HSCS Committee 16/01/24

Roughly transcribed (there may be errors); links open to the Scottish Parliament TV website.

Alternative link (YouTube)

Committee members:
CH: Claire Haughey (Convener)
PS: Paul Sweeney (Deputy Convener)
SG: Dr Sandesh Gulhane
EH: Emma Harper
GM: Gillian MacKay
RM: Ruth Maguire
CM: Carol Mochan
IM: Ivan McKee
DT: David Torrance
TW: Tess White

Giving evidence:
MM: Michael Matheson, Cabinet Secretary for NHS Recovery, Health and Social Care
RC: Rachel Coutts, Scottish Government Legal Directorate, Food, Health and Social Care
NR: Nigel Robinson, Unit Head, Professional Healthcare Regulation, Chief Nursing Officer’s Directorate
SW: Scott Wood, Unit Head, Sponsorship and Infrastructure, Health Workforce Directorate, Scottish Government.

10:37:22 CH Our third item of business today is consideration of an Affirmative Instrument, Anesthesia Associates and Physician Associates Order 2024. The purpose of this instrument is to allow the statutory regulation of anesthesia associates and Physician Associates by the General Medical Council. It provides a framework for AA and PA regulation and establishes the powers and duties in relation to the GMC including the autonomy to set out the detail of its regulatory procedures in its rules.

The Delegated Powers and Law Reform Committee consider this instrument at its meeting on the 9th of January 2024 and made no recommendations in relation to this instrument. We will have an evidence session with the Cabinet Secretary for NHS Recovery, Health and Social Care and Supporting Officials on the instrument. Once we have all our questions answered, we will proceed to a formal debate on the motion and I welcome to the committee Michael Matheson, Cabinet Secretary for NHS Recovery, Health and Social Care Rachel Coutts, Scottish Government Legal Director at Food, Health and Social Care, Nigel Robinson, Unit Head Professional Health Regulation Chief Nursing Officers Director, and Scott Wood, Unit Head Sponsorship and Infrastructure Health Workforce Director, all from Scottish Government. I invite the Cabinet Secretary to make a brief opening statement.

10:38:46 MM Thank you, Convener.

This Statutory Instrument is first and foremost about patient safety.

Safe, effective and person-centered practice is the driving force behind how we deliver health care in Scotland and patients have right to know that they are being cared for by professionals with the appropriate level of assurance and accountability.

Convener, these rules have been practising across the UK for 20 years now and we cannot delay the regulation any longer. With numbers and skills continuing to grow, we must introduce consistent UK-wide standards supported by meaningful sanctions when those are not met.

This is also a significant stride in the road to meaningful reform of the regulation of health professionals, something I know that several of us around the table today will appreciate. In bringing these devolved professions into statute regulation, this order also brings the General Medical Council within the competence of the Parliament and therefore this committee for the first time. The regulatory landscape is complex and unwieldy, with each regulator operating within their own legislative framework. There is too much inconsistency and bureaucracy, which restricts the ability to swiftly adapt to the evolving demands on our health services without recourse to legislation.

This order is the culmination of years of collaborative working between the four governments of the UK and multiple public consultations.¹ As such, it is the first step towards a modern and flexible model of regulation, establishing the first generation of a framework that will ultimately apply consistently across the health professions. It requires the GMC to set up a register and to put in place processes around education and training, fitness to practice, offences and appeals for these roles.

However, I must acknowledge the pejorative commentary around these roles in recent weeks across both social and mainstream media. This relentless negativity has been detrimental to our Physician Associates and Anaesthesia Associates, and I hope that this statute regulation will promote respect for their contribution to our healthcare system.

It is important to note that while each of the Governments agree that regulation is necessary, decisions on their utilisation within NHS Scotland will be taken by Scottish ministers and based on what is best for the people of Scotland. A wider approach to the development of this workforce will be informed by our newly established MAPs Implementation Programme,² overseen by a Programme Board made up of a range of key partners.³ We expect that board to meet for the first time next month.

Thank you, Convener. Of course, I’m happy to respond to any questions the committee may have.

10:41:54 CH Thank you very much Cabinet Secretary for that opening statement. Before I begin, can I refer members to my Register of Interests and that I hold a bank staff nurse contract with the Greater Glasgow and Clyde NHS? I’m a registered mental health nurse, registered with the NMC.

