The Anaesthesia Associates and Physician Associates Order 2024

Part 1 GENERAL

Citation and commencement

1.—(1) This Order may be cited as the Anaesthesia Associates and Physician Associates Order 2024.

(2) Article 19(1)(b) comes into force on 13th December 2026.

(3) The remaining provisions of this Order come into force on 13th December 2024.

Interpretation

2.—(1) In this Order—

“approved qualification” means a qualification approved under article 4(1)(a)(ii);

“associate” means—

(a)

anaesthesia associate, or

(b)

physician associate;

“case examiner” means a person who carries out case examiner functions under articles 10 and 13 on behalf of the Regulator;

“court”, except in the terms “county court” and “relevant court”, means—

(a)

in the case of a person whose address is shown in the register, or would have been so shown if the person were registered, as being—

(i)

in Scotland, the Court of Session;

(ii)

in Northern Ireland, the High Court of Justice in Northern Ireland, and

(b)

in any other case, the High Court of Justice in England and Wales;

“Final Measure” means a requirement set out in article 10(10) and imposed under article 10(3)(b)(i) or (5)(b)(ii) or 14(3)(c);

“fitness to practise proceedings” means proceedings and decisions which relate to consideration of whether a person’s fitness to practise as an associate is impaired;

“Interim Measure” means a requirement set out in article 11(8) and imposed under article 11(1) or 12(4)(c);

“the MPTS” means the Medical Practitioners Tribunal Service established under section 1(3)(g) of the Medical Act 1983(1);

“Panel” means a panel constituted pursuant to rules made under paragraph 6 of Schedule 4 which has functions under this Order;

“the register” means the register referred to in article 5(1)(a);

“registrant” means a person registered under article 6;

“the Registrar” means the Registrar appointed under paragraph 1(b)(i) of Schedule 1;

“registration” means registration in the register and “registered” must be construed accordingly;

“the Regulator” means the General Medical Council(2).

(2) Any reference in this Order to—

(a) fitness to practise being impaired is a reference to impairment by reason of—

(i) inability to provide care to a sufficient standard, or

(ii) misconduct;

(b) a member of the Regulator is to a person appointed under paragraph 1A(2) of Schedule 1 to the Medical Act 1983(3).

Part 2 STANDARDS AND APPROVALS

Standards

3.—(1) The Regulator must determine standards applicable to associates.

(2) The standards must relate to—

(a) education and training,

(b) knowledge and skills,

(c) experience and performance,

(d) conduct and ethics,

(e) proficiency in the English language, and

(f) such other matters as the Regulator may prescribe in rules made under paragraph 2(2)(a) of Schedule 4.

(3) Before determining a standard, the Regulator must consult such persons as the Regulator considers appropriate.

(4) The Regulator—

(a) must keep the standards under review, and

(b) may vary or revoke a standard.

Approval of education, training, etc.

4.—(1) For the purposes of enabling a person to attain the standards determined under article 3, the Regulator may—

(a) approve—

(i) education or training provided;

(ii) a qualification conferred;

(iii) an examination or assessment provided,

inside or outside the United Kingdom;

(b) approve a person who provides education or training inside or outside the United Kingdom;

(c) determine that—

(i) education or training provided;

(ii) a qualification conferred,

by an institution other than one established in the United Kingdom, is acceptable for practising as an associate in the United Kingdom.

(2) The Regulator may—

(a) attach a condition to an approval;

(b) limit the time for which an approval is to have effect;

(c) vary or revoke an approval.

(3) The Regulator may coordinate the stages of education and training approved under paragraph (1).

Part 3 THE REGISTER

Register

5.—(1) The Registrar must—

(a) keep—

(i) a single register of persons registered under article 6, and

(ii) that register correct in accordance with the provisions of, and made under, this Order, and

(b) take steps to guard against, and facilitate the discovery of, falsification of the register.

(2) The Registrar—

(a) must divide the register into—

(i) one part for anaesthesia associates, and

(ii) one part for physician associates, and

(b) must not divide the register into further parts.

