Marion and Brendan Chesterton are joining us in the legal action against the medical regulator, the GMC. Their daughter Emily died  of a blood clot on her lungs, as she was misdiagnosed by a Physician Associate she thought was a GP. They have accused the GMC of failing to distinguish between the role of doctors and non-doctors.

The BMA has kindly and generously agreed to fund our adverse costs. But we still need to raise funds to pay our own lawyers, who have had to put in many additional hours.

We don't know for certain how much we will need, but the cost is likely to be substantial. Please help us get there.

We would appreciate it if, after making a donation, if you could then share it Social Media to spread our reach.

It has been announced today in the Mail on Sunday that our legal case against the GMC has been joined by two families who have suffered tragic bereavements following care delivered by Physician Associates (PAs). Statements are being prepared in which both will give evidence to the Court.

These families have chosen to stand with us.  This is a significant development and underscores the gravity of the case. We extend our deepest sympathy to them for their loss, and we are grateful for their courage and bravery in stepping forwards. It is critical that everyone understands just what inadequate standards, supervision and lack of regulation can lead to.  

Please help us reach our fundraising target so we can ensure the case can be filed in court in the next few days. 

The Mail on Sunday piece is timely: it highlights the growing public concern over the devastating consequences of inadequate supervision, PAs and AAs (Anaesthetist Associates) not identifying themselves and explaining their roles and, most importantly of all, the lack of clearly understood and enforced limits on those roles - so when a patient needs a doctor, it is a doctor that sees them, not just a PA of AA. patient.

Documents retrieved by AU under Freedom of Information laws reveal 'really quite shocking' policies at local level, according to AU's senior solicitor, who was quoted in the Mail article  . They show AAs are being allowed to sedate patients, including children, without direct supervision from a doctor.

Our legal case demands change. It demands that the GMC takes responsibility - which is what we believe Parliament intended when it gave the GMC the power to regulate PAs and AAs. We want to close the alarming gaps in regulation - gaps that allow PAs to operate in critical situations without defined standards. Gaps that fail to define lawful practice measures. And gaps which have led to tragedy.

It is as remarkable as it is regrettable that the GMC sees things so differently. Charlie Massey, the GMC CEO and a government appointee, made many assurances to the Chesterton family at a meeting on 17 July 2024 about the way regulation would be introduced. 

Hoodwinked

Speaking to the Mail on Sunday Marion Chesterton said "During our meeting Mr Massey agreed with more or less everything I said we wanted to achieve and the fact that patient safety should be paramount. At the end he looked at me and said 'I promise you, no more Emily's. We came away very reassured that the kind of regulation we wanted would be in place....But now, having seen from legal letters that proper regulation isn't going to be sorted, I wonder whether we were being a bit placed, a bit hoodwinked". 

Mr Massey’s assurances have been flatly contradicted by the GMC’s own lawyer in their reply to our own lawyers’ detailed letter. As the GMC is refusing mediation, we and the Chestertons must now put our concerns directly to the High Court. We are renewing our call to those who share our concerns for the funds we need. 

Our legal action is not only for those already affected but also to protect the safety and wellbeing of future patients in the NHS. Nobody else should be put at risk by the failure of the GMC to set and enforce standards.

Anaesthetists United has brought doctors, patients and the public together. But taking on a legal challenge of this magnitude comes with substantial costs. We are relying on the generosity of the public. Every donation, large or small, will go towards holding the GMC to account, getting it to discharge its duties as a regulator rather than evading them, and preventing further harm.

Our latest video - featuring Helen Salisbury and Richard Marks - explains why we are taking this action. Please share with friends and family.

We have to reach £200k in the next few weeks - and it would be a tragedy for something as important as this to fail through lack of support.

The GMC’s response to our Letter Before Action is a disgrace - a blatant evasion of responsibility. What AAs and PAs can safely do, whether patients are to be told they are not being treated by doctors and the specifics of supervision are, in their view, nothing to do with them. This is just unacceptable. Please donate now so we can put our arguments to the High Court

Our lawyers think we have a solid case to challenge this.  It remains vital for promoting patient safety, and may be the last chance the country gets to define the lines separating doctors from Associates.  But the harsh reality is that we need to raise £200,000 immediately to continue this battle. We’re asking for your help - right now - through CrowdJustice.

The GMC’s response to our Letter Before Action is infuriating, for both what it says and its silence on so many of the important issues we have raised.

To start with, it says nothing about patient care even in the face of concerns raised by a coroner  following a patient death involving PA care.  Instead, it starts with nitpicking details from the Human Rights Act, argues about the timing of the claim (despite the fact that regulation hasn’t actually started and their own consultation on it remains unpublished) and then attempts to justify their refusal to set scope of practice for Associates by playing word games with ‘standards’.