Am I correct in thinking that these regulations follow on from a 2019 agreement with the UK Department of Health and Social Care, along with discussions with all the other devolved health departments about the GMC taking on this role of regulation of PAs and AAs?

10:42:28 MM Yes, it’s part of a long-standing piece of work we’ve been taking forward with the UK government and back in 2019, the then Cabinet Secretary for Health and Sports signaled an agreement with the UK government that we should bring forward legislation to regulate both AAs and PAs. However, there were issues around the wider regulatory framework which was part of that discussion which was about carrying out quite a significant review of the regulation of health care professionals and it was then viewed actually trying to do all at one time. It was not going to be effective, it was too complex and the decision was made to take the PA and AA aspect of regulation separately while the wider piece of work around health regulation was being considered separately, so that’s a separate piece of work and which is why this has been brought forward as a standalone order.

10:43:26 CH Thank you for that clarification and a welcome in your statement with regards to some of the commentary that there has been on health care professionals working as AAs and PAs.

Can I ask the Cabinet Secretary how he responds to some of the claims that having the GMC as regulator will add to confusion between doctors and PAs and AAs and how that can be mitigated?

10:43:54 MM I’ve heard some of the commentary around this. I don’t subscribe to it so we have a range of different health regulators that regulate a range of different professional groups. The idea of the GMC being able to take on the regulation of PAs and AAs in my view I don’t think will cause any confusion so long as there’s a very clear regulatory body responsible for dealing with any issues relating to PAs and AAs.

I’ve heard some of the commentary but I’m not persuaded by it given the fact that we’ve got a range of other regulators that cover other professional groups and in my basis I don’t see why that would be any different, why it would create any confusion for the GMC given that it doesn’t for other health regulators.

10:44:55 CH Can I ask if the Cabinet Secretary considered making the Health and Care Professionals Council, the HSPC regulator for PAs and AAs, if there was any consideration given to that and why you decided that the regulation of GMC as other parts of the UK would be more appropriate?

10:45:12 MM There was a consultation exercise on which regulatory body would be most appropriate for the regulation of them and a very significant majority of those that responded to the consultation said it was the GMC would be the most appropriate body to carry out that regulatory function. So the order is reflective of the feedback rate which is under 60% if I recall correctly.⁴ It believed that it should be the GMC should be responsible for the regulation in this area and therefore the order an approach has been taken by both the Scottish and UK governments is reflective of the feedback we received from that consultation exercise.

10:45:50 CM Thank you very much Cabinet Secretary, that’s very helpful. Sandesh Gulhane.

10:45:55 SG Thank you and just to clear my register of interest as a practicing and NHS GP.

I do agree with the expansion of the multi-disciplinary team we do need to ensure that we have appropriate staff but I am concerned about physicians associates and anaesthetic associates and so, a number of concerns.

My first is about confusion, and so why has the name changed from physicians assistants in 2003 to physicians associates in 2014 and why are we sticking with physicians associates?

10:46:30 MM Maybe I ask Nigel in terms of the history to back in 2003 why there was a change in the name at that particular point?

10:46:39 NR I think it’s important to note that a Physician Associate as a role arrived from America around about 20 years ago. They were they’ve been established for quite some time notably in NHS Grampian in partnership with Aberdeen University’s course. These courses have been running for that duration so we have a cohort of practitioners in place already who have they have attained accredited qualifications⁵ using that title and there are currently courses running using that title so there would be significant problems in retrospectively changing it and we believe that that would result in unacceptable delays to the further legislation to bring them into statute regulation which is absolutely necessary for patient safety.

10:47:29 SG Sorry they’re not regulated currently so if you’re creating legislation you can put any name you want.

10:47:38 NR We could, but not with this legislation this legislation would have to fall in this parliament and in the UK parliament and the whole process would have to start again we’re in it looks like we’re going through any UK election year so we would have no guarantee when we would actually be able to bring these these roles into statute regulation.

10:48:02 SG Okay and one of the things the BMA is telling us is that patients and their families are unaware in a lot of times whether they’ve been assessed by a doctor or not so following on from the question from the convener, seeing as the GMT regulate doctors getting them to regulate somebody else, wouldn’t that then add to that confusion?