(3) The Registrar must record in the register in respect of each registrant—

(a) a registration number and date of most recent registration;

(b) the person’s name and such contact details as are prescribed in rules made under paragraph 1(3) of Schedule 4;

(c) such other information in respect of the person’s identity, inclusion of which in the register the Regulator is satisfied serves the purpose of protection of the public;

(d) information in respect of any—

(i) warning under article 10(3)(a)(ii) or (5)(a)(ii),

(ii) Interim Measure or Final Measure, or

(iii) decision under article 16(5) or article 17(6);

(e) such other information in respect of the person’s practice as an associate, inclusion of which in the register the Regulator is satisfied serves the purpose of protection of the public.

(4) The Registrar may record information in the register other than that mentioned in paragraph (3).

Registration

6.—(1) Except where paragraphs (2) or (3) apply, the Registrar must register a person who applies for registration (“the applicant”) if the applicant—

(a) meets the standards determined by the Regulator under article 3(1) as being required for registration,

(b) has provided the Registrar with the information specified in paragraph (4), and

(c) has complied with—

(i) any procedural requirements prescribed in rules made under paragraph 4(1)(a) of Schedule 4, and

(ii) such other requirements as the Registrar may direct.

(2) Where the applicant’s entry in the register has been removed due to the imposition of a Final Measure, the Registrar must register an applicant if—

(a) such a person or Panel as is prescribed in rules under paragraph 2(1)(a) of Schedule 4 is satisfied in respect of the matters specified in paragraph (1) (a) to (c), and

(b) a Panel has determined that the applicant’s fitness to practise is not impaired.

(3) Where the applicant’s entry in the register has been removed other than due to the imposition of a Final Measure, the Registrar must register an applicant if—

(a) such a person or Panel as is prescribed in rules made under paragraph 2(1)(b) of Schedule 4 is satisfied in respect of the matters specified in paragraph (1) (a) to (c), and

(b) in such cases as may be prescribed in rules made under paragraph 2(2)(d) of Schedule 4, such a person or Panel as is prescribed in rules made under paragraph 2(1)(c) of Schedule 4 has determined that the applicant’s fitness to practise is not impaired.

(4) The information referred to in paragraph (1)(b) is—

(a) proof of the applicant’s identity;

(b) evidence to demonstrate that the applicant has in force, or will have in force by the date on which the applicant begins to practise in the United Kingdom—

(i) an indemnity arrangement,

(ii) an insurance policy, or

(iii) a combination thereof,

which provides appropriate and adequate cover in respect of the applicant’s practice as an associate.

Periodic assessment

7.  The Regulator must carry out a periodic assessment as to whether a registrant continues to meet the standards determined under article 3(1).

Conditions on practice as an associate

8.  The Regulator may impose conditions on the practice of such descriptions of associate as may be prescribed in rules under paragraph 2(2)(e) of Schedule 4.

Removal of an entry

9.—(1) The Registrar, as soon as reasonably practicable, must remove an entry from the register where—

(a) the Registrar is satisfied that the person to whom the entry relates has died,

(b) a Final Measure is imposed requiring the removal of the entry, or

(c) the person to whom the entry relates has a conviction for an offence listed in—

(i) paragraphs 1 to 8 of Schedule 2, or

(ii) any other paragraph of Schedule 2 in respect of which a custodial sentence has been imposed,

which was committed on or after the date on which this article comes into force.

(2) The Registrar may remove an entry from the register where—

(a) registration was procured fraudulently or made incorrectly,

(b) a registrant does not meet the standards determined by the Regulator under article 3(1) pursuant to an assessment made under article 7, or

(c) the person to whom it relates—

(i) has requested the removal, or

(ii) has not—

(aa) complied with an assessment procedure prescribed in rules under paragraph 4(2)(c) of Schedule 4,

(bb) paid a fee in accordance with rules made under paragraph 8 of Schedule 4,

(cc) an indemnity arrangement, insurance policy or combination thereof in force which provides appropriate and adequate cover in respect of their practice as an associate,

(dd) maintained an effective means of contact with the Registrar,

(ee) provided information in accordance with a requirement of, or made under, this Order, or

(ff) complied with a condition on registration imposed under article 8.