What are we asking for?

There should be standards defining what Associates can and cannot do; safe and legal practice measures. To us that seems very obvious.

Other bodies, especially the Medical Royal Colleges, can of course issue their own guidance on scope of practice. But these are meaningless because they have no regulatory or statutory authority. Many hospitals are openly and brazenly overriding College guidance. And the Royal Colleges have no real disciplinary powers over them.

The law that introduced regulation for Associates places a duty on the GMC to set standards, including standards for performance. Only the GMC doesn’t want to do that, because their paymasters - the Department of Health and Social Care (DHSC) - want to blur the distinction between doctors and Associates as much as they can.

The GMCs defence

Their defence hinges on twisting words. The law requires the GMC to set standards for Associates. They have decided that ‘standards’ means ‘a standard’. A standard is something reached for and then attained, after which AAs and PAs have free reign. They say that prohibiting an AA or PA from undertaking certain kinds of work, however unsafe that might be for patients, would be a ‘limit’ rather than a ‘standard’, and so nothing to do with them.

They continue “The fact that ‘standards’ …refers to expected level of attainment and conduct is evident from the word itself”.

This is, of course, an artificial distinction. There are plenty of other limits that are set; a standard and a limit are simply two sides of the same coin. ‘Setting a standard’ means setting a pattern or model that is generally accepted, a level of quality. The legal duty for the GMC to set standards of performance for AAs and PAs means what it says on the tin.

Evading their responsibility

At the heart of the problem is the worrying conclusion that if the GMC does not set limits on Associate practice then there is nobody else with the authority to do so. And they are failing to address this situation in any way.

Patient Consent to treatment

On the issue of  patient consent, they write “There is no duty on a healthcare professional to give the patient details of their own qualifications or experience.” This neatly ignores their own advice on informed consent stating that patients “should be told the roles of key people involved in their care.”

Specific aspects of patient care

In a presentation to the House of Lords, the GMC and DHSC claimed that Associates deliver “specific aspects of patient care”. We asked them what those were. They refused to answer because they claimed it was a trick question; forcing them to admit that these ‘specific aspects’ actually exist.

Ensuring that AAs and PAs are properly supervised

They now say that supervision is, in fact, the doctor's problem.  Nothing to do with regulation of PAs. The doctors can be the fall-guys here. How convenient for the GMC that will be.

The expectation of what Regulation would mean

Regulation has been under development for a long time, and various assurances were given during the consultations as to what it would involve.  The GMC now claims that this information should not be admissible in court.

The coroners case

Recently a coroner asked the GMC about a national scope of practice. We asked them what their response was going to be. They refused to answer, saying it would be inappropriate to pre-empt their own reply.

But it comes down to money

We think their arguments are no answer to our claim. There is a compelling public interest for the High Court to decide what protection the public can expect from the GMC as the regulator of AAs and PAs - if anything.  

But now we have to raise the funds to make that happen.  We are incredibly grateful to those that have given so far. But we cannot get to the next stage without £200,000, and we need it soon. 

We have spent almost £78,000 so far to prepare our case. We need, in addition, an estimated £60,000 towards potential adverse costs up to the permission stage, a £25,000 cushion for contingencies, and then VAT on top - bringing the total to £200,000. 

If we proceed to a court hearing we will need to raise more funds after that, and we estimate that will be around £500,000. We could reach that easily if just 5000 doctors donated £100 today. And more smaller donations will really help.

The legal costs could be significantly reduced if the GMC agreed to ADR (mediation). But they have stubbornly refused to do this. The only way our concerns can now be resolved conclusively is by putting them to a judge. 

This is everybody’s struggle. All of us that work in healthcare, and all of those that receive care, have a stake in this. Our case is strong;  please help us protect the standards of UK medicine.

Most sensible people would think that, faced with a serious legal claim about the public interest in robust regulation of  new professions whose work inevitably involves risks to patients, a regulator would be willing to discuss it and try and find a compromise.

Not the GMC.

The GMC’s lawyers have written to us to say they will not have any discussions in an independent mediation process about our case.

This is not helpful. Their attitude is ‘put up or shut up’- in other words we should give up our fight for proper regulation and patient safety or take it to court. We will know just how intransigent the GNC is tomorrow when it responds to our lawyers’ letter.

It is very likely we will then need your urgent help to make our legal challenge possible.

Yet at the heart of our case is a very simple question that could be answered very quickly – including in the mediation process the GMC will not agree to.

In their email they wrote:-

We recognise the importance of parties attempting alternative dispute resolution (‘ADR’) [mediation], where appropriate, before resorting to litigation.  However, we do not consider that this would be an appropriate case for ADR, whether in the form you propose or any other form. That is because the remedy you are seeking, in the litigation and presumably in the ADR too, is for the GMC to do something it considers that it should not do – i.e. create guidance on safe and effective practice for Anaesthesia Associates (’AAs’) and Physician Associates (’PAs’). The GMC is not the appropriate body to create such guidance. The medical royal colleges and faculties, rather than the GMC, are the specialist experts in terms of clinical practice in their fields.