10:48:32 MM I’ve heard this argument a few times I don’t quite follow it, so there are other professional regulatory bodies for example around pharmacy etc that actually cover not pharmacists they cover other groups or supplementary to pharmacy as well. I don’t follow this argument that in some way that by the GMC taking on the role of regulating PAs and AAs in some ways will cause public confusion around the role of the GMC.

If you’ve got a complaint to make about a PA or an AA or a doctor and the regulator is the GMC that’s responsible for doing that then you’ll take the complaint to them. I don’t follow this argument that for some reason that the GMC for some peculiar reason it will become really confusing if they regulate two other groups other than just doctors given other regulatory bodies do that and it doesn’t appear to cause any difficulty for the public in pursuing a complaint or pursuing an issue with the relevant regulatory body.

10:49:43 SG Okay and so can we talk about money? The cost of regulating a PA will be half of that of the cost of regulating a doctor and the government is putting money into subsidize this regulation process is that fair?

10:49:57 MM Yeah I think the process here is initially is to get the eventually it’ll be a self-funding model which will operate but this is a measure which will be for the initial couple of years in order to get the regulatory process up and running and as that workforce expands then it will be a self-funding model in the way in which most of the regulators now operate anyway.⁶ So yeah this is part of the initial process to support the GMC in taking on this regulatory role.

10:50:29 SG And in the cost of half of what it would cost to regulate a doctor?

10:50:33 MM I don’t know what the exact costs are associated with that for individuals. Yeah I don’t know what it is but it’s the the UK government have taken the decision that they’ll fund the GMC to support the GMC in the introduction of regulation around this and the regulation of PAs and AAs but eventually it will move to the normal self-funding model that all the regulators more or less operate to if not the majority of them.

10:50:58 SG Okay and if you’re going to regulate you need to have very tight definitions of what it is the profession is doing that you know there’s very tight definitions about nursing, about expanded roles, about what a doctor does. So with the scope of practice of an AA and a PA, 69% of respondents for a BMA survey said they were concerned that there had indeed been this expansion in the role to where it where that it really shouldn’t be and an example would be I’ve heard of the med reg bleep which is one of the most senior positions in a hospital being held by a physician’s associate. What is the scope of practice for a PA when it comes to the complaints procedure and that regulation?

10:51:52 MM So well they’re unregulated at the present moment so and the way in which we deal with them in Scotland would be with a very small cohort of around 150 operating within the NHS is that we issued direction back in 2016 around the type of role and the scope of the role within NHS Scotland⁷ so that’s already defined clearly is the GMC calling the regulatory function they’ll be responsible for setting out these definitions and in terms of those definitions as well going forward …

10:52:28 SG The GMC have said that is not their role and and in your in the the work that you put out you haven’t defined what supervision means.

10:52:36 MM So in terms of how we then use them within NHS Scotland will be determined by us and that will be the approach it will take through the group that I said to that will set up that will consider their role going forward. We’ve taken a very different approach which is part of I think the concerns that the BMA have flagged from the UK government in this matter where the use of PAs and AAs are a key part of their workforce plan going forward and the very, the proposed, fairly rapid expansion of their use has raised a lot of concerns and I understand that which is why we’ve taken a different approach here in Scotland and I’ve read outlined to the BMA is that we’re going to take much more of an incremental and it will better much be an evidence-based approach⁸ as to how PAs and AAs will be used within NHS Scotland and how they will be deployed within the NHS Scotland workforce and how they’ll be utilised, and that’s exactly part of the process that we put in place in order to manage that so we’re not intending to replicate the very rapid expanded that the UK government are applying within NHS England we are taking a much more evidence-based⁸ and a much more limited approach to how they’ll be used and how that will be defined.

10:53:50 SG Can I just be clear that you said you would have a are you doing work into that is that a program you’re setting up?

10:53:55 MM Yeah I mentioned it in my opening comments so we’ve set up the MAPs Implementation Program Group² which is a is a Program Board³ and that’s got key partners on it so from within NHS Scotland, Royal Colleges are involved in that in order to make sure that we’ve got a very clear implementation process for the use of PAs and AAs as you go forward as a regulated body and how they will be deployed and used within NHS Scotland, and I’ve also set out very clearly to the BMA the difference in the approach that we are taking with the UK government because I think a lot of the concerns that the UK government are sort of the BMA have around it is the way in which the UK government have taken issue of regulation around PAs and AAs and also how they’ve set out within their workforce plan which has conflated two issues and the approach we’re taking in Scotland’s a different one, it’ll be much more evidence-based⁸ it’ll be much more managed and it will also be very clearly defined in the role in the way in which they will be used within NHS Scotland.

