Regulation exists in many forms, from employer-led to statutory, with several variations in structure and processes but with a common aim to ensure public safety. The reason for such variation is historical legal frameworks which over time, have seen changes to rules and regulations, often in relation to fitness to practice arrangements.
We currently have three approaches to regulation including:
- statutory regulation of 32 professions across nine professional regulatory bodies
- accredited registers that are maintained by professional bodies
- an employer-led system that exists for the whole workforce, not just those who are not subject to additional layers of regulation and registration.
The Professional Standards Authority (PSA) oversees the professional regulators, working with them to improve the way that professionals are regulated. They also have powers to assess and accredit organisations who register practitioners, who are not regulated by law, and work closely with the Government by giving policy advice and encouraging research to improve regulation.
Statutory regulation refers to professions that must be registered with a professional regulatory body by law. Employers must check that healthcare professionals are registered with an appropriate regulated body by law and are fit and licensed to practise in their chosen profession before they start work. They should also ensure that professionals continue to maintain registration and fitness to practise for the full duration of employment with them.
There are nine statutory professional regulatory bodies across the health and care sectors. Each regulator maintains a register of individuals who meet the required standards set for the specific profession. Including standards of education, training, professional skills, behaviour and health.
Each regulator has its own systems to enable you to check their registers and have detailed processes of how to alert them if you have concerns about an individual's fitness to practise. You can find these on the websites below.
The professional regulators
- General Chiropractic Council (GCC) regulates the chiropractic profession.
- General Dental Council (GDC) regulates dental professionals. This includes dentists, dental nurses, dental technicians, clinical dental technicians, dental hygienists, dental therapists and orthodontic therapists.
- General Medical Council (GMC) regulates doctors.
- General Optical Council (GOC) regulates the optical professions.
- General Osteopathic Council (GOsC) regulates the practice of osteopathy.
- General Pharmaceutical Council (GPhC) regulates pharmacists, pharmacy technicians and pharmacy premises in Great Britain.
- Health and Care Professions Council (HCPC) regulates 15 health and care professions: arts therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dietitians, hearing aid dispensers, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, practitioner psychologists, prosthetists/orthotists, radiographers and speech and language therapists.
- Nursing and Midwifery Council (NMC) regulates nurses, midwives and nursing associates.
- Pharmaceutical Society of Northern Ireland (PSNI) is the regulatory and professional body for pharmacists in Northern Ireland.
The list of accredited registers is managed by the PSA.
The accredited registers work alongside employers, commissioners, local authorities, patients, and consumer protection agencies as part of a quality assurance network. They set the same level of standards for practitioners working in unregulated health and care occupations as those on statutory regulated professions.
Seeking health care professionals that are on an accredited register can offer peace of mind to employers, the public and patients that they are competent, trustworthy and are committed to achieving high standards of personal behaviour, technical competence and, where relevant, business practice. It also offers a means to take action if there is any cause to raise concerns about a registrant's fitness to practise.
The list of accredited bodies can be found on the PSA's website.
Encouraging individuals to join an accredited register
While it is not compulsory for unregulated practitioners to go on an accredited register, employers may wish to consider profiling the benefits of being part of an accredited register as part of their recruitment process because of the added levels of assurances it can bring.
Where requiring individuals to be part of an accredited register, employers must ensure that job adverts and personal specifications are updated to include reference to all the registers that are relevant to that profession to ensure they do not inadvertently restrict or prevent individuals from being considered for the role.
Voluntary registers - top tips
There are currently 85,000 qualified practitioners on accredited registers, overseen by the PSA. These are the four key things you can do to help maximise employment opportunities for these practitioners and increase your workforce supply pool.
Tip - Ensure recruiting managers understand the role of the PSA and the standards it sets
The PSA helps to protect the public by accrediting a number of registers of professions that are not required by law. All practitioners registered meet a set of standards which accredited bodies have to uphold to demonstrate their commitment to ensuring good practice and patient safety.
The standards can be found on the PSA website. You can also view the check a practitioner tool, which allows you to check the registration of a practitioner when employing them.
Tip - Signpost recruiting managers to the registers
It is important that recruiting managers know about the different registers and acknowledge that in some cases, there is more than one register per profession. Not only is this awareness important in encouraging staff to consider the benefits of joining an accredited register, but ensures that all the appropriate registers are highlighted when recruiting.
For example, the PSA accredits six bodies in the field of counselling and psychotherapy and two for healthcare science – all who meet the high standards set by the PSA and have processes in place to deal with registrants who fall short of these.