Part 4 FITNESS TO PRACTISE

Steps which may be taken where a question as to fitness to practise arises

10.—(1) Where the Regulator considers that a question has arisen as to whether an associate’s fitness to practise is impaired, the Regulator must—

(a) carry out an initial assessment, and

(b) where the Regulator considers appropriate, refer the matter to a case examiner.

(2) The case examiner to which a referral is made under paragraph (1)(b) must take one of the steps specified in paragraphs (3) and (4).

(3) The step specified under this paragraph is for the case examiner to determine whether the associate’s fitness to practise is impaired and—

(a) where the associate’s fitness to practise is found not to be impaired—

(i) take no further action, or

(ii) issue the associate with a warning;

(b) where the associate’s fitness to practise is found to be impaired—

(i) subject to paragraph (8), impose a Final Measure, or

(ii) refer the matter on to a Panel.

(4) The step specified under this paragraph is for the case examiner to refer the matter on to a Panel.

(5) A Panel to which a referral is made under paragraph (3)(b)(ii) must satisfy itself as to whether, and under paragraph (4) must determine whether, the associate’s fitness to practise is impaired and—

(a) where the associate’s fitness to practise is found not to be impaired—

(i) take no further action, or

(ii) issue the associate with a warning;

(b) where the associate’s fitness to practise is found to be impaired—

(i) take no further action, or

(ii) impose a Final Measure.

(6) The case examiner may withdraw a referral to a Panel if the Panel has not yet satisfied itself as to whether, or determined whether, fitness to practise is impaired.

(7) Paragraph (5) does not apply to a referral which is withdrawn under paragraph (6).

(8) If a case examiner determines that an associate’s fitness to practise is impaired, the case examiner may only impose a Final Measure if the associate—

(a) has agreed to the Final Measure being imposed on the basis that—

(i) the associate’s fitness to practise is impaired, and

(ii) the associate has accepted the case examiner’s findings, or

(b) has been notified that the case examiner proposes imposing a Final Measure and a reasoned response by the associate has not been received by the case examiner within the period prescribed under paragraph 11(1)(a) of Schedule 4.

(9) A notification under paragraph (8)(b) must—

(a) request that the associate provide a reasoned response within the prescribed period, and

(b) inform the associate that a Final Measure may be imposed if the associate fails to respond.

(10) A Final Measure imposed under paragraph (3)(b)(i) or (5)(b)(ii) may require that an associate’s entry in a part of the register (into which the register is divided under article 5(2)(a)) be—

(a) subject to condition,

(b) suspended, or

(c) removed.

Interim Measures

11.—(1) Where a question has arisen in accordance with article 10(1) as to whether an associate’s fitness to practise is impaired, an Interim Measure may be imposed upon that associate by a Panel, pending—

(a) the conclusion of an assessment under article 10(1)(a);

(b) a determination by a case examiner under article 10(3);

(c) a determination by a Panel under article 10(5);

(d) a determination by the Regulator under article 14(2);

(e) a decision under article 16(5) in respect of articles 10(3)(b)(i), 13(1) or 14(3);

(f) a decision under article 17(6) in respect of articles 10(3)(b)(i) or (5)(b)(ii), 11(1), 13(1) or 14(3),

where the Panel considers that such an Interim Measure is necessary for the protection of the public, or is otherwise in the interests of the public or the associate.

(2) A Panel which imposes an Interim Measure under paragraph (1) must specify the period for which the Measure is to remain in force.

(3) The Panel may not specify a period longer than 18 months.

(4) The Regulator may—

(a) where it is carrying out—

(i) an assessment mentioned in paragraph (1)(a), or

(ii) a determination mentioned in paragraph (1)(b) or (c), and

(b) before the expiration of the period for which the Interim Measure to which the assessment or determination relates is to remain in force,

apply to the court for an extension of the period.