10:54:59 CH Thank you. Carole Mochan.

10:55:05 CM Thank you Convener and it’s just quite a sort of perhaps more a sort of statement but obviously I totally agree in terms of regulation it’s really really important and actually to clear I was on the Healthcare Professions Council about about 15 years ago and they have very diverse group of professionals and they’re quite used to this sort of advanced role so I’m just interested to know was there a debate about whether they sat neatly on the GMC or the HCPC and because they are obviously very skilled in that sort of diverse role with these advanced practices as well.

10:55:38 MM Yeah just coming back to the answer I gave everyone there was a debate around it and it was part of the consultation it was carried out where we asked for feedback on which body would be the most appropriate to regulate PAs and AAs and the very clear majority just under 60% said it should be the GMC should be responsible for doing that.⁴

The GMC have also been very clear and they believe that they’re capable of actually carrying out that regulatory function as well and have already been putting in place arrangements to manage that process I think they gave evidence the committee and we’ve met with them and discussed that matter with them as well⁹ so I’ve got, you know, I used to be regulated by you know the Healthcare Professions Council and you know it regulates a whole range of bodies different professional groups of idea and I don’t think that it causes any confusion for the public so I think the idea of another regulator taking on a bit of additional regulatory work I don’t think causes great difficulty for the public to be able to understand.

10:56:45 CM Yeah no I mean it’s not that I disagree it was just of interest to know with that sort of diverse group already being as a you know a whole regulated body and if it made sense for them to go there I suppose was my question.

10:57:03 EH Thanks convener I’m going to declare an interest as well as a registered nurse and I worked with Physicians Assistants and Physicians now Physician Associates when I worked in a level one trauma center in California including anesthesia as well so I’ve been interested in following this and I’ve looked at a little bit at the like American perspective where in May 2021 the House of Delegates passed the resolution to formally name physicians associates as associates and I know there are issues where there’s concerns where during the training of physicians associates or anesthesia associates that it might impede the ability of junior doctors to find time for their training as well has that something that’s been considered so that we can allay I guess concerns that might impact the training of our junior doctors.

10:58:04 MM Yeah look I think that’s a very legitimate concern to be raised which is why as I mentioned to Dr Gulhane the the the measured approach that we are taking in the evidence-based approach we are taking to the use of PAs and AA’s going forward as well and where they will sit within NHS Scotland in our workforce development going forward.

Scott would consider a bit more about that because it is important that we make sure that the important training environment for our junior doctors is not compromised as a result of this but I believe that can all be managed if we do that in a proper programmed way with a very clear sense of where we see the role of PAs and AA’s and where they can help add value to our health care system. Scott do you want to say a bit more about that?

10:58:50 SW Of course thank you Cabinet Secretary, so ultimately investing in the PA and AA workforce should help us to create additional clinical capacity across the system and so liberate the time on the part of doctors that can then be invested in other activities including supporting high quality training opportunities for doctors in training.¹⁰ Now clearly we need to make sure that we are carefully planning any plans for future growth of PA and AA roles in order to ensure that there’s sufficient educational supervision capacity across the system in order to support those individuals alongside doctors in training and certainly that will be part of the discussion that takes place through the MAPs implementation program board that the Cabinet Secretary referred to a short while ago so we will be sure to ensure that any future plans around growth take account of the training needs of those doctors and training in the system as well.

10:59:39 EG Just another quick question it’s about the scope of practice of Anesthesia Associates for instance and so in my experience as an operating room nurse the anesthesia associates would anaesthetise patients that were pretty young fit healthy they didn’t have additional comorbidities they didn’t have out of control type 1 diabetes for instance so there was it was very structured in the scope of what they were allowed to anaesthetise patients for instance it was monitored anesthesia care it was it was it was quite limited and they would support consultant anesthetists in other sicker patients for instance so in in looking at this taken forward regulation after having 20 or 30 years of non-regulated work force this is about safety and about making sure that everybody understands the parameters of the scope of practice the Royal College of Physicians website says that there are over 40 specialties across primary, secondary and community care and they say the role of the Physician Associate is varied dynamic and versatile and that they’re medically trained generalists and that they’re health professionals so can I just ask you just to reiterate that this is about optimizing the safety of patients whatever they’re being looked after whether it’s in primary care or secondary care and in the community well?

