Dear Department of Health and Social Care,

I refer to the Memorandum of Understanding between your Department and the General Medical Council on implementing the regulation of physician associates and anaesthesia
associates, kindly provided by your Department.

The aims for the GMC include, at points 17.4: 'To develop and implement a regulatory framework that provides parity of esteem for PAs and AAs with doctors'
and for the DHSC, at point 17.7: 'To ensure that the implemented regulatory framework provides parity of esteem for PAs and AAs with doctors'

Please provide information on the activities that are intended to lead to this stated aim of 'parity of esteem with doctors'.
Please provide information on the monitoring of progress by DHSC towards this outcome.
Please advise what key indicators will allow either body to claim that this aim has been achieved.
Please advise the consequences if either party fails in its aims and objectives.

Yours faithfully,

Susan Sollazzi

Dear Department of Health and Social Care,

Thank you again for your response to my queries about the agreement between the DHSC and the GMC in relation to the registration of PAs and AAs. Freedom of Information Request References FOI-1544934 and FOI-1544935

The phrase 'parity of esteem for PAs and AAs with doctors', which is one of the aims set out in the MoU, has attracted attention and controversy. You have kindly sought to clarify the meaning of this phrase as follows: 'The principle of parity of esteem simply means that the GMC will apply the same robust regulatory processes fairly and equally to all its registrants.'

This explanation raises two points:
1. Applying the same robust regulatory processes fairly and equally to all registrants would be parity of process, nothing at all to do with esteem
2. The GMC cannot apply the same robust regulatory processes to PAs as to doctors, given that PAs:
- have no scope of practice against which to judge their actions, nor has the GMC any intention of introducing/accepting one
- have no specialist training or exams to demonstrate their safety in specialist areas where they may work, leaving their competence to be judged locally
- work in supervised positions, meaning they are not ultimately responsible for their patients, entirely unlike doctors.

Therefore your definition of 'parity of esteem' appears meaningless. Given that the phrase appears twice in the MoU, as a responsibility both for the Department and for the GMC, and that you have described it as 'an underpinning principle of regulation', I feel it is not satisfactory to leave the matter there and must ask two further questions.

1. Noting the dictionary definition of esteem as 'respect and admiration', what is the real meaning of 'parity of esteem for PAs and AAs with doctors'?
2. Even accepting your explanation, how would parity of esteem be possible for a workforce that will remain unregulated even after the GMC's registration comes fully into force in 2026, unlike doctors who are highly regulated?

Thank you for considering these important issues.

Yours faithfully,

Susan Sollazzi