(5) On an application under paragraph (4), the court may only extend the period if it is satisfied that the current period will not allow such time as is reasonable in the circumstances of the case for the assessment or determination to conclude.

(6) The court may not extend the period for longer than 12 months on each application.

(7) For the purposes of paragraphs (4) to (6), reference to a period for which an Interim Measure is to remain in force includes a period as previously extended under those provisions or in accordance with article 12.

(8) An Interim Measure imposed under paragraph (1) may require that an associate’s entry in a part of the register (into which the register is divided under article 5(2)(a)) be—

(a) subject to condition, or

(b) suspended.

Interim Measures - review

12.—(1) In respect of an Interim Measure which remains in force in respect of an associate, the Regulator must carry out—

(a) a first review of the Measure before the end of a period of six months beginning with the date on which it first had effect, and

(b) subsequent reviews of the Measure before the end of a period of six months beginning with—

(i) the date of the previous review, or

(ii) where a court has, since the previous review, extended the period for which the Measure is to remain in force, the date on which the order to extend is made.

(2) A failure to conduct a review in accordance with paragraph (1) does not affect the validity of the Interim Measure.

(3) The Regulator may at any time review an Interim Measure which remains in force, including where a question arises as to whether an associate is complying with a condition on their registration.

(4) On a review under this article, the Regulator may—

(a) extend the period specified for the Measure to remain in force,

(b) vary a condition to which an associate’s entry is subject,

(c) revoke an Interim Measure and impose a different Interim Measure in respect of an associate,

if, in the opinion of the Regulator, an Interim Measure remains necessary for the protection of the public or remains in the interests of the public or the associate upon whom the Measure is imposed.

(5) Where the Regulator imposes a different Interim Measure under paragraph (4)(c), it must specify the period for which the Measure is to remain in force.

(6) Article 11(8) applies to a different Interim Measure imposed under paragraph (4)(c).

(7) The Regulator may not exercise the power under paragraph (4) so as to provide that an associate is subject to an Interim Measure or Measures in respect of the same matter for a period of longer than 18 months.

(8) On a review under this article, the Regulator may only revoke an Interim Measure without imposing a different Interim Measure if, in the opinion of the Regulator, the Interim Measure is no longer necessary for the protection of the public or is no longer in the interests of the public or the associate upon whom the Interim Measure is imposed.

(9) Where—

(a) an appeal is brought under article 16 or 17 against a decision or a part of a decision, and

(b) the decision, or part of it, is revoked or revised under this article before the appeal is determined,

the appeal (or the part of the appeal which relates to the revoked or revised part of the decision) will lapse.

Final Measures

13.—(1) A case examiner who imposes a Final Measure under article 10(3)(b)(i), or a Panel which imposes a Final Measure under article 10(5)(b)(ii), must specify the period for which the Final Measure is to remain in force.

(2) The case examiner or the Panel may not specify a period of longer than 12 months.

(3) This article does not apply where the Final Measure imposed is for an associate’s entry to be removed from a part of the register.

Final Measures - review

14.—(1) The Regulator may at any time review a Final Measure which remains in force in respect of an associate where that associate’s entry in the register is subject to a condition or is suspended, including where a question arises as to compliance with a condition on that associate’s registration.

(2) On a review under this article, the Regulator may revoke a Final Measure if, in the opinion of the Regulator, the fitness to practise of the associate in respect of whom the Final Measure is imposed is no longer impaired.

(3) On a review under this article, the Regulator may—

(a) extend the period for which a Final Measure is to remain in force,

(b) vary a condition to which an associate’s entry in the register is subject,

(c) revoke a Final Measure and impose a different Final Measure in respect of an associate,

if, in the opinion of the Regulator, the fitness to practise of that associate remains impaired.

(4) For the purposes of paragraph (3)(a), the Regulator may only extend the period—

(a) specified under article 13(1), or

(b) previously extended under paragraph (3)(a),

by a period not longer than 12 months on each occasion.

(5) Article 13 applies to the Regulator in imposing a different Final Measure under paragraph (3)(c) as it applies to a case examiner and Panel.