11:01:16 MM Absolutely, so given the role that some of them play at the present moment and the need for us to have a statutory regulatory process in place so that’s why I said in my open statement that the heart of this is patient safety so it’s about accountability so for health care professionals in the role that they carry out and in the very important role that PAs and AAs play and you mentioned for example around anesthesia assistance and the role that they can play within the theater environment it’s important they’re also accountable for how how they manage that provision of course they carry out these things under medical supervision as well but it’s important that there is very clear lines of accountability and and responsibility that goes, go with that, so that’s all the more reason to why we need to get into a regulatory environment where we’ve got statutory regulation of the of these groups which I think is in both patients interests and I think it’s also in a wider health care system’s interests that they are properly regulated the role has been clearly defined and also very clear accountability for any decisions or actions that they take that they they should be able to account for in a way that other health care professionals are.

11:02:32 CH Okay thank you thanks. Paul Sweeney.

11:02:37 PS Thank you. I would just like to pick up on points raised by the association of anesthetists in response to our call for views on this matter. They highlight the issue of distinction of registration so whilst they welcome the different registration number the AAs and PAs will have to distinguish them from doctors under GMC registration numbers they’ve called for a separate register that’s distinct from doctors whether that be online or in print form this is ordered to provide absolute clarity for patients and others accessing the registers it is to protect everyone from accidental or deliberate misrepresentation there is no legitimate reason that this could not be done with modern information technology systems would the Cabinet Secretary be sympathetic with that perspective?

11:03:27 MM Yeah I understand their concern, I’ll ask Nige maybe to say a bit more in terms of just the practical application of the process and how the GMC might address some of these issues?

11:03:39 NR Yes in terms of the sort of modern IT infrastructure that you’ve mentioned it’s important to note that all this data will be held on a database by the GMC it will be in reality in one database it will be searchable according to the individual professions and the individual professions will have a slightly different alphanumeric format or a basis for their actual registration number so in reality it will appear to all intents and purposes to be separate registers.

11:04:12 PS Okay so if I were, say, searching for an individual I would, I could only search one doctor’s register and then I would have a separate web page to go into to search for Physicians Associates and these Anaesthetist Associates…

11:04:24 NR You would be able to filter, but this is this is work in progress and as a matter for the GMC as part of their broader program and how they actually bring these groups into regulation once the legislation’s in place because they can’t begin that process properly - their council can’t take those decisions - until they have the actual powers to do so.¹¹

11:04:48 PS Okay do you as a organisation have a role in discussing the specification of such matters with the GMC or does that matter entirely for the GMC?

11:04:57 NR It’s a matter for the GMC’s Council to make the final decisions but we do work closely with the GMC’s office in Edinburgh and also their headquarters in London.

11:05:04 MM Okay it’s worth adding that this now brings the GMC into the competence of the Scottish parliament which ultimately obviously could be accountable to the Parliament and to this Committee if it believes it’s not taking an approach which it believes is consistent with what they think is the right way to do things so it provides the committee with a direct route into the GMC in a way that hasn’t been there previously.

11:05:27 PS Yeah that’s certainly an interesting point you’ve raised Cabinet Secretary just also want to quickly raise the point of scope of practice also raised as a concern by the Association of Anesthetists; they highlight that there should be a national scope of practice for AAs both on their qualification and for any postgraduate extension of practice and any future changes to scope should be developed in conjunction with the regulator and should be agreed at a national level and that it shouldn’t be, for example individual health boards to determine that: would you agree that that’s an appropriate way forward, do you have anything to say on that matter?

11:06:00 MM So it’s part of the work that we’re looking for the national board to take forward Scott Wood to say a bit more about that but I think there is a need for us to make sure there’s a consistent approach introduced.

11:06:10 SW Absolutely, so scope of practice in relation to PAs and AAs it will be individual specific to the individual healthcare professional in question so it will take account of the the skills and knowledge that they’ve attained in the course of their initial training it will reflect any constraints or limitations associated with the role in which they’re deployed at a given point in time and finally, it will reflect the skills and experience that they’ve attained over the course of their careers in the form of continuing professional development, so in the case of PAs where we’ve heard of course that they can be deployed in a wide range of healthcare settings it’s hard to draw firm lines in terms of scope of practice that you need to create some flexibility that said we are very happy to look at what further guidance might be required exactly as the Cabinet Secretary described earlier on in his his comments in order to support organisations supervisors and PAs and AAs themselves to define that scope of practice.

