Anaesthetists United Limited & Ors, R (on the application of) v General Medical Council

A regulator’s decision about professional standards is unlawful only if its process contains a material logical error or omission, or its outcome falls outside the range of reasonable decisions. A court must not resolve a genuine policy debate about whether nationally fixed limits on a healthcare role would improve public safety. The Anaesthesia Associates and Physician Associates Order 2024 required reasonable inquiry into the regulatory approach needed to protect the public, but did not require nationally defined ceilings of practice. Locally determined scope and supervision, supported by general professional standards, could rationally be adopted. The law of informed consent did not require extending Montgomery to create a general duty to disclose the practitioner’s qualifications as a material treatment risk.

The claimants, including a doctors’ advocacy body and the parents of a deceased patient, challenged the General Medical Council’s regulation of physician associates and anaesthesia associates. The British Medical Association supported the challenge. The claim alleged irrationality, breach of the Padfield principle and failure to comply with the Tameside duty of inquiry.

The central complaints were that the GMC had failed to impose nationally applicable limits on associates’ clinical work, had issued inadequate guidance on supervision and delegation, had failed to require associates always to state that they were not medically qualified, and had not made sufficient inquiries into patient-safety risks. The court also considered whether the existing guidance unlawfully conflicted with informed-consent principles.

1. Claim dismissed. All grounds were rejected.
2. The irrationality challenge included both outcome and process rationality. Process rationality required attention to mandatory relevant considerations and reasoning free from logical error or a critical gap. The court accepted that the GMC’s extensive preparatory work, consultations and evidence-gathering were relevant to both aspects.
3. The GMC rationally adopted a high-level professional-standards model based on its experience regulating doctors, the approach of other regulators, the Department of Health and Social Care’s position, and the statutory framework. It considered evidence of associates working beyond competence, inadequate supervision and public confusion. It was not required to seek further evidence merely repeating concerns already identified.
4. There was a genuine policy debate about the advantages and disadvantages of nationally fixed limits on associates’ practice. Fixed limits could eliminate risks associated with particular tasks, but could also restrict competent practice, workforce flexibility and patient care. The court was not entitled or equipped to resolve that debate. It was rational for the GMC not to impose national ceilings, particularly since detailed clinical limits were better developed by employers, supervisors and specialist bodies.
5. The same reasoning disposed of the supervision challenge. The GMC’s April 2025 Supervision Practice Advice answered any free-standing complaint about supervision guidance. A lack of granularity did not make the guidance irrational.
6. The existing introduction guidance, properly understood, required associates to explain their role and, where a patient might reasonably expect a doctor to perform the task, to make clear that they were not medically qualified. Greater drafting clarity was desirable, but the guidance was not unlawful under the categories identified in R(A).
7. The court declined to extend Montgomery so that a practitioner’s qualifications constituted a material treatment risk requiring disclosure in every case. Such a significant development should be considered incrementally and in an individual factual setting, not in the abstract.
8. The Tameside duty required reasonable steps to obtain information necessary to answer the relevant regulatory question. The GMC had undertaken extensive research, stakeholder engagement, surveys and consultations. It was not required to conduct an end-to-end review of local employer practice or to undertake the inquiry later conducted by the Leng Review.
9. The precautionary principle added nothing to the ordinary Wednesbury test. Even if there had been a reasoning defect, relief would have been refused because the outcome was highly likely to be the same under section 31(2A) of the Senior Courts Act 1981.

First-instance judicial review in the Administrative Court. The judgment states that the claim was dismissed on all grounds; no appellate decision is described.