PI Brief Update

Mazur and the Wild West in Law and Medicine - Dr Mark Burgin

12/11/25. Dr Mark Burgin explains how the case of Mazur has shone a light on how delegation by professional groups is challenging current regulatory structures and undermining reputation in law and medicine.

Mazur appears to be a simple decision about the protection given the title solicitor. That it caused disruption suggests that there may be deeper problem. Much of the work that 2 decades ago was performed by doctors and lawyers is now carried out by associates. These associates are experienced and competent so there is no problem, or is there?

In general practice the ratio of GPs to associates was 1 to 1 so the GPs could provide comprehensive supervision. Now the ratio is 1 to 3 and any illusion of supervision is a faint memory. Practice nurses, paramedic, pharmacists, physiotherapists have taken over front line work in primary care. Only when physician assistants were added did the medical profession draw a line.

In legal cases the case handler can even go further than a solicitor. It is not unusual for case handlers to instruct me to change my opinion even when I point out that this against the SRA codes of conduct and CPR35. I have written an article detailing the problems I encountered and the responses from the solicitor in charge of the case.

Wild West?

The Wild West had lawmakers but they were not effective in enforcing the law and they relied upon vigilante justice. Using this as an analogy, we have professionals (solicitors and doctors) but they do not directly supervise the work of the associates. When bad outcomes occur there is little recourse for the victim. The GMC and SRA will not impose penalties on the professionals for failing to supervise.

The comparison feels overly harsh as Mazur would not have occurred if there was truly a Wild West. The Wild West is one end of a spectrum and any movement towards organising systems that way should be resisted. The progressive failure of regulators to address the changing environment indicates an uncomfortable direction of travel. Prevention is better than cure.

We can learn from The Wild West how rapid population growth, limited professionals and absence of leadership can set the stage for breakdown of order. The response will be self-reliance (litigants in person), vigilantes (protest groups) and private lawmen (ChatGPT). The Wild West’s main problem was reputational, accounts of problems both real and in fiction created fear. It took a long time to repair this reputation.

Supervision

Supervision if properly organised can help associates perform a useful role. Like the posses in The Wild West deputies were able to help enforce the law. There are significant limitations on the work that these associates can do. Individually some may be capable of specific roles but this would require a standardised system of testing.

The response from some associate groups has been to apply for permission for all associates to be permitted to perform these roles. This is wrong on several levels, first they have not had specific training or testing as it not core role. Second it devalues the training and regulation of other professionals. In medicine many associates are allowed to prescribe which has led to a lower standard of care.

The conflict between the increasing professional standards and permitting often unsupervised associates to the same work is problematic. In clinical negligence I am not permitted to ask about the associate’s training, experience and supervision. These are material to the claimant making their case that the associate should have asked for assistance from a professional.

Preventing The Wild West

Some experts have argued for a return to professional delivered services however this is improbable. Many fully trained doctors and solicitors are unemployed or cannot find a job in their chosen field. Watering down the standards so that professionals and associates both work to the same duty of care is one possible approach. There is evidence that an associate can do the same role as a doctor to a different expected standard.

Supervision has been championed as the answer but lack of detailed advice on what this means has led to a failure to implement. I would recommend that any associate has 30% of their hours in direct supervision. This is particularly true of senior associates who are doing more complex tasks. This is impossible for primary care where professionals would spend about 100% of their time providing supervision to their three associates.

Creating systems to allow associates to advance for instance physician assistants to become doctors is more likely to succeed. Profession training used to be an apprenticeship and this would also address issues such as diversity. Doctors and experienced PAs are likely to have different strengths and weaknesses. It has been long argued that purely academic training delivers professionals who lack skills.

Conclusions

Mazur may be an Emperor’s New Clothes moment or may be quickly forgotten. The case highlights the difficulty when people work outside their expertise. In medicine and law this creates a reputational damage as well as suffering for the individuals. Leaders of professional groups will only take notice if there is grass root pressure.

Doctors have gone on strike because of pay erosion, lack of training posts, lack of work when they are fully trained. These are symptoms of the problem but are not going to lead to meaningful change or improvement. We can accept a wholesale replacement by less well qualified associates as has happened in teaching and nursing. Or find a solution that addresses the fundamental issue.

All parties including professionals and associates must ask for a structured, accountable and competency-tested pipeline. This is most urgent in the busiest areas such as GP and A and E, PI and litigation. New examinations should be created to ensure that anyone who wants to deal with common issues such as minor illness, minor injuries and psychological management have the required standards. In law PI, debt recovery and commercial contracts might be prioritised.

The GMC and SRA already make it mandatory for professionals to raise the issue if they see an associate acting outside of their expertise. The public and associates could help by complaining about the lack of supervision. When enough people are talking about the need for training, the press will demand action.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is a Disability Analyst and is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 01226 761937 websites drmarkburgin.co.uk and gecko-alligator-babx.squarespace.com

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

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