Now, we already have guidance published by the Association of Anesthesia Associates around scope of practice to support those discussions at the moment and we understand that the Faculty of Physician Associates are currently considering producing similar guidance¹² so we’ll keep a close eye on the development of that guidance, keep it under review, and then we can consider what further action we need to take to supplement that in order to deliver the ones for Scotland approach to the deployment of these roles that we want to see for for NHS Scotland.

11:07:27 PS Okay I appreciate your comments, thank you.

11:07:33 CH Thank you, um can I thank the Cabinet Secretary and his officials for a answering the committee’s questions we now move to agenda item four which is the formal debate on the Affirmative Instrument on which we’ve just taken evidence. Cabinet Secretary can I now ask you to speak and move motions six one one six six eight.

11:07:51 MM I’ve nothing further to add convener but I’m happy to move the motion.

11:07:56 CH Thank you, can I remind the committee that members should not put questions to the Cabinet Secretary during the formal debate and officials may not speak in the debate, and I invite members who wish to contribute to make themselves known. Sandesh Gulhane.

11:08:16 SG Thank you convener I’m not sure if I need to declare my register of interest again but I shall do as a practicing NHS GP um, so I have met with the Association of Anesthetics, BMA, Scottish GMC on multiple occasions about Physicians Associates and Anaesthetic Associates and I have a number of concerns about the role and that’s really important when it comes to regulation because you can’t regulate someone or a body if you don’t know what their role and scope of practice is, so supervision level has not been defined: is it one-to-one? Is it two-to-one? Is it three-to-one? You know, and these numbers go on and you know Emma Harper in her questioning spoke of the tightly defined role of anesthetic associate in the US.

But let’s look at the two issues that we have here: the first is that those fit and healthy patients that Emma Harper spoke about are actually exactly the type of patients our junior doctors require to train because when you start off, you cannot start off on the really complicated patients: you need to start off on patients who are are fit and healthy and people that you can you can anaesthetise - obviously with supervision - but that’s really important. So it does impede training and potentially even more.

Also, here I have heard of Anaesthetic Associates anaesthetising children. I’m also concerned about how anesthetic consultants know how to supervise and what their rate their level of, um of of when something goes wrong, what their level of cover is when this happens, and they have never been trained on how to supervise anesthetic associates.

11:10:18 RM I’m just interested in Sandesh, you appear to be making an argument against Physicians Assistants and - I can’t say the word - AAs, shall I say, when we’ve heard that they’ve been practicing for for 20 years and that this Instrument is about regulation of those professionals. Can I just be clear: are you are you making an argument against us having those professionals in the system?

11:10:46 SG No. What I’m what I’m arguing is is yes this is about the role of regulation - of course regulation is important, it must occur - but you cannot regulate what you cannot define. So scope of practice is a very important part of that regulation and as is supervision level and scope of practice.

We know that there has been an expansion in what it is our PA’s and AA’s have been asked to do, and turning to PA’s, I know GP practices almost entirely running on Allied Health Professionals, thus saving the practice money but providing potentially a two-tier system and service to patients in remote and rural areas where they’re not going to be seeing doctors in the main, they’re going to be seen by others, and with that expansion of that PA role also from that point…

11:11:42 CH Is Sandesh Gulhane arguing against multi-disciplinary teams and not acknowledging the advanced practice that there is and specialties within nurses and AHPs to provide actually better and more appropriate care at times to patients in those practices?

11:12:05 SG No, and the work that I do with my MDT is absolutely vital: our pharmacists and our nurses, in fact I can tell you that my practice nurse handles diabetes better than I do because that is a lot of of what she does, but my argument is, you’re seeing an expansion in the roles of a PA which is which means that they are no longer looking to get doctors into that practice: they are expanding into the PA thus creating this dichotomy.

The last thing I’d like to say is I’ve also heard of reports of PA’s setting up privately saying that they can offer all the same services so if we can’t define the supervision level and we can’t define the scope of practice it’s very difficult to be able to regulate and these things have to be very tight and have to be defined in the same way that Emma Harper spoke about when we were talking about what happens in the US.

