Consultation response
Commencement
We need to ensure that the commencement of the General Medical Council Order 2026 is managed in a safe and effective way that mitigates the risks of a regulatory gap during this transition.
A ‘coming into force date’ mechanism has been included for parts 2 to 10 of the draft order. However, we have not specified a date for when parts 2 to 10 come into force as per article 2(2)(b) of the draft order. Article 2(2)(b) relates to the coming into force of the majority of the provisions within the draft order.
Although a coming into force date for the General Medical Council Order 2026 would provide clarity, there would be advantages in allowing flexibility regarding when provisions are activated, in particular for areas involving transition of cases from the old framework to the new. This could be achieved by specifying dates in tertiary legislation – for example, to be made through a Privy Council Order.
Do you agree or disagree that a specific ‘coming into force’ date should be included in article 2(2)(b) of the final General Medical Council Order 2026?
Neither agree nor disagree
Please explain your answer. Do not include any personal information in your response.
As a patient body, Avma’s primary concern is that patient safety is protected during the transition period between the old framework and the new. We defer to the judgement of those with greater expertise as to which commencement arrangements are best applied to mitigate the risk of regulatory gaps.
Governance
Separate to annual report requirements relating to equality and diversity, the draft order contains the following for GMC relating to equality, diversity and inclusion:
- a duty to ensure that, in the exercise of its functions, it applies good practice in relation to equality and diversity,
- where it considers that an improvement may be required, a duty to take such steps as it considers appropriate to make that improvement, and
- a duty to have regard to any current or future principles set by PSA regarding equality, diversity and inclusion.
Do you agree or disagree with the inclusion of these requirements in the order?
Agree
Please explain your answer. Do not include any personal information in your response.
The inclusion of these requirements is entirely appropriate to maintain good practice, or any necessary improvements, around equality, diversity and inclusion.
Parts 2 to 4 of the draft order relate to GMC’s governance and operating functions. This includes provisions relating to:
- delegation of exercise of functions,
- disclosure of information,
- guidance,
- annual reports,
- fee setting and other financial requirements, and
- default powers of the Privy Council.
The provisions in these sections aim to improve the efficiency of GMC’s administrative functions, reducing bureaucracy.
Do you agree or disagree that the provisions set out in parts 2 to 4 of the draft order enable GMC to carry out its governance and operating framework functions appropriately?
Agree
Please explain your answer. Do not include any personal information in your response.
These arrangements are suitable. As a patient body, we particularly welcome Part 3, Articles 13 (Public Engagement) and 14 (Co-operation) that the GMC must have and publish arrangements for engaging with the public and appropriate co-operation with organisations.
Schedule 1 of the draft order includes provisions to enable GMC and MTS to effectively operate. It outlines how the GMC board may operate under the order, how committees may function and how adjudicatory bodies such as appeal panels may operate. It also puts a duty on GMC to appoint a registrar and case examiner or case examiners to exercise certain functions on behalf of GMC. In addition, the Privy Council must, by order, make further provision as to the constitution of the regulator.
Do you agree or disagree that the powers and duties in schedule 1 on constitution of the regulator are sufficient to enable GMC and MTS to carry out their functions appropriately and proportionately?
Agree
Please explain your answer. Do not include any personal information in your response.
The powers and duties in schedule 1 are sufficient.
The draft order proposes that the Privy Council’s default powers continue to apply (they are currently contained in section 50 of the Medical Act 1983). These are powers which the Privy Council may use if it feels that GMC has failed to carry out its regulatory functions. In relation to GMC’s rule-making powers in the draft order, the Privy Council will no longer be required to approve new rules or rule changes made by GMC under the draft order. However, should any future rules be deemed to require Privy Council approval, such approval will be put in place.
Do you agree or disagree that the powers and duties in the draft order in relation to the Privy Council are sufficient to support GMC to carry out its functions appropriately?
Agree
Please explain your answer. Do not include any personal information in your response.
These changes allow the GMC to operate efficiently. We support the retention of suitable oversight function from the Privy Council should it be found that the GMC has failed to carry out its regulatory functions.
PSA evidence gathering
The draft order, as per a recommendation of the Mann Review, provides for a consequential amendment to be made to the National Health Service Reform and Health Care Professions Act 2002 to allow PSA to have a power to compel information from GMC.
Do you agree or disagree that the draft order provides PSA with sufficient and proportionate evidence-gathering powers?
Agree
Please explain your answer. Do not include any personal information in your response.
As the regulator, it is entirely necessary and correct for the PSA to have powers to compel information from the GMC. We anticipate that members of the public would be unaware that such evidence-gathering powers are not already in place.
