healthcare

Physician and Anaesthesia Associates: Delegation, Informed Consent, and Montgomery in the Administrative Court

26 September 2025 by Guest Contributor

By Kian Leong Tan

INTRODUCTION

In R (Anaesthetists United Ltd and Others) v General Medical Council [2025] EWHC 2270 (Admin) (“Anaesthetists United”), Mrs Justice Lambert dismissed a judicial review claim brought by the claimants against the defendant regulator for Physician Associates (“PAs”) and Anaesthesia Associates (“AAs”) – collectively referred to hereafter as “Associates” – in the UK.

The claim is the most recent instalment in a brewing saga over the continued use and regulation of Associates in the UK’s healthcare system:

• In April 2025, Lambert J dismissed the British Medical Association (“BMA”)’s judicial review challenge (R (British Medical Association v General Medical Council [2025] EWHC 960 (Admin)) to the GMC’s decisions to (i) apply the same basic professional standards to doctors and Associates, and (ii) refer to all three professions collectively as ‘medical professionals’.
• Just prior to the handing down of Anaesthetists United, Professor Gillian Leng released her final report following the conclusion of her independent review into the Associate professions.

Should there be a statutory public inquiry into the murders and attempted murders by Lucy Letby?

23 August 2023 by Peter Skelton KC

Why wasn’t Lucy Letby stopped sooner? This is the burning question that the families of her victims, and the public, are now asking. Steve Barclay, the Health Secretary, has decided that the best means of answering it is a ‘non-statutory public inquiry’. But what is such an inquiry, and will it be better than a full-blown statutory public inquiry?

Non-statutory inquiries can be set up by anyone, at any time, to investigate anything.  They proceed in private and have no legal powers to demand the disclosure of documents or to call witnesses to give evidence. But they have the twin merits of speed and informality. The former may be very valuable, particularly where urgent changes are needed. The latter can facilitate a greater degree of candour about errors that have been made, as witnesses feel less pressure than they do in the full glare of public scrutiny. But such inquiries are entirely reliant on organisations and individuals to assist them. This cannot be guaranteed, particularly where livelihoods, reputations, and even freedoms, are at stake. So they may fail where this doesn’t happen. 

Non-statutory inquiries also don’t always give victims, their families, and the public, the assurances they need that the Government understands the gravity of what has happened. An example of this is non-statutory inquiry into the horrific abuse perpetrated by David Fuller – who sexually assaulted many dead bodies that were supposedly safe in a hospital mortuary. Ordered by the then Health Secretary, Sajid Javid, on 8^th November 2021, its proceedings have been entirely behind closed doors and it has yet to report almost two years on.

Unpublished policy and unlawful detention: a case note on R (MXK) v Secretary of State for the Home Department

29 June 2023 by Lance Baynham

In R (MXK) v Secretary of State for the Home Department [2023] EWHC 1272 (Admin), the Administrative Court held that:

1. the repeated detention of the claimants – foreign nationals with limited leave to remain – when they returned to the UK from travelling abroad, so that they could be questioned about their NHS debts, was unlawful;
2. the policy pursuant to which the claimants were detained (the “Policy”) was unlawful because it contained a positive statement of law which was wrong or, alternatively, because it failed to provide a full account of the legal position;
3. the Policy was unlawful because it was unpublished; and
4. the Secretary of State for the Home Department (“SSHD”) was in breach of the public sector equality duty (“PSED”) under s.149 of the Equality Act 2010.

In reality, the facts carried the day. This was true not only in relation to the unlawful detention issue, but also on some other points – for example, the SSHD failed to evidence any public interest in not publishing the Policy or any consideration given to the equality impacts of the exercise of the relevant powers of detention. Insofar as there are lessons to be learned, they are likely to be found in the criticisms levelled at the evidence (or lack thereof) provided by the SSHD.