Regulatory reform at the GDC

Our views on proposals to regulate anaesthesia associates and physician associates

The Government invited comments on proposals set out in, Regulating anaesthesia associates (AAs) and physician associates (PAs). The consultation is now closed.

The consultation included proposed legislation to provide the General Medical Council with the necessary powers to regulate AAs and PAs in the UK. The Department of Health and Social Care (DHSC) presented the proposed legislation as a template for future reform of all health and care professional regulators, including the GDC. For that reason, we have provided a detailed response to DHSC setting out our concerns about the proposals, which are summarised below.

The DHSC previously consulted on the principles and proposals for reform of health and care regulators from March to June 2021. Our response to the proposals set out in Regulating healthcare professionals, protecting the public, can be found on our website. The DHSC published an analysis of the consultation results and its response in February 2023.

For some years we have been calling for reform, to unlock the prescriptive and outdated legislation under which we currently operate. Our legislative framework continues to limit our ability to respond to changes in dental practice, and to operate an efficient, effective, and proportionate regulatory system. We need a modernised and flexible legal framework that ensures effective regulation today and remains fit for the future.

We have welcomed the intent to introduce flexibility into the legislative framework, to ensure regulators can adapt to meet the changing needs of patients and dental professionals and drive improvements across regulatory functions. However, we have a range of concerns relating to the reform proposals included in the consultation.

Our concerns relating to the overall reform programme:

There continues to be no indicative timetable for reform of the Dentists Act, meaning that reform for the GDC is at least several years away.
There are multiple areas where the stated policy intent has not been effectively translated into legislation.
The drive for consistency between regulators risks leaving little room for differences between regulators or bespoke approaches to allow for the unique features of the dental sector.

Our key concerns on the proposals set out in the consultation:

There is no legal basis to make rules for the “initial assessment” stage of fitness to practise, which could mean that we have to refer every concern raised to a case examiner for an investigation (Part 4 Fitness to Practise, Article 9) (consultation Q12).
Under these proposals, the standards which professionals would have to meet to register with us have been conflated with standards for the quality of dental education and training and standards for maintenance of registration. There is also a lack of clarity around new registration standards for performance, conduct and ethics, and how these could be assessed (Part 3 Registration, Article 6(2)(c)(i)) (consultation Q4).
Proposals to reduce the grounds for impairment in fitness to practise could lead to risks. For example, we may be prevented from being able to consider the potential for future harm when concerns are raised. Further, our ability to manage health cases appropriately would be reduced (Part 1 General, Article 2(2)(a)) (consultation Q13).
Proposals on fee setting may compromise our financial independence, and could lead to highly variable fees from year to year and result in uncertainty for fee payers (Schedule 4 Rule-making powers), Paragraph 7(2)) (consultation Q29).
The need to demonstrate an “intent to deceive” as opposed to our current “strict liability” approach to illegal practice offences would make it more difficult and more expensive to prosecute those who may be putting the public at risk (Part 6 Miscellaneous, Article 14) (consultation Q20).
Proposals for reviews of decisions and appeals are overly complicated, which could lead to needlessly lengthy or costly appeals. Moreover, the proposals do not provide for the variation in processes needed to challenge decisions associated with different regulatory functions, which could result in disproportionate outcomes (Part 5 Revisions and appeals, Articles 11-12) (consultation Q17-19).

Some of our other concerns relating to the proposals:

The proposed approach to ongoing assurance of registrants, or how to ensure registrants’ skills and knowledge are kept up to date, appears to be based on the revalidation model, which narrows the options available to health and care regulators and registrants (Schedule 3 Evidence gathering, notifications, publication and data, Paragraph 7) (consultation Q25).
The proposals for “conditional registration” (which does not refer to fitness to practise sanctions) are meant to enable provisional registration processes. However, they are unworkable as they do not provide a way for registrants who do not comply with conditions to be removed from the register (Part 3 The register, Article 7) (consultation Q8).
There is a need for clarity around requirements for the approval of international education and training leading to registration. This includes a need to remove conflicts with other relevant legislation, such as the Professional Qualifications Act, which could later pose barriers to our international registration improvement work (Part 2 Standards and approvals, Article 4, and Part 1 General, Article 2 Interpretation, “approved qualifications”) (consultation Q1-3).

You can find our full response to the consultation on our website.