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Anaesthesia Associates and Physician Associates Order 2024

My Lords, I declare my interest as the chair of the General Dental Council. It is not for me to comment extensively on matters affecting a fellow healthcare professional regulator, but I will say one thing directly in response to what the noble Lord, Lord Lansley, said about the substance of the order. Unlike the GMC, the GDC is responsible for all dental professionals, including dentists, dental nurses, dental technicians and so on in the four nations of the UK. I believe that it is helpful to the public to be assured that all the professionals they encounter when they enter a dental surgery will be registered as professionals by the same regulator and that they will have equal levels of assurance about the training and standards they can expect—and within a framework that indicates what the limits are of each of their professional responsibilities, what can and cannot be done, and how they are appropriately supervised.

My reason for intervening, however, is separate. The DHSC has made it clear that this order is the first step in the reform of the way that all the healthcare professionals are to be regulated. Indeed, it told the Secondary Legislation Scrutiny Committee that the intent is to provide all regulators with “broadly equivalent powers”. While the GDC is some way down the queue—it is after the NMC, the Health and Care Professions Council and so on; although it is still helpful to get in early—this is potentially a template that will apply to all the regulated professions.

I make it clear that regulatory reform is welcome and long overdue. The GDC’s framework was set out in the Dentists Act 1984—that legislation is 40 years old, with only limited updating since then; somehow, the GMC is slightly more prominent and gets more updating than some of the other professions. The Government first consulted about the scope of reform in 2017, following Law Commission recommendations three years earlier. It has taken a decade to get even to this stage, and we are still a very long way off from orders being prepared to cover the dental professions. By the time the orders for all the other professionals are agreed, the model in today’s order may be outdated.

The GDC welcomes the intention to give the regulatory bodies more authority to update their procedures and processes without recourse to Privy Council approval and the delays inherent in waiting for the DHSC to draft regulations and lay them before Parliament. Such updating would of course be subject to full consultation in each case by the regulators concerned and would be only in the framework laid out in orders such as the one we are debating. We need such reforms to enable regulators to operate as effectively as possible to protect the public better in the light of changes in the way the professions deliver their services.

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My concern, therefore, is whether tonight’s order is going to be a rigid framework for all subsequent orders. Is the template used here for anaesthesia and physician associates going to be used for nurses, midwives and dentists, as well as all the other healthcare professionals? One size will not fit all. Differences between the various healthcare contexts lead to different sorts of public protection risks, and that must be reflected in the way in which the different regulators regulate.

I will give three examples. First, in the order there is quite properly a requirement for periodic revalidation, but that will be different for associates covered by this order operating in a medical setting, often as part of larger organisations with well-developed clinical governance mechanisms, from what it would be for dental professionals, for example, many of whom work in single-handed practices or exclusively in private care. A different approach to revalidation and continuous professional development will be necessary, and that will need to be reflected in the framework laid down by a future order.

Secondly, those different ways of working also apply in terms of complaints and fitness-to-practise concerns. Associates, and indeed most doctors and nurses, will mostly be subject to existing complaint resolution processes handled via the NHS. Fitness to practise is a separate mechanism for them that comes into play often after those complaints have been through an NHS process, but such arrangements will need to be designed differently for most primary care dentistry that may well be outside the NHS.

Thirdly, the order says an offence is committed by someone who uses the title of anaesthesia or physician associate with the intent to deceive. At the moment, for dental professionals this is a strict liability offence. Maybe it is possible—although, having listened to the noble Lord, Lord Winston, I doubt it—for someone to claim they are an anaesthesia associate without an intent to deceive, but I have to say it is difficult to see why and how that could apply to someone purporting to be doing that or, for that matter, to be a dentist. If this wording were used for a future GDC order, why impose an additional requirement of proving intent to deceive rather than leaving it as a strict liability offence?

The examples that I have given all relate to dentistry but, as well as the GDC and the GMC, there are eight other professional healthcare regulators, each of which will have examples of its own. My plea to the Minister is that the DHSC should not use this template without careful consideration of the very different circumstances of each of the other healthcare professions.

Lastly, can the Minister give an estimate of when we can expect to see a draft order covering dental professionals? That is urgent because the GDC is essentially using 40 year-old mechanisms and procedures that are no longer fit for purpose, and it is in a context where more and more new models of dental practice and cosmetic dentistry are emerging—for example, remote orthodontics, where professional oversight is ostensibly being provided remotely, or non-UK providers of services offering “initial consultations” in hotel

rooms. Such practices are affecting patient safety now, but the regulatory tools to address them do not yet exist. Flexibility is needed, and we cannot wait indefinitely for regulations to be brought forward.