The draft GMC Order 2026 consultation just dropped. Buried in it is a fundamental change to who can be awarded a Certificate of Completion of Training (CCT).

This matters enormously. Let me explain why.

https://twitter.com/ramey999/status/2037265128773542001

2/ Currently, under s34L of the Medical Act 1983, a CCT can only be awarded to a registered medical practitioner who has completed an approved specialist or GP training programme. This is one of the statutory foundations of the specialist register.

1/ Now the embargo has lifted, I’ve had time to read the @lengreview in full. While some celebrate minor cosmetic wins, I see the formal entrenchment of a parallel, underqualified medical workforce — built without medical training. 2/ Yes, it recommends a name change to physician assistant, uniform clarity, and a supposed ban on "undifferentiated" patients. But these are caveated, partial, and don't touch the deeper structural concerns.

@NickTriggle I tried to reach out when I saw you were writing on this topic. It's unfortunate we didn't speak before publication. I have... corrections, to put it mildly.

bbc.co.uk/news/articles/… The opening story is emotive, but like many pro-PA articles, it leaves out the most crucial voice: the patients.

Did patients know they were being seen by non-doctors? Was it what they wanted? Were there any adverse outcomes? These are glaring omissions.

@StGeorgesUni was an early supporter of the PA project, launching the UK's first PA programme in 2008.

It now faces scrutiny following revelations from a 2023 revalidation report and FOI data by @drisunny.🧵 A concerning decision has been made to cut general medicine placements in Year 2 from 12 weeks to just 9, citing students found it “too difficult” (Revalidation Report, p. 6).

1/ A recent acquired Root Cause Analysis (RCA) sheds light on further critical safety issues surrounding Physician Associates (PAs) in the NHS. 2/ The case involved a PA administering intra-articular injections to the wrong patient. Fortunately, no harm occurred—but the investigation revealed alarming gaps in policy, supervision and practice.

(1/10) Another patient has died due to a PA.

Most concerned about PAs have probably heard of a few key cases already:

-Emily Chesterton, died following misdiagnosis of a PE

-Christopher Tucker, died in hospital following an inappropriate procedure & poor antibiotic management
-Ben Peters, died following a missed aortic dissection

-Susan Pollitt, died following an inappropriate and unwarranted procedure which led to a fatal infection

I have this morning written to @KateTerroni, new @CareQualityComm interim CEO, to request an update into the CQC investigation into Mr Tucker's death. I am told by Thames Valley Police that they have not had any update since reporting the case in May this year.

https://twitter.com/JanetEastham/status/1761524813653291286

Mr Tucker died of urosepsis following cystoscopy which multiple clinicians believe should not have been undertaken. Following FOI, @RBNHSFT case files showed that the PA and supervising consultant responsible for Mr Tucker's care were allowed to investigate the death themselves. The death was not reported to the Coroner.

I have been subjected to immense stress and threats to my livelihood due to vexatious police & GMC referrals by Mr Nash, the leader of a PA union-in-waiting, all of which have thankfully been dismissed. He has faced no consequences, leaving me anxious about what he might do next.

https://twitter.com/medicalmodelbri/status/1794671185244152304

As co-chair of DAUK, a doctors' campaign group, I uncovered serious issues with the physician associate role, which have been widely reported in the press. The medical profession is currently in uproar over this role.

Family of film make-up artist call for inquest after treatment by physician associate which led to death.

@JanetEastham @TheDA_UK @TheBMA

telegraph.co.uk/news/2024/02/2… Last month, Dr Janet Lippett, the trust’s CMO, told BBC Radio 4 that senior doctors “are always available for [PAs] to discuss cases” – and a hospital spokesman reiterated this “stringent supervision”.

The following piece in the @guardian paints a picture of PAs that is not fully accurate, based on our data. It is disappointing The Guardian did not seek a comment from @TheDA_UK before publication.

theguardian.com/society/2024/j… In our recent DAUK survey on MAPs, we received over 680 responses, uncovering significant concerns about the role of PAs in the NHS, including at the Royal Berkshire Trust.

Tomorrow, a crucial piece of legislation around healthcare will be scrutinised by MPs.

It will happen in a committee room, away from the main chambers, on a whisper.

If it passes, it will worsen the health of the UK population.

Did you know about it? No?

A thread 🧵 Physician Associates and Anaesthesia Associates are a relatively new role, which the Government is relying on to meet the aims of the Long Term Workforce Plan. Together, along with a smaller separate surgical role, they form a group called Medical Allied Professionals (MAPs).

There is an experiment within the NHS to reinvent what a clinician is. There is a move away from rigorous, academic and experienced doctors towards a new role, with shorter training, lesser standards and (presently) zero regulation. There is little clear evidence this is working, that it is definitively safe, and there are numerous examples of bad practice. Notably, 3 cases where people have died and the coroner drew concerns that these patients had not seen a doctor.