Education and training
The draft order sets out that GMC can approve overseas undergraduate, foundation and postgraduate education and training programmes.
Do you agree or disagree that GMC should be able to approve overseas undergraduate, foundation and postgraduate education and training programmes? This does not mean that people who take part in such overseas programmes would be given priority for places on the UK foundation programme or for speciality training in the UK, subject to a few limited exceptions in the Medical Training (Prioritisation) Act 2026.
Neither agree nor disagree
Please explain your answer. Do not include any personal information in your response.
It seems reasonable that the GMC should be able to approve overseas undergraduate foundation and postgraduate education and training programmes as fulfilling the curriculum and training needs and standards of doctors wishing to work in the UK, should there be thorough oversight and regular review. How far this would be useful to the GMC without overseeing the quality of education and training provided, and how far this work would improve the quality and standard of care received by UK patients is unclear. Should this be introduced, as a patient body, Avma would want to see the GMC establish a requirement that approved training education and training programmes include consideration of the need for harmed patients, including through understanding and application of the duty of candour.
Part 5 of the draft order relates to GMC’s education and training functions. This includes provisions relating to:
- standards in connection with practising as a regulated professional,
- approval of education and training, an examination or assessment or a qualification,
- supply and production of information and evidence,
- criminal offences,
- certification of completion of a course, and
- other related powers.
Our proposed changes aim to enable GMC to undertake more flexible and swifter education and training functions.
Do you agree or disagree that the powers and duties set out in the draft order enable GMC to carry out its education and training functions sufficiently and proportionately?
Agree
Please explain your answer. Do not include any personal information in your response.
The powers and orders set out in the draft order are sufficient.
Postgraduate Medical Education and Training Order of Council 2010
As a consequence of modernising GMC’s register and legislative framework, many of the current provisions contained within the Postgraduate Medical Education and Training Order of Council 2010 (‘the PMET Order’) will become obsolete.
The draft order therefore proposes that the PMET Order is revoked, including the list of recognised specialties currently contained in the schedule to the PMET Order, and the Privy Council is given a power to specify categories of speciality in practice in the UK in an order of council.
Do you agree or disagree that the PMET Order should be revoked and the categories of speciality in practice should be set out in a new order of council?
Don’t know
Registration
The draft order provides that medical practitioners may be able to be registered despite having a complete restriction on registration. This means they will be registered as a medical practitioner but not allowed to practise. A medical practitioner may choose to have a complete restriction on their registration, or a complete restriction could be, for example, the result of failing to complete periodic assessment.
Do you agree or disagree that doctors should be able to be registered with a complete restriction on registration?
Disagree
Please explain your answer. Do not include any personal information in your response.
As a charity with over forty years of expertise working with patients and families, we are aware of the potential for confusion around medical terminology and language. Avma is unconvinced that most patients, service users and families will understand the technical distinction between restriction and registration unless this is explicitly explained to them. While we recognise the benefit for doctors who currently hold registration only without a licence, applying a non-practising restriction will allow them to remain on the register, while making clear they can’t practise and aren’t required to take part in revalidation. It seems an unnecessary complication to register an individual with a complete restriction and is ripe for misunderstanding from the public. We also note that the draft legislation specifies that this restriction only applies to doctors. We think it’s important that there is a consistent approach for all three professions registered under the GMC.
Part 6 of the draft order relates to registration and includes provisions regarding the process of entering the register. It also includes provisions which enable GMC to provide assurance that individuals on its register have the necessary education, training, knowledge, skills and experience required to practise safely in the UK.
Do you agree or disagree that the draft order enables GMC to carry out its functions relating to registration sufficiently?
Agree
Please explain your answer. Do not include any personal information in your response.
The draft order enables GMC to carry out its functions relating to registration.
Protection of title
Protected title status means it is a criminal offence for someone to practise and use a protected title without being registered with the relevant regulator and on the relevant register, or part of the register, relating to that regulated profession.
The draft order proposes that the titles of ‘apothecary’ and ‘licentiate in medicine and surgery’ should no longer be protected in legislation as they are not reflective of current practice. It also proposes that the title of ‘bachelor of medicine’ should no longer be protected as this is linked to a qualification rather than a professional title.
Do you agree or disagree that the titles of ‘apothecary’, ‘licentiate in medicine and surgery’ and ‘bachelor of medicine’ should no longer be protected in legislation?
Agree
Please explain your answer. Do not include any personal information in your response.
These entirely outdated and antiquated language and terms are unhelpful to patients. They have the potential to cause confusion which increases the risk of safety breaches. Avma entirely supports the decision to no longer give these titles protected status in legislation.
