AC-2024-LON-003354 - [2025] EWHC 2270 (Admin)

Supervision

GMP Domain 3 (‘Colleagues, culture and safety’) includes the following principles:

Further detailed guidance on supervision and delegation is set out in Leadership and management and Delegation and referral – professional standards, both updated on 13 December 2024. The guidance provides high-level advice for doctors and associates on delegation of tasks and responsibilities which echo the principles in GMP.

In “Guidance on PAs and AAs in practice” (published 16 December 2024), under the section Clinical Governance the defendant explains that:

“effective clinical governance systems are vital to make sure that PAs and AAs are properly and safely deployed.  Organisations that employ PAs and AAs should make sure their governance arrangements take into account that these professionals are trained and will be registered on the basis that they will always work under supervision. We recommend that organisations identify an individual at board level who is responsible for PAs and AAs and that local processes are established governing how these professionals are deployed and supervised”.

In the same document, under “Supervision” the defendant says:

“Our clinical governance handbook sets out our expectation that organisations who employ PAs and AAs should make appropriate arrangements for their deployment and supervision….Many doctors already supervise colleagues or lead multi-disciplinary teams that include PAs and AAs. When it comes to good supervision, there isn’t a one-size fits all approach. PAs, AAs and their named supervisors should agree a level of supervision appropriate to each individual’s skill level, experience, role and the nature of the task.

We recommend that organisations identify an individual at board level who is responsible for PAs and AAs and that local processes are established governing how these professionals are deployed and supervised. The aim of these processes should be to ensure high quality, safe care, and to support effective multi-disciplinary working.

On 24 April 2025, the defendant published “Supervision Practice Advice” on its online Ethical Hub. This is advice for doctors produced outside the suite of materials consulted upon as part of the changes to GMP. The Advice states that it ‘does not set new professional standards and is not intended to replace the formal guidance’; instead, it serves to draw together and signpost different resources to assist doctors.

The Supervision Practice Advice identifies the role of the ‘named supervisor’ to an associate. For PAs the named supervisor (usually a senior doctor or consultant) “will have a clear understanding of their competences, skills and experience. If the named supervisor is not working directly with the PA themselves they will work with the PA to communicate this to the doctor who is responsible for overseeing the care of patients. This will enable that doctor to make sure all members of the team are working together.”

For AAs, the named supervisor “will determine the range of activities an AA can do and with what level of supervision. This may be modelled on the supervisory approach set out by the Royal College of Anaesthetists in .. their Anaesthesia Associate Interim Scope of Practice 2024.”

The Supervision Practice Advice anticipates that the associate’s named supervisor will be the doctor responsible for the patient’s day to day care. The document also provides guidance to those doctors who are overseeing the clinical work of an associate but who are not the named supervisor. It sets out that that doctor will need to be aware of the range of tasks and the extent of the competence of the associate and ensure that there is the appropriate level of supervision. The doctor is referred to the:

“.. knowledge and skills expected at qualification… the job description which will outline what they are able to do and what knowledge, skills and experience is required for the post they undertake”. It continues “ more experienced PAs and AAs may have extended their safe scope of practice beyond this level shaped by their supervised training and experience and the clinical context of their work. Some royal colleges and PA and AA professional bodies have published interim guidance on post-qualification scope of practice Though there is no set consensus you may find them helpful as a starting point. The Leng Review is also likely to make recommendations in this area later in 2025.”

The Supervision Practice Adviceemphasises that associates are not able to work completely independently of supervision, that they cannot work as a sole practitioner or in settings where doctors are not present. The guidance draws attention to non-statutory guides from various Royal Colleges.