Intended for healthcare professionals

Opinion Primary Colour

Helen Salisbury: Blurring the boundaries of the medical profession

BMJ 2024; 384 doi: (Published 28 February 2024) Cite this as: BMJ 2024;384:q494
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on X @HelenRSalisbury

The updated 2024 version of the General Medical Council’s guidance document Good Medical Practice came into force at the end of January.1 Previous versions were addressed solely to doctors, but this iteration is aimed at “medical professionals” including physician associates and anaesthetic associates. It seems sensible that these staff should be regulated and held to professional standards of conduct, but there is disagreement about which regulatory body should do this task. Legislation that will amend the 1983 Medical Act, and allow the GMC to fulfil this role, is now making its way through the Houses of Parliament. It is likely to pass into law, despite concerns tabled in the House of Lords.23

Until recently, the terms “medical professional,” “medical practitioner” and “doctor” were widely regarded as synonymous. Doctor cannot, of course, be a protected title as academics with PhDs are also doctors, although most would not leap to their feet if anyone called: “Is there a doctor in the house?” “Medical professional” now seems to have been repurposed to encompass a much wider group than simply medical doctors, which leaves “medical practitioner” as the only title that remains exclusive to the medical profession.

Bear with me, because here it starts to get a bit confusing. It seems an anaesthetic associate is a medical professional but not a member of the medical profession. A physician associate, although trained in “the medical model”4 and practising as a medical professional, is nevertheless not a medical practitioner. It feels as if we have gone through the looking glass to a world where, as Humpty Dumpty tells Alice, “When I use a word, it means just what I choose it to mean—neither more nor less.” “The question is,” says Alice, “whether you can make words mean so many different things.”5

When the GMC was set up, its role was to ensure that the public could be confident that anyone who called themselves a doctor really did hold a valid qualification. As it proudly proclaims on its website: “Persons requiring medical aid should be enabled to distinguish qualified from unqualified practitioners.”6 I wonder what the person on the street will believe about the qualifications of those who tell them they are medical professionals on the GMC register. I guess that most will assume they are fully qualified doctors, but, if the legal changes proceed as expected, they could just as well be a physician associate with two years of training.

The BMA and many of the doctors it represents are deeply concerned about this blurring of boundaries between doctors who hold a primary medical qualification and others who do not.7 Physician associates have already been put on doctor’s rotas and have been given (and used) prescribing rights in error, as employing hospital trusts contribute to this confusion.89

All agree that these new staff groups need regulation; the disagreement is about who should do it. Right now, many doctors are feeling battered by continuing pay erosion and the logistical nightmare of endless relocation for specialist training. This new version of Good Medical Practice, and the insistence that physician associates and anaesthetic associates are enrolled on the same medical register as doctors, adds insult to injury and leads some doctors to look back on their long professional journeys and ask themselves: “Was it really worth it?”