Under the draft order, ‘registered medical practitioner’ is due to become a protected title.
Do you agree or disagree that ‘registered medical practitioner’ should become a protected title?
Neither agree nor disagree
Please explain your answer. Do not include any personal information in your response.
Avma advocates for clear communication with patients and families to avoid confusion which can contribute to patient safety issues. We are unsure how much awareness or understanding the public has of the term ‘registered medical practitioner’ and should it be introduced, we would encourage the DHSC to consider how they educate the public on what this term means so they can make informed decisions about their care and medical team.
In line with the recommendation of the Leng Review, the draft order proposes that ‘physician assistant’ replaces the title of ‘physician associate’, and ‘physician assistant’ becomes a protected title.
Do you agree or disagree that the title of ‘physician associate’ should be changed to ‘physician assistant’ and protected in law?
Agree
Please explain your answer. Do not include any personal information in your response.
The use of ‘assistant’ rather than ‘associate’ provides greater clarity for the public around the supportive nature of the role. It is important that patients, service users and families understand the difference between professional groups to avoid misunderstanding. Avma strongly believes that this change should be accompanied by the other recommendations from Professor Gillian Leng’s review which support public awareness including standardised clothing and lanyards and providing patients with clear information about the role.
In line with the recommendation of the Leng Review, the draft order proposes that ‘physician assistant in anaesthesia’ replaces the title of ‘anaesthesia associate’, and ‘physician assistant in anaesthesia’ becomes a protected title.
Do you agree or disagree that the title of ‘anaesthesia associate’ should be changed to ‘physician assistant in anaesthesia’ and protected in law?
Agree
Please explain your answer. Do not include any personal information in your response.
In line with our response above, Avma feels that the term ‘assistant’ provides greater clarity for patients, service users and families than ‘associate’. It is sensible to use the title ‘physician assistant’ consistently across the roles to help increase public understanding of the role and its function within wider team structures, adding ‘in anaesthesia’ as a qualifier for the specialism.
To allow time for the healthcare service to implement the new titles effectively, we are proposing that the protection of the ‘physician assistant’ and ‘physician assistant in anaesthesia’ titles will commence following a transition period of 6 months after the order comes into force, if approved by Parliament.
Do you agree or disagree that there should be a transition period in relation to moving from the associate titles to the assistant titles?
Neither agree nor disagree
Please explain your answer. Do not include any personal information in your response.
This is an internal management issue and as such we would expect the DHSC and GMC to make appropriate evidence-based decisions around the need for a transition period. However, as a patient body we would ask for full consideration be given to how any transition arrangements are communicated effectively with the public to assure clarity for patients.
Should there be any protection of the ‘physician associate’ and ‘anaesthesia associate’ titles alongside the proposed new titles?
Don’t know
Please explain your answer. Do not include any personal information in your response.
Again, it would be for the GMC and DHSC to judge the risk of individuals wrongfully using the outmoded titles. Public needs consistency and clarity so they can have trust in the teams delivering their care, and to limit opportunities for misunderstanding and confusion which can impact safety and quality of care.
Fitness to practise — mandatory removal from the register
The draft order requires GMC to mandatorily remove a registrant from its register, if the registrant has been convicted of a serious criminal offence, as set out in schedule 4 (known as a listed offence), without GMC having to investigate or MTS having to hold a fitness to practise panel hearing to determine whether the registrant’s fitness to practise is impaired.
Do you agree or disagree with the listed offences set out in schedule 4 of the draft order?
Agree
Please explain your answer. Do not include any personal information in your response. (Optional)
Avma fully supports the government and devolved governments’ determination that sexual assault, violence and misconduct is unacceptable within the health and care service. There must be clear expectations around professionals and the standards of behaviour to which they should adhere. The GMC / MTS should not have to waste time investigating registrants whose behaviours has fallen below these standards.
Under the draft order, former registrants of GMC who have been mandatorily removed from the register following conviction for a listed offence in schedule 4 of the draft order will not be able to apply for re-entry to the register.
Exceptions would apply where the conviction has been quashed or was for a lower-level listed offence (blackmail or extortion), and the custodial sentence has been quashed and replaced with a non-custodial sentence.
Do you agree or disagree that former registrants who have been mandatorily removed from the register following conviction for a listed offence should not be able to apply for re-entry to the register, save for in the limited exceptional circumstances prescribed in the draft order?
Agree
Please explain your answer. Do not include any personal information in your response. (Optional)
Avma acknowledges that the criminal justice system is based on a system of rehabilitation but with the proximity of the relationship between doctor and patient and the difficulty in policing the behaviour of sexual offenders, permanent exclusion is justified.