(6) Article 10(10) applies to a different Final Measure imposed under paragraph (3)(c).

(7) Where—

(a) an appeal is brought under article 16 or 17 against a decision or a part of a decision, and

(b) the decision, or part of it, is revoked or revised under this article before the appeal is determined,

the appeal (or the part of the appeal which relates to the revoked or revised part of the decision) will lapse.

Part 5 REVISIONS AND APPEALS

Revision of decisions

15.—(1) The Regulator may revise such decisions under this Order as are prescribed in rules under paragraph 3 of Schedule 4.

(2) A decision may be revised if—

(a) the decision was based on an error of fact or law;

(b) except in respect of a determination under article 10(2) to (5) and (8) and article 11(1), a material change in circumstances has occurred since the decision was made.

(3) The Regulator may not revise a decision in order to—

(a) extend the period for which a Final Measure or an Interim Measure is to remain in force;

(b) vary a condition to which, by virtue of a Final Measure or an Interim Measure, a person’s entry in the register is subject.

(4) For the purpose of any rule as to the time allowed for bringing an appeal under article 16 or 17, the decision revised under this article is to be deemed as made on the date on which it is so revised.

(5) Where—

(a) an appeal is brought under article 16 or 17 against a decision or part of a decision, and

(b) the decision, or part of it, is revised under this article before the appeal is determined,

the appeal (or the part of the appeal which relates to the revised part of the decision) will lapse.

(6) A decision prescribed in accordance with paragraph (1) includes such a decision—

(a) as previously revised under this article, and

(b) as amended following an appeal under article 16.

Appeal to a Panel

16.—(1) In respect of a provision listed in the first column of the following table, a decision of the decision maker listed in the corresponding entry in the second column may be appealed to a Panel by a person listed in the corresponding entry in the third column.

Provision	Decision maker	Appellant
article 6(1)	the Registrar	the applicant
article 6(3)	the person prescribed	the applicant
article 7	the Regulator	the person registered
article 8	the Regulator	the person who is subject to the condition
article 9(2)	the Registrar	the person to whom the entry relates
article 10(3), other than sub-paragraph (b)(ii)	the case examiner	the person to whom the determination relates
article 12(4)	the Regulator	the person to whom the Interim Measure relates
article 13(1)	the case examiner	the person to whom the Final Measure relates
article 14(3)	the Regulator	the person to whom the Final Measure relates

(2) A person who wishes to appeal under paragraph (1) must seek permission to do so from the Regulator within 28 days beginning with the date on which the decision was notified to the person listed in the third column of the table.

(3) Following receipt of an application for permission to appeal, the Regulator must—

(a) grant permission,

(b) refuse permission, or

(c) where the rules under paragraph 3 of Schedule 4 permit, revise the decision under article 15.

(4) Rules made under paragraph 12 of Schedule 4 may prescribe other persons who may appeal against a decision made under a provision listed in the first column of the table in paragraph (1).

(5) On an appeal under this article, the Panel may—

(a) dismiss the appeal;

(b) quash the decision under appeal;

(c) substitute for the decision under appeal a decision that could have been made;

(d) remit the matter to be disposed of in accordance with directions.

(6) No appeal under paragraph (1) lies against a decision made solely on the ground that the person has not—

(a) applied for registration under article 6 in accordance with rules made under paragraph 4(1)(a) of Schedule 4, or

(b) paid a fee payable in accordance with rules made under paragraph 8 of Schedule 4.

(7) Reference to a decision under paragraph (1) includes a decision—

(a) as previously revised under article 15, and

(b) as amended pursuant to article 17(6)(d).

Appeal to a court

17.—(1) In respect of a provision listed in the first column of the following table, a decision of the decision maker listed in the corresponding entry in the second column may be appealed to the court by a person listed in the corresponding entry in the third column.

