Final day Anaesthetists United in court today. Are the heavyweight blows on process rationality delivered by AU+BMA barristers invalid, as the GMC submits, since the grounds of the claim filed are limited to outcome rationality? Vital subject, AU solicitors letter began to address it:

This directly contradicts the GMC's submission on day 2 that they have high-level standards to address a PA in general practice overstepping RCGP guidance should a complaint be made they are doing so. Their approach is clearly not to use RCGP guidance in any practical sense.

The GMC pretended to be sincere that associates "are not doctors and cannot replace them". Now it says to the High Court that PAs working in general practice can be 1st point of contact for undifferentiated, undiagnosed patients. If that's not practising as a doctor, what is?

Judge: so college ScOP guidance is evidence of good practice in FtP proceedings? GMC barrister: yes But this contradicts other GMC submissions. Their position properly distilled is: an associate is free to do whatever they can competently do, to hell with the doctors' register

The judge in Anaesthetists United case asks why GMP doesn't just have a standard saying associates must explain they aren't medically qualified and aren't a doctor. The BMA Dr Melissa Ryan 🦀 probably can't believe their ears, but perhaps suggests some re-thinking has gone on...

This in particular from the GMC's AA/PA learning outcomes marries with GMP's standards on working within limits of competence to mean an associate is expressly permitted by the GMC to be supervised by a non-doctor:

The judge now makes a big deal about this, clearly concerned if/when it would come, asking for it to be dealt with in the oral submissions of the GMC so she can grapple with it in her judgment

The GMC submit at the High Court their resources are public-minded and if you google 'what are associates' you'll soon come across its webpages. Unfortunately, they removed index searching from their website to avoid scrutiny, so you'll never come across its pages by googling!

Funny moment for me in AU case today.. Judge: and I asked for what you had on the medical model GMC barrister (nervously): the medical model? Judge: yes GMC barrister: um..uh.. Judge: by which I mean the decision to regulate associates like doctors GMC barrister regains colour

Absolutely. The supervisor empowers, and so the supervisor falls. Did the GMC ever publicly release their real reasoning behind why doctor's fees are higher than associates?

The GMC has set a competency that PAs must be supervised by a doctor *or healthcare professional* This can only mean- •an employer may appoint a PA as supervisor of PA(s) if they see fit •a supervising doctor may set a PA's scope to supervise PA(s) •a supervising PA may.. etc

Secret Physician On a set of nights didn't realise senior in ED was an ACP until the point they asked for a CT abdo for ?perf/?malignancy. I asked them to repeat their exam & Hx with specific questions/pmhx fact finding - ended up doing CT mesenteric angio for ischaemia/angina which was proven.

Bored of legal nuance? Know this: fundamental to the case, AU's counsel yet again emphatically invited the judge to find the witness statements of the GMC's Director of Standards a load of implausible porky pies. By itself, a quite astonishing state of affairs...

Exclusive footage of Philip Banfield 💙 outside GMC headquarters Dr Melissa Ryan 🦀 The BMA

Not passing anyone's sniff test Found the 'source' from some policy tank called Nesta: media.nesta.org.uk/documents/calo… It doesn't say what Streeting claims and to be fair is quite clear about it, even before critically evaluating the modelling, data, assumptions etc

The @anaesunited case forced the GMC, very late on, to settle on a hand. It effectively said a supervising dr has the power to anoint an AA/PA a scope that constitutes that of a medical officer (s.47 Medical Act). I maintain this is unlawful, perhaps appealable? Dr Melissa Ryan 🦀