Healthcare Professional Regulation PDF

Our current system of regulation of healthcare professionals has evolved over many years and is subject to piecemeal legislation. There have been several landmark events which rocked the public’s confidence in healthcare professionals and led to a major shake up of the regulatory environment: Histor...

Our current system of regulation of healthcare professionals has evolved over many years and is subject to piecemeal legislation. There have been several landmark events which rocked the public’s confidence in healthcare professionals and led to a major shake up of the regulatory environment: Historical context The 1998 Bristol Inquiry (Kennedy) exposed deficiencies the profession and ultimately, resulted in the shift away from self-regulation. KEY CHANGES Mandatory clinical audit Defined clinical standards Revalidation Framework for assessing performance Defined responsibilities within team based care Review of informed consent Measures to improve clinical communication skills Patient safety metrics Fast on the heels of the Bristol Inquiry, came the conviction of Shipman in 2000. The Shipman Inquiry, chaired by Dame Janet Smith, generated 6 reports. The GMC was subject to criticism for historically acting more to support doctors than to protect the interests of patients. The GMC response, “Developing Medical Regulation”, proposed a four-layer model of self-regulation: 1. Personal regulation – by doctors committed to a code of ethical conduct 2. Team-based regulation – individual healthcare professional’s taking responsibility for the teams in which they work 3. Workplace regulation – the responsibility of employers to ensure their staff’s fitness to practise 4. Professional regulation – by the GMC to include education, registration and ongoing checks. Independent versus Self-regulation There has been a gradual shift towards more independent regulation Future Directions Further changes will be required in order to respond to the current healthcare challenges. It is recognised that the current structure of 9 regulatory bodies, ranging significantly in size and efficiencies is not sufficiently agile or cost effective to meet the ambitions of the Five Year Forward View. Moreover, the number of regulatory bodies and the inconsistency of decision making creates confusion and frustration for the public. The Department of Health published a consultation paper, Promoting professionalism, reforming regulation, in October 2017. This paper proposes efficiencies including reducing the number of regulators to design a more responsive model of regulation and introduction of joint working and sharing of functions and services across the regulators. More info is available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/at tachment_data/file/655794/Regulatory_Reform_Consultation_Document.pdf The Government published a response in July 2019. This is available at: https://assets.publishing.service.gov.uk/government/uploads/system/upload s/attachment_data/file/820566/Promoting_professionalism_reforming_regulati on_consultation_reponse.pdf Key proposed changes include: Modernisation of fitness to practise procedures to allow regulators to dispose of cases consensually Regulator governance changes Increased flexibility for regulators to amend rules The Government launched a consultation in March 2021: https://www.gov.uk/government/consultations/regulating-healthcareprofessionals-protecting-the-public The over-arching objective of healthcare regulation must be to protect patients and the public from harm. The Professional Standards Authority for Health & Social Care (PSA), is a proponent of ‘Right Touch’ regulation. This concept recognizes that regulation may not always be the best solution to problems. For example, a more appropriate response to an issue, may be to strengthen employment practices or to foster professionalism. According to the PSA, the six principles of regulation should be: The PSA has published a document "Standards of Good Regulation". This is available at: https://www.professionalstandards.org.uk/publications/detail/standardsof-good-regulation-2019 There are currently three approaches to regulation including: Statutory regulation across 10 professional regulatory bodies A number of accredited registers which 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 There are currently 10 Healthcare Professional Regulatory bodies. The most recent addition was Social Work England, which became operational on 02 December 2019. The NMC has recently taken on registration for Nursing Associates in England. The relevant legislation is the Nursing and Midwifery Order (2018). The Government White Paper Trust, Assurance and Safety – the Regulation of Health Professionals in the 21st Century, highlighted the need for independence of the regulatory bodies ‘to sustain the confidence of both the public and the professions through demonstrable impartiality. Regulators need to be independent of government, the professionals themselves, employers, educators and all the other interest groups involved in healthcare’. The Role of Parliament The UK Parliament is responsible for the regulation of healthcare professionals in England and Wales. It is a devolved matter in Northern Ireland. In Scotland, it is devolved for healthcare professionals who entered regulation after the passing of the Scotland Act 1998. The Role of the Professional Standards Authority for Health & Social Care (PSA) The PSA oversees the 10 regulatory bodies and reviews their decisions regarding fitness to practise. The PSA has the power to appeal decisions to the relevant court if it considers that a fitness to practise decision does not protect the public. In 2019/20, the PSA referred 21 cases to court, using powers conferred under section 29 of the NHS Reform and Healthcare Professions Act 2002. It also sets standards for organisations holding voluntary registers for people in unregulated health and care occupations, and accredits those organisations which meet their