Tip - Ensure your job descriptions and person specifications reflect the relevant registers
Given that all accredited registers meet the same standards, we recommend employers state all of the applicable registers in job descriptions and person specifications. Not only does this good practice widen the talent pool when recruiting to vacancies and give you confidence in who you are recruiting, it ensures fairness and equality to individuals within the profession.
Please remember that it is not compulsory for unregulated practitioners to go an accredited register but employers may wish to consider profiling the benefits of being part of an accredited register as part of their recruitment process.
Information on the benefits of choosing an individual from an accredited register can be found on the PSA website.
Tip - Keep aware of changes
As organisations continue to realise the benefits of having accreditation with the PSA, the register grows. You can find out who is registered and who is seeking accreditation on the PSA website:
It may also be worthwhile encouraging recruiting managers to subscribe to regular newsletters from the PSA.
Role of the employer
Employers need to assure their board that the quality of care and experience not only meets the desired standard but is continually improving. This is achieved through a variety of employment and workforce practices.
There are several priority areas for the employer which, when reviewed against the expectations of the service, can provide assurance of the competence of their whole workforce.
1. Recruitment: clear expectations, the use of employment checks and induction.
2. Supervision: systems in place to provide supervision to individuals where appropriate and for the overall care being delivered to patients.
3. Continuing Professional Development: to ensure all staff continue to meet the requirements of the role they are employed to undertake.
4. Clear standards, expectations and boundaries: to ensure appropriate delegation and assure individuals do not operate beyond their scope of competence.
5. Appraisal: using the many different tools available to support the assurance process.
6. Policies: embedded into practice that support staff to challenge issues of concern and deal with unacceptable behaviour or poor standards of care in an appropriate way.
These actions help to create a local system that puts patient safety at the heart of employment practice. We know there is compelling evidence showing links between high levels of staff engagement and overall organisational effectiveness, so the actions need to be underpinned by a set of behaviours that create a culture of patient safety and continual improvement in quality:
- strong leadership
- environment where staff are happy to raise concerns
- staff engagement drives service delivery
- effective team working and a team ethos to delivering care.
Fair recruitment requirements
Some healthcare practitioners are eligible to join more than one register depending on their qualifications and it is important employers don't limit the pool of candidates by requesting statutory registration with a regulatory body when in some cases, this doesn't exist for the individual.
- Healthcare scientists - some who are statutorily regulated by the Health and Care Professions Council and others who register with the Academy for Healthcare Science or indeed both.
- Sonographers - some who may have already trained as a nurse or radiographer and therefore are regulated by the Nursing and Midwifery Council (NMC) or HCPC and others who trained through a direct entry route and who are voluntary registered with the Register of Clinical Technologists. You can find out more in the medical radiography and ultrasound workforce section of the website.
Under the Health Care and Associated Professions (Indemnity Arrangements) Order 2014, healthcare professionals who are statuorily registered are legally required to confirm that they have relevant indemnity insurance. This is to cover the different aspects of their practise for them to register or remain on a register with a professional regulatory body in the UK.
We strongly recommend that NHS organisations provide information to all healthcare professionals, regardless if they are statutorily registered, either directly employed or contracted through an agency or third-party supplier. Organisations should explain what indemnity arrangements are offered and the scope of that cover. This will enable individuals to make an informed decision about whether they need to seek their own professional indemnity insurance.
What questions might staff ask?
Please note that NHS Employers cannot respond to individual queries from staff about the scope of local indemnity arrangements as this will be determined by local agreed terms of employment.
Healthcare professionals may seek further information about indemnity cover from their:
- employing organisation's human resources or personnel department
- professional regulatory body.
Where healthcare professionals have taken out a separate indemnity policy, they should contact their insurance company to ensure they continue to have the correct level of cover for the type of services they are or will be providing.
Further information can be found on the NHS Resolution website.
In 2007, the government published a white paper which proposed that all healthcare professionals should complete a process of revalidation.
Revalidation is a process that health professionals undertake to collect evidence and demonstrate their fitness to practise to renew their professional registration.
Further information about revalidation can be found on the websites of the GMC (medical revalidation), NMC (revalidation for nurses and midwives) and GPHC (revalidation for pharmacists).
In 2021, the government opened a consultation to consider how the powers to introduce and remove professions from regulation might be used in the future. It sought views on:
- the proposed criteria to make decisions on which professions should be regulated
- whether there are regulated professions that no longer require statutory regulation
- whether there are unregulated professions that should be brought into statutory regulation.
The consultation is now closed and feedback is currently being analysed. NHS Employers will continue to monitor this and will provide an update on the consultation as soon as we are able.