Profession
Work is moving from doctors to pharmacists, nurse practitioners and physician associates, and overseas-trained doctors are being fast-tracked.
Under a new federal interpretation of the Canada Health Act, medically necessary care that nurse practitioners, pharmacists and midwives provide in place of a doctor is to be publicly funded. The policy took effect in April 2026, with penalties from April 2027. Ontario missed the deadline.
Ontario pharmacists now prescribe for 28 minor ailments, after 9 were added on 1 July 2026; Nova Scotia pharmacists can prescribe for conditions including hypertension and type 2 diabetes.
New Zealand's bill would let the Health Minister direct the health regulators on policy and let a ministerial committee overturn registration refusals. Parliament has since been dissolved for the November 2026 election.
Physician associates came under the Medical Council of New Zealand on 1 October 2026. Existing practitioners must apply by 30 November 2026.
Planned to grow to 10,000, physician associates came under GMC regulation in 2024. After coroners' findings and an independent review, the roles are to be renamed and restricted, but not abolished.
No reforms tracked for this country yet.
The Court of Appeal dismissed the BMA's challenge to the GMC's use of the term 'medical professionals' for both doctors and physician and anaesthesia associates in Good Medical Practice. A separate judicial review by Anaesthetists United, seeking national limits on scope of practice, was dismissed by the High Court in September 2025.
Why it matters: The courts found the GMC acted lawfully on both terminology and scope of practice. In our view, change will have to come through policy, not litigation.
Reviewed UK research on physician and anaesthetic associates published from 2015 to January 2025. Of 29 studies meeting its inclusion standard, none examined safety incidents and only one directly observed clinical competence.
Why it matters: In our view, a clear statement of the evidence gap: the authors warn that absence of evidence of safety incidents is not evidence that the roles are safe. Co-author Martin McKee was BMA president in 2022-23.
An independent review found the evidence on the roles weak and based on observational data. It made 18 recommendations, including renaming the roles 'physician assistant' and 'physician assistant in anaesthesia', and requiring a named supervising doctor for each physician assistant. The government accepted all of them.
Why it matters: In our view, a template for how a government re-tightens a role after scaling it ahead of the evidence.
A senior coroner found that an ascitic drain, which a junior doctor had decided to place, was not clinically indicated. The physician associate who inserted it was unaware of local guidance, left it in for 21 hours and directed that it be clamped, which the coroner found was unwarranted. The report also raises the absence of a regulator at the time, title confusion, and a competency sign-off that covered only the technical skill of inserting the drain, not consent, risk factors or aftercare.
Why it matters: Its first concern was that there was then no regulator at all, so it does not show that proportionate regulation fails; its other concerns (training, supervision, the title, competency sign-off) remain relevant under regulation.
No library items for this country yet.