team and referencing GMP.
b. The guidance is high level and will also apply to apprenticeship courses, although some supplementary guidance may be needed - eg in relation to study leave.
c. Education colleagues are developing a package of work to respond to innovations in training delivery for both doctors and PAs which could result in changes to our standards and SC emphasised the importance of this.
ACTION: SE to notify Programme Board as to progress and also signpost to the standards for PA/AA curricula when these are available.
Approach to approval of PA/AA courses
GL explained the work undertaken and the decisions of E&S DLT in relation to the process for approving existing PA and AA courses:
a. To qualify for approval, courses must have satisfactorily engaged with the QA process plus met five additional criteria. If they don’t, approval can be deferred.
b. We plan to ‘bulk approve’ satisfactory PA/AA courses in one in spring 2025 to avoid unfairly advantaging or disadvantaging particular courses.
c. The decision on who can approve courses for the GMC has been delayed until the legal framework on appealing decisions has been established, but the team has set out some expectations around who could be the approver.
d. Decisions are needed on when and how to explain the approval process to courses and students.
GL invited questions and views on the terminology ‘bulk approval’ which isn’t ideal.
CB asked whether courses will need to wait for at least one cohort to graduate after the start of regulation before they can be approved. GL clarified that this wasn’t necessary if they have graduated students in the past and are engaging with the QA process.
CB also questioned the delay in deciding who the approver should be. PC explained that we are waiting for clarity on the legislation and rules before making decisions in relation to PAs and AAs. Options being considered including assistant registrars. SC emphasised the importance of consistency in the approval mechanism for our professions in terms of parity of esteem.
HA felt the process was sound but messaging would be important to avoid inaccurate perceptions that courses that aren’t ready at the cut-off point for the first round of approvals are necessarily of poor quality.
SM agreed we should reconsider the term ‘bulk approval’ and have a separate conversation about communications for this piece of work.
ACTION: PC/GL to liaise with MAPs Comms colleagues to discuss communications approach for the approvals process, including potential alternative terminology for initial ‘bulk’ approval.
- There was no other business. The next Programme Board meeting is 21st November.