On 23 January 2018, the Department of Health and Social Care closed its consultation ‘Promoting professionalism, reforming regulation’.
According to the consultation paper published on 31 October 2017:
‘The regulation of healthcare professionals must change in order to protect patients, to support the transformation of our healthcare services and to meet future challenges. It needs to be faster, simpler, better and less costly.’
The Minister for Health, Philip Dunne, said in his written statement accompanying the consultation that the model of regulation in the UK for healthcare professionals has become ‘increasingly complex and outdated’ and requires reform.
The Government’s objectives in taking the reform forward are to:
- ‘Improve the protection of the public from the risk of harm from poor professional practice
- Support the development of a flexible workforce that is better able to meet the challenges of delivering healthcare in the future
- Deal with concerns about the performance of professionals in a more proportionate and responsive fashion
- Provide greater support to regulated professionals in delivering high quality care
- Increase the efficiency of the system’
The aim of the consultation is to consider what reforms are needed in order to maximise public protection while supporting workforce development.
Public protection and regulatory oversight
The consultation document proposes the Professional Standards Authority (PSA) to be in the best position to advise on professional regulation.
The PSA was established under the NHS Reform and Health Care Professions Act 2002. The Health and Social Care Act 2012 gave it new responsibilities and the PSA has the authority to review decisions about fitness to practice and to direct a regulator to change its rules. It currently provides an accreditation scheme for voluntary registers.
The report expresses concern that there are no formal criteria for determining an appropriate level of regulatory oversight. Applying clear criteria and ensuring regulation is proportionate, are key factors in the consideration of any scheme.
The report advocates a reduction in the number of regulators. This would provide consistency between regulators and is a more cost-effective approach. It would also simplify regulation and make it more ‘user friendly’ for both professionals and the public.
Responsive regulation and fitness to practice
The report proposes improvements to the system of investigating and resolving fitness to practice complaints. Whilst it is recognised that some regulators, i.e. GMC, NMC, GDC and GOC, have made changes for flexible working, this is not yet across the board.
The report highlights that ‘fitness to practice cases accounts for 61% of the General Dental Council’s expenditure and 76% of the Nursing and Midwifery Council’s expenditure.’
It suggests that the adversarial processes of regulators and a legalistic and defensive nature needs to change.
There are various ways in which regulators can provide support to healthcare professionals, including accrediting courses and approval of courses for entry into professions. The role of regulators and supporting professionals is described as ‘crucial’ for ‘assuring’ the ongoing quality of each profession.
There are four potential areas where improvement to public protection and efficiency may be assisted by joint working:
- A shared online register, search engine or online portal of all registered healthcare professionals. This will make it easier for patients, the public and employers to access details about whether a health professional is registered and about that professional’s registration.
- A single set of generic standards for all healthcare professionals (underpinned by profession-specific standards owned by the individual regulators). This will ensure that all health professionals are working to the same core set of professional standards. The standards will only differ where there is a profession-specific need. This model has been successfully operated by the HCPC for many years.
- A single adjudicator responsible for all fitness to practice decisions. This will provide greater consistency of decision-making on all fitness to practice cases, making the process fairer for regulated professionals and for patients and the public. This could build on the Medical Practitioners Tribunal Service which considers fitness to practice cases brought by the GMC.
- A single organisation conducting back office functions, such as HR, finance and IT. Each regulatory body is currently responsible for their back office services. If one organisation was responsible for these functions, they are likely to be delivered more efficiently.
The consultation builds on the issues which have been raised in the Law Commissions’ review in 2014. The Government published its response to the Law Commissions’ report in January 2015. Although in the majority of cases there has been no change in the Government’s position, the Department of Health and Social Care is reconsidering the recommendations.
It is unclear how the recent consultation will impact on the Government’s approach and we await the details of the response to the consultation as to what, if any, progress is likely to be made to modernise and simplify professional regulation.