11:13:00 CH Thank you. Emma Harper.

11:13:03 EH Thank you Convener. I just want to clarify that like, in my experience in the US it was, it’s very regulated and and when I describe the fit and healthy patient you know the American Society of Anesthesiologists have an ASA Classification for fitness to um of patients to undergo anesthesia so it’s a classification one through four so that’s already in use in this country and we we use it and it’s been done like, it’s a long time since I worked in the operating theater for seven years, but um you know we we use this classification for junior doctors to be able to assess patients so that then they can have a registrar do an anesthesia um a surgery or a consultant for instance and then it allows an assessment of a patient through safety and everything like that so the scope of practice that they do they’re already working within a scope of practice and again this is one of the, you know, there’s lots of different specialties that if we’re talking about physicians uh associates um in the community or in GP practice or whatever I think what we need to be careful about is that this is about regulation where there has been an absence of regulation so that we can promote safety and um for patients no matter where where they’re working. You know, I’ve worked in areas of uh departments where you know care can be led by a team with lots of different people with different scope of job and everybody knows their role and and it works absolutely fine and ultimately in a team environment the the physician the surgeon who’s a consultant uh would have the the buck stops here um type of ability to direct the care so I, I am interested in the whole issue around supporting our PA’s and AA’s in order to practice and develop their scope and I don’t think we’re suggesting that the PA’s and AA’s are going to be calling themselves doctors

11:15:29 CH Thank you, Ms Harper. If that’s all the contributions from members, Cabinet Secretary would you like to sum up and respond to the debate?

11:15:40 MM Yeah, thank you Convener, and I’ve listened very closely to the issues that have been raised by uh members of the committee uh on this matter um I think ultimately we should keep in mind this is about helping to promote patient safety so for example the use of PA’s for example even PA’s setting themselves up in private practice are unregulated as it stands at the present moment my view is that they should be regulated I mean to be clear about the terms of that regulation as well I think it’s also worth keeping in mind is that most health regulators don’t operate in the basis of setting out scope of practice what they do is that they they supervise or they deal with issues in the basis of whether you were within the scope of your competence in the role that you actually had because people progress through their careers and get greater experience and understanding and as a result they should be operating within the scope of their competence at that particular point and that happens where across health care professionals uh in in how the regulatory process operates additionally aspects such as supervision are dependent again on someone’s scope of experience uh and the skills which they have someone who may move into a new area where they have got less experience and less knowledge maybe put on an increased level of supervision in order to achieve that experience and that knowledge so therefore the issue of I think this issue of scope of uh scope of practice is something which the regulators already deal with in terms of they deal with issues whether you go out with the scope of your your competence and your practice ability and supervision is is a very dynamic uh provision is very much dependent again on the environment and someone’s skills and their needs at that particular uh point and, you know, I know when I qualified my level of supervision was greater than it was as I moved through my career reflective of the experience and knowledge which you you build up in my regulatory body would expect that to happen um in terms of uh my competence and I also think the issue of the for example the use of things like PA’s etc within General Practice right now the for General Practice they’re outwith the scope of even the letter the direction that we’ve set as a Scottish Government⁷ because they can be directly employed by a GP practice to be deployed in a way that they see is most appropriate for their needs. We are not able to give any direction around that, in a way which we can within the NHS. As it stands, again, why they should be regulated so I think, a second sorry convener: I think the key thing here is that um is that there is a process been taken forward by the GMC uh in order to ensure that both PA’s and AA’s are appropriately regulated and I don’t think that it is in the interest of patient safety for these professional groups who are already with us and operating within our healthcare system to remain unregulated and in my view it will enhance patient safety and accountability by introducing this regulation which is why it’s critical that this order is passed today by the committee.

11:18:58 CH Thank you, Cabinet Secretary. The question is that motion S6M11668 be agreed to: are we all agreed? No we are not all agreed. I will call the division by inviting members to indicate in sequence by show of hands:

Those for the motion

Those against the motion

And any abstentions

11:19:47 CH Thank you, so the result of the vote is, for the motion eight, against the motion two and there were no abstentions. Thank you, and that concludes consideration of the Instrument at our next meeting we will be taking evidence on the draft funeral director code of practice 2024 from the minister for public health and women’s health and that concludes the public part of our meeting today.

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Questions for FOI