Regulating healthcare professionals, protecting the public: Consultation response

The reform

The Department for Health and Social Care (DHSC) has recently published a response to the consultation it ran from 24 March 2021 to 16 June 2021, in which it sought views on proposals to reform the regulation of healthcare professionals.

The reforms have been a long-time coming, and therefore we were very eager to see what responses the DHSC received.

The UK model of regulation for healthcare professionals is rigid and complex, and has long needed modernisation. The government’s commitment to reforming the legislative framework for each of the nine health and care professional regulators has therefore been warmly welcomed. It is an important step towards carrying out improvements to the UK system of professional healthcare regulation, its workforce and, most importantly, to patient and public safety.

Overall, the proposals for reform, and therefore the basis of the consultation is aimed to:

• improve public protection;
• support the development of a flexible workforce that better meets the challenges of delivering healthcare;
• improve the support given to regulated professionals in delivering high quality care;
• enable regulators to address concerns about the performance and conduct of regulated professionals in a timely and proportionate manner; and
• increase the efficiency of the regulatory system.[1]

In the long-run, it is suggested that, through similar legislation, each regulator will be given broadly identical powers. The consultation also sought views on the proposed approach to introducing statutory regulation for physician associates (PAs) and anaesthesia associates (AAs) who are yet to be regulated professions.

The consultation

The consultation asked seventy questions on the four areas of reform, as well as the introduction of regulation of AAs and PAs.

1.Governance and operating framework

The reforms in this area aim to provide the regulators with increased autonomy balanced with increased accountability.

It is proposed that each regulator will have greater autonomy to set out the details of their regulatory procedures in legislation that they themselves publish. Regulators will be required to consult on their rules, but will not need to secure the approval of Parliament or the Privy Council to make their rules, giving increased flexibility to rapidly adapt their processes and procedures to changing requirements.

In turn, there are measures in place to ensure regulators remain accountable for the decisions they make, for example through submitting evidence of the likely impact of any fee change in a reporting year, a requirement for regulatory activities to be carried out in a transparent manner and submitting annual reports to the devolved legislatures in Scotland, Wales and Northern Ireland. In the rare instance of a regulator failing to deliver its statutory functions, there are steps that can be taken, such as putting into effect Privy Council’s default powers. The regulators, which are accountable to Parliament, can also be called before the Health and Social Care Select Committee (or equivalent in the devolved legislatures) at any time.

 

2. Education and training

The reforms in this area aim to give regulators greater flexibility to determine how they set standards for, and quality assure, education and training. By removing overly prescriptive legislation and providing all regulators with broadly equivalent powers, the intended reforms will enable regulators to adapt more efficiently to changes in the healthcare environment and to the changing needs of service users and the general public. In turn, this will provide ongoing assurance that newly qualified professionals are equipped to offer safe and effective care.

The reforms will provide all regulators with a full range of powers to set standards in relation to:

• the outcomes of education and training
• specific courses and programmes of training
• education and training providers

These powers will provide assurance that approved courses are equipping learners with the skills, knowledge and experience that they need.

The regulators’ increased autonomy will be balanced by the duties set out in the governance and operating framework.

 

3. Registration

The reforms in this area focus on providing a high-level framework of requirements relating to the form of the register and the criteria for registration that are needed to maintain high standards of public protection.

The reformed legislation will enable regulators to set out many of the detailed requirements for registration in their own rules. Regulators will have greater flexibility to set out the routes to registration, as well as any conditions on registration.

 

4. Fitness to practise

The reforms in this area aim to provide greater consistency between regulators’ fitness to practise functions. The proposed changes will deliver a fitness to practise process that is swifter, fairer and less adversarial, which will benefit all parties involved in fitness to practise proceedings and, most importantly, will ensure swift public protection where needed.

 

5. Regulation of AAs and PA

In order to regulate AAs and PAs, the GMC will be required to:

• register qualified and competent AAs and PAs;
• set standards of education, training, knowledge, skills, experience, conduct, performance, ethics and English language; and
• operate fitness to practise procedures for both roles.

The GMC’s powers will be extended to enable it to:

• approve and quality assure AA and PA education and training programmes; and
• determine which international qualifications it will recognise for the purposes of registration in the UK.

Regulation will also mean that it will be an offence for someone, with intent to deceive, to:

• use the titles ‘anaesthesia associate’ or ‘physician associate’ if they are not registered as such with GMC (though note the transitional arrangements below)
• falsely represent anyone to have an approved qualification (which will cover AA and PA courses) or be registered
• make a false representation as to the content of the register
• procure, or attempt to procure, the inclusion or exclusion of information in the register

 

Outcome of the consultation

The DHSC received 525 responses from individuals, organisations, healthcare professionals and members of the public. On the whole, the response to the consultation was positive. There is clear support for changes to the legislative structure that underpins the regulatory bodies and the creation of a more consistent legislative framework. For instance, the General Medical Council (GMC) welcomed the consultation “as a major step towards fulfilling the UK government’s longstanding commitment to reform of professional regulation”. The reform is hoped to enable shared approaches amongst healthcare regulators.

The feedback also pointed out those areas which needed further consideration and the DHSC have since engaged extensively with the regulatory bodies and other stakeholders to develop their policies further. There is now a further opportunity to comment on these proposals through the consultation on the draft Anaesthesia Associates and Physician Associates Order, which has been published alongside the consultation response. Each regulator’s reformed legislation will also be subject to future consultation.

These responses will result in a number of finalised policy positions adopted by the government. Such positions will provide the basis for legislation enabling the GMC to regulate AAs and PAs.

Comment

Professional regulation is essential to set and enforce professional behaviour, competence and ethics expected of healthcare registrants. It primarily exists to protect the public. However, the regulatory and legislative structures in place to do so have not kept up with changes in healthcare systems and society’s expectations of the functioning of such systems.

The GMC has rightly pointed out that “As individual professionals increasingly work together as part of the wider healthcare team, the differences and disconnections between the way different professions are regulated have become all too apparent. This lack of consistency and co-ordination has hampered regulators in their efforts to protect the public and support those we regulate to deliver great care.”

These reforms should therefore provide all nine healthcare professional regulators with flexible, modern and efficient processes which have long been needed.

 

FURTHER INFORMATION

If you have any questions or concerns about the content covered in this blog, please contact Shannett Thompson.

 

ABOUT THE AUTHORs

Shannett Thompson is a Partner in the Regulatory Team having trained in the NHS and commenced her career exclusively defending doctors. She provides regulatory advice predominantly in the health and social care and education sectors. Shannett has vast experience advising regulated individuals, businesses such as clinics and care homes and students in respect of disciplinary investigations.