standards. This includes 26 organisations covering 88,000 practitioners across a range of unregulated professions including public health, counselling and psychotherapy and health sciences. The accredited registers can be used by employers and members of the public to choose a practitioner to meet their needs and be assured that they are safe and competent to practise. The Role of the Privy Council The regulators (apart from PSNI) are accountable to the Privy Council, and the PSA provides oversight of how they carry out their regulatory functions. The Privy Council has default powers to direct most of the regulators if they fail to deliver their objectives. However, this does not apply to the GDC and GPhC. The Current Regulators Most of the regulatory bodies cover the whole of the UK. The exception to this is the GPhC which regulates pharmacists and pharmacy technicians in England, Scotland and Wales, whilst the PSNI (Pharmaceutic Society of NI – not Police Service Northern Ireland!) regulates pharmacists in Northern Ireland. Prior to 2001 social workers were not subject to statutory regulatory regimes. The regulation of social workers differs across the different jurisdictions. The NHS has seen the emergence of new professional roles working within multidisciplinary teams as part of a continuing drive to provide safe, accessible and high-quality care for patients across the UK. The GMC is preparing to regulate Physician Associates and Anaesthesia Associates. This is subject to changes in legislation. In Summary Fitness to Practise refers to minimum standards expected of health professionals, as defined by their Regulatory body. Fitness for Purpose refers to employer’s role specific requirements. https://www.gmc-uk.org/guidance/21721.asp The key standards are set out in Good Medical Practice (2013) available at: https://www.gmc-uk.org/guidance/good_medical_practice.asp As per the GMC “serious or persistent failure to follow this guidance will put your registration at risk”. Following the Fifth Shipman report recommendations, The MPTS was established in June 2012 to provide a clear separation between the investigatory function of the GMC and the adjudication of hearings. It is funded by the GMC, however, there is a clear operational separation. In 2015, it was established as a statutory committee of the GMC, thus strengthening the separation. It has a responsibility to deliver an annual report to Parliament. The GMC acquired the right to appeal MPTS decisions. This right has become highly controversial, as highlighted by the BawaGarba case. The subsequent Williams review has recommended that this right is revoked. Prof Williams review “Gross Negligence Manslaughter in healthcare” is available at: https://www.gov.uk/government/groups/professor-sir-norman-williamsreview The GMC commissioned an Independent Review into Gross Negligence Manslaughter. This was chaired by Leslie Hamilton. Key recommendations include: The need for quality expert evidence Better support for doctors in Coroners’ courts Culture change to ‘just culture’ Consistency and improved quality of local Serious Incident investigations It is available at: https://www.gmc-uk.org/-/media/documents/independentreview-of-gross-negligence-manslaughter-and-culpable-homicide---finalreport_pd-78716610.pdf The GMC has indicated that until the legislation is changed, it plans to continue to exercise the right of appeal. Investigation Anyone can complain about a doctor to the GMC. In 2016, the GMC piloted a ‘Provisional Enquiry’ scheme in order to improve efficiency and streamline the investigation process. This involves an initial assessment to determine whether or not a full investigation is required. In 2016, 75% of the 350 complaints dealt with in this way, were closed down without full investigation. This led to significantly shortened complaint handling timescales. Instances in which Provisional Enquiries may be used include: The allegation is unclear and/or; It is unclear whether the allegation is serious enough to raise a question about the doctor’s fitness to practise or; Where the supporting information may be unlikely to support the concern about the doctor’s fitness to practise Where a referral involves a doctor who has raised patient safety or system concerns, where further information would help make a more informed decision. If a complaint involves a single instance of poor clinical care. Some health cases The GMC write out to the doctor’s Responsible Officer for further information in order to assist with the decision as to how to handle the complaint. For full investigations, the complaint is looked at by 2 Case Examiners – 1 lay and 1 medical. Further information will be requested from the complainant, the doctor and the employing organisations. Expert opinion may also be sought and the doctor may be asked to undergo a Health Assessment or Performance Assessment. The Case Examiners may decide: To close the complaint with no further action To issue a warning (except in cases where the issue relates solely to health) Agree undertakings To refer to an Interim Orders Tribunal To refer to the MPTS Fitness to Practice Tribunal The table below illustrates trends in complaints received between 2011 2021 The overall number of investigations has dropped over this period: Adjudication There are two types of hearing: 1. Fitness to Practise Tribunal Three stages The standard of proof is the civil standard: ‘balance of probabilities’. Prior to May 2008, the criminal standard ‘beyond reasonable doubt’ was used. The tribunal is comprised of 3 tribunal members, at least one must be medically qualified and one must be lay. The 2015 amendments also allowed for the introduction of legally qualified chairs. Tribunal members are appointed on the basis of competency assessment. Hearings are held in public, unless there is a specific reason (e.g. health), for the case to be heard in private. The types of cases brought before the MPTS Fitness to Practise Tribunal include one of more of the following categories of