Provision	Decision maker	Appellant
article 6(2) and (3)	the Panel or person prescribed	the applicant
article 7	the Regulator	the person registered
article 9(1)(c)	the Registrar	the person to whom the entry relates
article 10(3), other than sub-paragraph (b)(ii)	the case examiner	the person to whom the determination relates
article 10(5)	the Panel	the person to whom the determination relates
article 11(1) and (2)	the Panel	the person to whom the Interim Measure relates
article 12(4)	the Regulator	the person to whom the Interim Measure relates
article 13(1)	the case examiner or Panel	the person to whom the Final Measure relates
article 14(3)	the Regulator	the person to whom the Final Measure relates

(2) In respect of a provision listed in the first column of the following table, a decision of the decision maker listed in the corresponding entry in the second column may be appealed to the relevant court by a person listed in the corresponding entry in the third column.

Provision	Decision maker	Appellant
article 6(1)	the Registrar	the applicant
article 8	the Regulator	the person to whom the condition applies
article 9(1)(a)	the Registrar	the person to whom the entry relates
article 9(2)	the Registrar	the person to whom the entry relates

(3) For the purposes of paragraph (2), the “relevant court” means a county court or, in Scotland, the sheriff in whose Sheriffdom is situated the address—

(a) which is shown in the register as the address of the person listed in the third column of the table, or

(b) which would have been so shown if the person were registered.

(4) Where an appeal lies against a decision by virtue of article 16(1), such an appeal may not be commenced under this article unless—

(a) permission to appeal has been refused under article 16(3)(b), or

(b) the Panel has disposed of the appeal in accordance with article 16(5).

(5) Where a person wishes to appeal to the court, county court or sheriff under this article, the appeal must be commenced within 28 days beginning with the later of the date on which—

(a) the decision,

(b) a revision of the decision under article 15,

(c) a refusal of permission to appeal under article 16, or

(d) the determination of an appeal against the decision under article 16,

was notified to the person listed in the third column of the table in paragraph (1) or (2).

(6) On an appeal under this article, the court, county court or sheriff may—

(a) dismiss the appeal;

(b) quash the decision under appeal;

(c) substitute for the decision under appeal a decision that could have been made;

(d) remit the matter to be disposed of in accordance with directions.

(7) The court, county court or sheriff may make any order as to costs or, in Scotland, expenses as it thinks fit.

(8) No appeal under this article lies against a decision made solely on the ground that the person has not—

(a) paid a fee payable in accordance with rules made under paragraph 8 of Schedule 4, or

(b) applied for registration in accordance with rules made under paragraph 4(1)(a) of Schedule 4.

(9) Unless the context otherwise requires, reference to a decision in this article includes a decision—

(a) as revised under article 15, and

(b) as amended following an appeal under article 16.

Part 6 MISCELLANEOUS

Opportunity to make representations

18.—(1) Subject to paragraph (2), a decision may not be made under—

(a) article 4(2)(a) or (c) unless the person who applied for the approval under article 4(1) has been given an opportunity to make representations beforehand, or

(b) article 12(4), article 13(1), or article 14(3) nor may a Final Measure be imposed unless the person affected has been given an opportunity to make representations beforehand.

(2) A case examiner may not refer a case under article 10(4) unless the person whose fitness to practise is in question has been given an opportunity to make written representations beforehand.

(3) Where practicable, representations made by an associate will be considered prior to a decision being taken under article 11(1) or (2).

Offences relating to registration etc.

19.—(1) A person commits an offence who, with intent to deceive—

(a) falsely represents anyone, including themselves, to have an approved qualification, or to be registered,

(b) uses the title of anaesthesia associate or physician associate without being registered as such,

(c) makes a false representation as to the content of the register, or

(d) procures, or attempts to procure, the inclusion of information in, or exclusion of information from, the register.

(2) A person who is guilty of an offence under paragraph (1) is liable—

(a) on summary conviction in England and Wales, to a fine;

(b) on summary conviction in Scotland or Northern Ireland, to a fine not exceeding level 5 on the standard scale.

Schedules 1 and 3 to 5

20.  Schedule 1 and Schedules 3 to 5 have effect.

Richard Tilbrook

Clerk of the Privy Council