Patients and families have clear expectations from professionals in health and care settings; there is basic level of trust that must exist between patients and those that care for them. When these standards are not met, registrants should not expect to be able to reapply for re-entry onto the register. The limited exceptional circumstances around application for re-entry are suitable.
Fitness to practise — grounds for action
Grounds for action set out the basis on which regulators can investigate and take action where there is a concern about a regulated healthcare professional’s fitness to practise. A regulated professional’s fitness to practise can only be found to be impaired if one or more of the grounds for action are met.
The draft order proposes that the fitness to practise of a regulated professional may be impaired if the regulated professional:
- is unable to provide care to a sufficient standard,
- has behaved in a way which amounts to misconduct, or
- is adversely affected by a physical or mental health condition.
Do you agree or disagree with the grounds for action set out in the draft order?
Agree
Please explain your answer. Do not include any personal information in your response.
Avma agrees with these grounds for action. Impairment caused by physical or mental health conditions should be included given the potential risk to patients in such cases (and thus the requirement for GMC to be able to adequately assess such risk), but Avma fully supports the need for health cases to be managed with empathy.
Fitness to practise — proceedings
Fitness to practise proceedings are one of the primary ways by which GMC ensures public protection. The fitness to practise model outlined in the draft order aims to make fitness to practise proceedings swifter, fairer and less adversarial for GMC’s registrants and people who raise concerns.
Do you agree or disagree that the fitness to practise powers and duties set out in the draft order for GMC and MTS are sufficient and proportionate for the safe and effective regulation of the professions GMC regulates?
Disagree
Please explain your answer. Do not include any personal information in your response.
Avma represents the voice of harmed patients and their families and is therefore concerned that these proposals do not go far enough to ensure that the voices of patients and families are listened to, or fully consider the moral duty of the GMC to these individuals. Patients and families who come to the GMC have commonly gone through the complaints, investigation or even Court process before getting to the GMC. During these processes they would have been given the opportunity to have input and to be heard. The Accepted Disposals process makes no opportunity for a complainant voice to be heard, merely identifying them as one group which the GMC might inform of their decision. This lack of concern or routine inclusion of harmed patients is deeply disappointing, painting patients and families as an optional accessory to the fitness to proactive process, when they should be afforded the same rights as the individual under investigation. It will cause patients and their families to lose confidence in the investigation held by the GMC. Patients deserve to be central to decisions and discussion about their care, especially when harm has occurred.
We also have some concerns around the new fitness to practise model which will allow complaints about doctors to be resolved by case examiners employed by the regulators through the ‘accepted outcomes’ route rather than by a Panel. We understand the efficiency of this approach however there is a clear need for processes of this kind to be fully transparent and assurances provided so that they cannot result in ‘plea bargaining’ on the part of a registrant. It is essential that complainants and registrants are given parity of information, time and ability to give evidence, as well as matched routes to appeal decisions.
We do however note and welcome the removal of the 5-year rule preventing complaints over 5 years old from being investigated. This is an important positive step to ensure that patients and families can take appropriate action following harm at a pace that supports their psychological and physical wellbeing and healing, rather than an arbitrary cut off period. Especially where there are accusations of sexual misconduct, victims may not feel ready to make a complaint immediately or may not have the information they need to do so within the 5-year period.
Interim registration measures
Under the draft order, a fitness to practise panel’s powers will be extended so that the panel can impose interim registration measures during registration proceedings, as well as during fitness to practise proceedings.
This would allow the panel to impose an interim registration measure while investigating whether a register entry is fraudulent, for example.
Do you agree or disagree that a fitness to practise panel’s power should be extended so that it can impose an interim registration measure during registration proceedings as well as fitness to practise proceedings?
Agree
Please explain your answer. Do not include any personal information in your response.
As well as being more efficient, this measure could prevent unsafe registration thus limiting adverse patient safety outcomes.
Evidence gathering
Under the draft order, GMC may, for the purpose of gathering evidence in connection with registration, fitness to practise and interim registration measure proceedings, require a person to supply such information or produce such a document as GMC may specify. GMC will also be able to require a witness to attend a fitness to practise panel hearing or an appeal panel hearing.
Do you agree or disagree that the draft order provides GMC with sufficient and proportionate evidence-gathering powers?
Agree
Please explain your answer. Do not include any personal information in your response.