We accept the GMC is not the only body that should have something to say about what Physician Associates and Anaesthesia Associates can and cannot do.  The Royal Colleges have some  relevant expertise. But as a regulator, the GMC must draw red lines on the limits of both roles because they are fundamentally different from doctors. Worse still, the current murky state of affairs is that Trusts are able to, and do, brazenly breach existing College guidelines, presumably in an attempt to cut corners and lower standards by using Associates without direct supervision.

The response to our request for mediation is disappointing. It doesn’t say that the GMC legally cannot take the steps we have asked for; it is that they are choosing not to. Their decision could have been influenced by the Department of Health. We have written back to ask whose decision this was. We are expecting a full result to this and our other questions by the end of this week.

“We don’t want to mediate” isn’t really much of a reason not to. And it is not what the Courts expect. Case law suggests that “No defence, however strong, by itself justifies a failure to engage in any kind of alternative dispute resolution. Experience has shown that disputes may often be resolved in a way satisfactory to all parties, including parties who find themselves able to resolve claims against them which they consider to be well founded.”

The refusal to mediate is having the clear effect of ramping up costs. We need to raise the first £200k as quickly as we can. If you haven’t yet given then please make a donation.  If you already have then we thank you, and kindly request that you use whatever influence you have on social media and personal conversation to raise the profile of our case. 

Ensuring that Associates are properly supervised and regulated is in all of our interests.

Our lawyers have written to the General Medical Council (GMC) to say they have acted unlawfully, by failing to set safe and lawful practice measures for AAs and PAs.  We are seeking legal challenge on three grounds. The costs of fighting this are considerable though, and we need to raise up to £500,000 to take on this case and ensure patients get the care they expect.

The case is complex: our lawyers’ letter is 49 pages long and we have posted a brief summary here. 

At the heart of the dispute are some very simple and central questions. What limits are there on the tasks AAs and PAs can do? How must they be supervised; and how should patients give consent to be treated by them?

We have written a longer statement here.

Our priority now is fundraising. There are many thousands of doctors in the UK; but many of them are unaware of the issues we are fighting over and the importance of this case. Please share awareness through local WhatsApp groups, email and other appropriate routes.

We held a very productive meeting yesterday with our full legal team at Blackstones. We discussed many of our concerns about the way in which the GMC has introduced regulation for Anaesthesia Associates and Physician Associates. Our lawyers shared our concerns and are preparing to write formally to the GMC on our behalf, hopefully next week. There is, however, a great deal of work still to do in preparing the case.

Our lawyers are especially interested in hearing from patients who have been directly affected by some of these issues and who are prepared to share their experiences. In particular, instances where patients were unaware that they were being treated by an Associate, rather than a doctor, and instances where there may have been inadequate levels of supervision. If you, or someone you know, are able to supply us with relevant personal information or case histories then please contact us by email at [email protected]

We would also be grateful if you could share this request for case histories with your friends and family. You can use the message at https://anaesthetistsunited.com/legal-case-update-3-7-24/

We are closely following the BMA’s own legal case and are fully supportive of their action. We are not duplicating what they are doing; the focus and aim of our own case is different,  and is concentrated on the true meaning and aims of ‘regulation’ and ensuring doctors and associates understand their respective roles with patient safety in mind.

We hope to have another update by the end of next week. In the meantime, we need funds in order to pay our legal costs, so please help by donating to our fund.

We're two-thirds of the way to raising the £100,000 target. Thanks to everyone that has contributed so far.

Looking at the comments that our donors have made we can see a significant proportion are members of the public - patients and future patients - who are shocked at what is taking place in the NHS and feel an overwhelming sense of betrayal.


I do not want to be treated by any PA, for any reason, unless under the direct supervision of a Physician or Surgeon fully qualified in the relevant field of Medicine being treated.

Thank you on behalf of patients everywhere

So important to protect patients from people who aren't competent

They are just trying to lie to the public, to provide much less well-trained staff masquerading as doctors,whilst still dumping the ultimate legal responsibility on the doctor. The whole thing is a lie. I have had multiple 'physician associates' imply to me they are qualified doctors until challenged

Thank you for your donations and please help us reach that £100k.

Thank you all for your kind donations. We have been overwhelmed by support, and we are now in a position to instruct our legal team to initiate work on the case.

We are aware that the GMC spends substantial sums defending themselves and that we might need to go to court.

So we have set a stretch target of £100,000 which would provide us a with solid footing for doing this. 

We are grateful as ever for your support.