impairment: Misconduct Deficient professional performance Conviction or caution for a criminal offence Adverse physical or mental health Not having necessary knowledge of English (as per changes to the Medical Act in 2015) A determination made by another regulatory body As per the table below which shows the types of alleged impairments in MPT hearings over the period 2017-2019, the highest proportion of cases related to misconduct. The GMC presents the case against the doctor, then the doctor or his/her representative has the opportunity to respond. The tribunal retires to discuss in camera at each stage. Stage 1 – Facts found proven? If the facts are not found proven, the case will be concluded. However, if the facts are found proven either in whole or in part, the matter of impairment will have to be determined. Stage 2 – Is the doctor's fitness to practice impaired? This stage is about whether or not on the basis of the facts found proved, the doctor’s fitness to practice is impaired. Both the GMC and the doctor or his/her representative have the opportunity to address the tribunal regarding the matter of impairment. The Tribunal then retires to reach a decision. In the event of the Tribunal determining that fitness to practice is not impaired, it may ask both parties as to whether or not the doctor should be given a warning. Warnings are regarded appropriate in cases where there has been a significant departure from Good Medical Practice, or if there is significant concern about some part of a doctor’s practice, but a restriction on registration is not deemed necessary. Prior to February 2018, warnings were published against a doctor’s entry on the medical register for five years, however, following a change in legislation, since February 2018, warnings are published on the Medical Register (on the GMC website) for two years, but are available indefinitely to employers. Stage 3 – Should sanctions be imposed? In cases where the Tribunal finds the doctor’s fitness to practice impaired, then it will process to step 3 to determine whether or not a restriction on registration or erasure is appropriate. The relevant guidance is ‘The Sanctions Guidance’, available at: https://www.mpts-uk.org/-/media/mptsdocuments/dc4198-sanctions-guidance---16th-november-2020_pdf84606971.pdf Possible outcomes include: No action (this is rare) Undertakings for a maximum period of 3 years when these have been proposed by the doctor and agreed by the GMC Conditions for a maximum period of 3 years. However, conditions must address the underlying impairment and must be workable. Suspension for a maximum period of 12 months Erasure. In such cases, it is 5 years before a doctor can apply for restoration to the medical register. There is a fairly high bar set for restoration cases, as the Tribunal considering such cases must be confident that the doctor can return to clinical practice unrestricted. In 2016, 6 out of 15 applications for restoration were granted. The table below shows outcomes from MPT hearings over the period 20172019. Concerns have been raised about potential worse outcomes for BAME doctors. A recent peer reviewed study has been published which indicates that engagement, not personal characteristics was associated with seriousness of regulatory adjudication decisions. Those who failed to attend the hearing or did not have legal representation were more likely to receive a more serious outcome. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-14511 In 2019, around 11% of doctors were unrepresented and 37% did not attend or were not represented. 2. Interim Orders Tribunal These do not make findings of fact. Their role is to protect patients, protect public confidence or (in cases involving the doctor’s health) act in the interests of the doctor concerned). They can make orders suspending a doctor’s registration or imposing conditions for up to 18 months. Reviews are carried out at least every 6 months, and can be extended beyond 18 months by the High Court only. Changes to the Medical Act in 2015 gave powers to hold review hearings on the papers when both sides agree the proposed outcome. Appeal The doctor, the GMC and the Professional Standards Authority (PSA) can appeal decisions to the High Court of Justice (England & Wales), Court of Session (Scotland) or the High Court of Justice of Northern Ireland. The Employer's Role - Disciplinary Action NHS England has recently published guidance – A Just Culture Guide. This is available at: https://www.england.nhs.uk/patient-safety/a-just-cultureguide Concerns in the workplace may relate to: Health Conduct Capability In secondary care, the relevant guidance for employers is ‘Maintaining Higher Professional Standards’. This was published by the Department of Health in 2003 and applies to doctors and dentists, not covered by Performers List Regulations. It is available at: https://resolution.nhs.uk/services/practitioner-performance-advice/usefulguidance Practitioner Performance Advice (previously NCAS), should be involved at an early stage. They can provide advice, undertake assessments and training. They also issue Healthcare Professional Alert Notices (HPANs). This informs NHS bodies and other organisations about health professionals who may pose a significant risk of harm to patients, staff or the public. In primary care, doctors fall under the Performers List regulations. The Framework for Managing Performer Concerns is available at: https://www.england.nhs.uk/publication/framework-for-managingperformer-concerns Professionalism is a concept which is difficult to define. Sir Kenneth Calman suggested that a profession has the following characteristics: Driven by a sense of vocation or calling, implying service to others Has a distinctive knowledge-base, which is kept up to date Sets its own standards and controls access through examination Has a special relationship with those whom it serves Is guided by particular ethical principles Is self-regulating and accountable The Royal College of Physicians’ description of medical