Dismissal of judicial review challenge relating to GMC’s approach to physician and anaesthesia associates

In R (on the application of the British Medical Association) -v- General Medical Council [2025] EWHC 960 (Admin), Mrs Justice Lambert was required to consider a judicial review challenge to aspects of the GMC’s approach to the regulation of Physician and Anaesthesia Associates (“Associates”), namely the use of the umbrella term “medical professionals” to apply to doctors and Associates and the application of Good Medical Practice (“GMP”) to both categories of registrant.

The challenge was brought on three grounds. Ground one was that the use of the umbrella term was inconsistent, and in conflict, with the relevant legislative framework. Ground two was that the promulgation of a single set of professional standards and the use of the umbrella term within those standards was contrary to the GMC’s statutory objective of protecting the public. Ground three was that the use of the term and the promulgation of a single set of standards was irrational.

The claim was determined in the context of there being no nationally agreed scope of practice for Associates, a number of high profile cases that indicated a level of confusion amongst the public and patients as to whether care was being delivered by a doctor or an Associate and a Prevention of Future Deaths report relating to the lack of clarity as between their respective roles.

Mrs Justice Lambert considered evidence as to the process undertaken by the GMC that had led to the adoption of the umbrella term and the application of a single set of professional standards, describing this as an exhaustive and detailed process involving public consultation, research and inquiry that had engaged all major stakeholders including the claimant. The Judge also noted the amendments that had been made to GMP to seek to clarify the position as between doctors and Associates.

The Judge dismissed all three grounds of claim.

On ground one, the Judge applied what she described as the “exhaustive rubric” for assessment of policy that had been provided by the Supreme Court in R(A) -v- Secretary of State for the Home Department [2021] UKSC 37. The claimant’s case had related to the offences created by the Medical Act 1983 in relation to the use of protected titles, names or descriptions of medically qualified professionals, and was that the use of an umbrella term was inconsistent with those aspects of the Act and could cause Associates to commit an offence. The Judge held that GMP did not include a positive statement of the law let alone one that was wrong. The term “medical professional” was not defined in law and therefore the use of that term was not a statement of the law and would not give rise to the commission of an offence. GMP imposed a clear ethical duty on registrants to be honest about their experience and role and the umbrella term was simply used as a collective way to describe all registrants to which it applied.

On ground two, the Judge considered whether the promulgation of a single set of standards and/or the use of the umbrella term infringed the principle established in Padfield -v- Minister of Agriculture, Fisheries and Food [1986] UKHL 1. This required her to identify first the policy and objects of the Act and then decide whether the exercise of the GMC’s statutory discretion by way of the promulgation of the single set of standards and/or the use of the umbrella term promoted or ‘thwarted or ran counter’ to that policy/those objects. The claimant argued that the approach taken by the GMC ran contrary to its statutory objective of public protection and was confusing and unsafe. The Judge noted that the Court was required to decide whether the objective at which the decisions were aimed was aligned to the statutory purpose, not whether that purpose had been achieved or optimally achieved, which was an ‘important restraint’. In the present case the Judge was satisfied that in promulgating common standards and using the umbrella term the GMC had acted for the purpose of promoting patient safety and no other collateral purpose. 

On ground three, the Judge cited the recent case of R(on the application of KP) -v- Secretary of State for Foreign, Commonwealth and Development Affairs & Others [2025] EWHC 370 (Admin) in which Mr Justice Chamberlain framed the test of rationality as being twofold: process irrationality (the decision maker must have regard to all mandatorily relevant considerations and no irrelevant considerations and there must be no logical error or critical gap in the process of reasoning that led to the decision) and outcome irrationality (the outcome reached is so unreasonable that no reasonable authority could ever have come to it, or to put it another way, it is outside the range of reasonable decisions open to the decision maker). The claimant framed this ground with reference to the public and patient concerns that had been widely reported and argued that no reasonable regulator in the position of the GMC would have promulgated a single set of standards or the use of a single term to describe doctors and Associates. The Judge rejected that argument, referring to the GMC’s status as an experienced regulator and the exhaustive and detailed process that had led to the taking of the impugned decisions. The Judge held that it was open to the GMC to conclude that the protection of the public was best served by applying the same high standards to Associates and that that approach was logical given the overlap between the work undertaken by doctors and Associates and the need for regulatory concerns about both categories of registrant to be considered against the same standards.

The Judge’s reasons for dismissing the claim provide a useful reminder of the limited scope that exists for successful challenge to policy decisions and approaches made in pursuance of a broad statutory discretion, following the Supreme Court decision in A, applying the Padfield principle and the established approach to rationality challenges that was recently reframed and reaffirmed in KP. The difficulty of overcoming the jurisprudential limits will be compounded in a case where the public authority promulgating the policy has undertaken the ‘detailed and exhaustive’ approach to policy development that was found to have been undertaken by the GMC in relation to Associates.

The judgment may provide depressing reading for those contemplating judicial review challenges to policy but provides a useful reminder to public authorities of the need for care, time and effort when promulgating policy and of the need to stay focussed on the statutory objective(s) that is/are being pursued when doing so to ensure that the Padfield principle is observed and the decision reached is not vulnerable to challenge on grounds of process or outcome rationality.

As a useful postscript, the Judge refused the claimant’s application for an extension of time. The Judge held that time to bring the challenge had started to run when the Council of the GMC had decided to promulgate a single set of professional standards for doctors and Associates, notwithstanding that the relevant legislation had not at that time taken effect and that the consultation process was ongoing. This is a helpful reminder if one were needed of the need for claimants to act promptly when decisions driving policy are made rather than awaiting their implementation or finalisation pending consultation/engagement.