Avma supports the GMC’s need to gather and present thorough and sufficient evidence. However, in doing so, it is crucial that meaningful consideration is given to the impact and stress this could have on witnesses. In the case of Fitness to Practice hearings, witnesses may be patients and service users who have suffered avoidable harm, or their families. In these cases, individuals may be grieving or dealing with life-altering consequences of an avoidable healthcare harm. We would like to stress the importance of considering the needs of witnesses, including the means and methods used to communicate with them and the requirements made of them including the practicalities of travelling to a hearing.
Rule-making powers
Under the draft order, GMC is able to make rules on specific procedures in relation to:
- governance and operating framework,
- education and training,
- registration,
- fitness to practise,
- interim registration measures, and
- revision of decisions and internal appeals.
Do you agree or disagree that the rule-making powers in the draft order are sufficient and proportionate for the regulation of the professions GMC regulates?
Agree
Please explain your answer. Do not include any personal information in your response.
These powers are sufficient.
Revision of decisions
Under the draft order, GMC will be able to revise specific:
- registration decisions (except emergency registration decisions),
- fitness to practise decisions (except fitness to practise panel decisions), and
- case examiner interim registration measure review decisions.
Do you agree or disagree that the draft order provides GMC with sufficient and proportionate powers and duties in relation to revision of decisions?
Neither agree nor disagree
Please explain your answer. Do not include any personal information in your response.
Whilst Avma recognises that there will be occasions where a revision of a decision is required, there is a need for assurance that any revised decisions are clearly and considerately communicated not just to the registrant but also so those bringing a complaint and any witnesses involved as deserving of an update on that activity. Moreover, it will be crucial that the GMC is required to thoroughly evidence and explain revised decisions of this nature and the justification by which the revision has come about, to ensure that the public can be satisfied that crucial decisions around regulation are taken with adequate scrutiny and objectivity.
Appeals
Under the draft order, applicants for registration, registrants and former registrants of GMC will have rights of appeal against specific registration and fitness to practise decisions.
Do you agree or disagree that the powers in the draft order provide individuals with sufficient and proportionate appeal rights?
Disagree
Please explain your answer. Do not include any personal information in your response.
Avma acknowledges the rights of applicants, registrants and former registrants to appeal. It is however important to highlight that appeals have an impact on patients and families involved, and in the case of harm or bereavement, could be highly retraumatising. It is therefore crucial that adequate consideration and support is given to complainants and witnesses in these cases, that they are properly communicated with, and ultimately that enough patient protections are in place throughout this process. Additionally, sufficient judgement must be applied that appeals are not brought as vexatious activity, and additional sanctions applied if this is found to be the case.
Moreover, there should also be sufficient rights for people who raise concerns about a health professional but where an investigation is refused or no regulatory action is taken to (a) appeal to the registrar of the regulatory body and have the decision reviewed, and (b) if the registrar’s decision is considered unreasonable, request the Professional Standards Authority to review and them to have the power to challenge the decision.
Under the draft order, as per a recommendation of the Mann Review, GMC will have a right of appeal against specific interim registration measure decisions and fitness to practise decisions made by a fitness to practise panel to the:
- High Court of Justice in England and Wales,
- Court of Session in Scotland, and
- High Court in Northern Ireland.
Do you agree or disagree that GMC should have a right of appeal to these courts against specific interim registration measure and fitness to practise decisions made by a fitness to practise panel?
Agree
Please explain your answer. Do not include any personal information in your response.
Should processes fail or serious concerns about a decision come to light, it is necessary that a right of appeal is available to the GMC. Our earlier comments about transparency, including proper documentation and justification of activity, are applicable here.
Under the draft order, a consequential amendment will be made to the National Health Service Reform and Health Care Professions Act 2002 to allow PSA to appeal specific fitness to practise and interim registration measure decisions made by a fitness to practise panel to the:
- High Court of Justice in England and Wales,
- Court of Session in Scotland, and
- High Court in Northern Ireland.
Do you agree or disagree that PSA should be able to appeal specific fitness to practise decisions and interim registration measure decisions made by a fitness to practise panel to these courts?
Agree
Please explain your answer. Do not include any personal information in your response.
As the regulator of the GMC, it is important that they have the appropriate powers to appeal decisions should there be a failure of process. As outlined above, this should be properly documented with adequate oversight.
Under the draft order, GMC will be permitted to administer its own internal appeals function. Applicants for registration, registrants and former registrants will be able to appeal specific registration and fitness to practise decisions to an appeal panel of GMC.
Do you agree or disagree that the draft order provides GMC with sufficient and proportionate powers and duties to administer its appeals function?
Neither agree nor disagree
Please explain your answer. Do not include any personal information in your response.
Avma recognises and understand the efficiency of the GMC administering its own appeal function but have some concerns that this could undermine public confidence in the process. Our earlier comments regarding transparency and openness apply here.