The system for the regulation of the healthcare workforce currently incorporates nine regulatory bodies including, the Nursing and Midwifery Council (NMC), the Healthcare Professions Council (HPC) and the General Medical Council (GMC), and the overarching Council for Healthcare Regulatory Excellence (CHRE).
This system of regulation has been the subject of two reviews led by Chief Medical Officer Professor Sir Liam Donaldson who set out proposals on the future regulation of the medical workforce following the Shipman inquiry (see Good Doctors; Safer Patients); and a review of the regulation of non-medical staff led by former DH director of workforce Andrew Foster.
The results of the reviews and proposals for a revised system which includes a much greater role for individual employers were published on July 14 2006 and are now subject to consultation.
The key recommendations from the CMO's review into the regulation of the medical profession include:
- The creation of standards for generic and specialist practice to give a clear, universal definition of a 'good doctor' and to allow patients, employers and doctors themselves to have a shared understanding of what is expected of doctors
- These standards would be incorporated into doctors' contracts
- Devolution of some of the powers of the GMC, as a statutory regulator, to the local level through the creation of a network of trained and accredited GMC affiliates
- The creation of an independent tribunal to adjudicate on fitness to practise matters. The GMC would focus on the assessment and investigation of cases
- A renewed focus on the assessment, rehabilitation and supervision of doctors with performance problems where these problems are not borne of malice
- Greater public and patient involvement to ensure public and patients work with the GMC affiliates in making decisions around fitness to practice, and with medical Royal Colleges in the process of re-certification
- A new twin-track system of revalidation and re-licensure for all doctors and re-certification for those on the specialist register
The key recommendations of the review of non-medical regulation include:
- Regulation of the professions should form one integrated and consistent framework across the different professions, and should link up better with the measures employers take to satisfy themselves that their staff are working safely
- Consulting on options for creating more independent adjudication about cases where someone's fitness to practise causes concern
- The need to provide objective and robust assurance that individual professionals remain fit to practice by standardising the content and enhancing the value of workplace appraisal
- Every registered professional will need to revalidate, but the amount of detail they need to provide will vary depending on how much risk to patients their work creates
- A major employer role in revalidation, with a system to check that employers fulfil this duty with parallel arrangements where there is no employer
Alongside these reviews NHS Employers has been involved in an ongoing programme of engagement with the regulators around how we can support employers. This work includes:
- A meeting held by NHS Employers to explore the regulation boundaries between the employer, regulator and individual professional
- A joint reference group whose members are NHS Employers and the General Medical Council (GMC) has been set up to provide the GMC with the employers' perspective on regulatory matters
- A project undertaken by CHRE on behalf of the Department of Health to address maintaining and promoting effective boundaries between patients and professionals.
Taking on board the views of employers and other parties involved in these meetings, NHS Employers has identified a preliminary work programme to complement the proposals outlined in the reviews. This includes:
- Developing a single investigatory process to satisfy employer and regulator requirements around complaints and serious incidents
- Developing a set of competencies required to undertake an investigation successfully
- Formulating a development programme for staff involved in investigations
- Developing an approach to the regulation of the healthcare support worker workforce.
NHS Employers' regulation reference group will be reviewing work undertaken by NHS employers in this area.
Last reviewed 13 Nov 2006