professionalism is: “a set of values, behaviours and relationships that underpins the trust that the public has in doctors." Over time, this concept has evolved to embrace “patient-centredness”. In 2006, the revised version of Good Medical Practice, was targeted specifically at patients as well as doctors and the principles, instead of being aspirational, were outlined as a minimum standard of conduct and behavior expected of all doctors. The role of the regulator has changed from gatekeeper to initial registration with a transactional role, collecting annual fees and very occasionally investigating a complaint to one of more regulator contact with responsibilities for revalidation and producing guidance. Professional guidance is available at: https://www.gmcuk.org/guidance/index.asp Candidates should familiarise themselves with the content. The GMC was first established under the Medical Act 1858. The main remit was to protect patients from unlicensed doctors, although it could prosecute practitioners who posed as medically qualified. Interestingly, it also had a remit to protect the qualified medical practitioner, and this created a tension between the two roles. The current Act is the Medical Act 1983, which has been amended on a number of occasions, most recently in 2015 by the General Medical Council (Fitness to Practise and Overarching Objective) and the Professional Authority for Health and Social Care (References to Court) Order 2015 (Commencement No.1 and Transitory Provisions) Order of Council 2015 ( https://www.gmc-uk.org/-/media/documents/gmc--fitnessto-practise-and-over-arching-objective--order-2015_pdf-62040595.pdf), which made the following key changes: • Placed the MPTS on statutory footing • Gave the GMC the right to appeal MPTS decisions • Made improvements on how the GMC investigates concerns The over-arching objective of the GMC in exercising their functions is the protection of the public. The pursuit of this over-arching objective involves the pursuit of the following: 1. To protect, promote and maintain the health, safety and well-being of the public 2. To promote and maintain public confidence in the medical profession 3. To promote and maintain proper professional standards and conduct for members of that profession The composition of the GMC The relevant legislation is The General Medical Council (Constitution) Order 2008. Prior to this Order, the membership of the GMC was made up of a number of lay members appointed by the Privy Council and a number of professional members who were elected representatives of doctors registered with the GMC or chosen by designated appointing bodies. The White Paper, Trust, Assurance and Safety – the Regulation of Health Professionals in the 21st Century, (2007) set out a substantial reform program, including the need for parity of membership between lay and professional members, appointed by an independent appointments process. The aim being, to enhance public confidence by ensuring professional concerns did not dominate the work of members. There are currently 12 council members, 6 medical and 6 lay, all of whom have been appointed by the Appointments Commission by virtue of a separate set of directions given by the Privy Council. The Chair is elected from amongst the appointed members. The Appointments Commission is also responsible for suspension or removal from office of members, however the GMC may also provisionally suspend members under its own standing orders, pending the outcome of the Appointments Commission consideration of the matter. The Council is the governing body of the GMC and ensures that the GMC is properly managed by the Executive Board and that the organization fulfills its statutory and charitable purposes to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. The Executive Board is chaired by the Chief Executive and consists of the senior management team. It is responsible for setting strategic direction and for performance. Revalidation for doctors was introduced on 03 December 2021, and has been influenced by the 5th report of the Shipman Inquiry. The relevant legislation is: Health Care and associated professions doctors The General Medical Council (Licence to Practise and Revalidation) Regulations Order of Council 2012 [(https://www.gmcuk.org/-/media/documents/LtP_and_Reval_Regs_2015.pdf_61954008.pdf) This requires doctors to be revalidated on a 5 yearly cycle in order to retain a licence to practise. It is a GMC process based upon licensed doctors: • Working within environments with robust clinical governance • Undertaking annual appraisals covering the entire scope of practice and embedding the values and principles of Good Medical Practice Annual appraisal was introduced in 2003. GMC guidance is available at: https://www.gmc-uk.org/registration-and-licensing/managing-yourregistration/revalidation/guidance-on-supporting-information-for-appraisaland-revalidation/supporting-information-for-appraisal-and-revalidation The GMC has also published guidance on reflection. The Reflective Practitioner, available at: https://www.gmc-uk.org/education/standardsguidance-and-curricula/guidance/reflective-practice/the-reflectivepractitioner---guidance-for-doctors-and-medical-students This updated guidance emphasises the need for quality rather than quantity of supporting information. It includes There is a need to demonstrate strengths and areas for development carefully select clear examples within each of the 6 categories of supporting information and be able to explain to the appraiser why those specific examples have been selected. Model of reflection The various Royal Colleges have published guidance regarding supporting information applicable to the relevant specialties. Key elements of appraisal include: 4 Domains: Knowledge, Skills, Performance Safety & Quality Communication, Partnership & Teamwork 6 Types of Supporting Information: Maintaining Trust Continuous Professional Development Quality Improvement Activities Significant Events Feedback from colleagues Feedback from patients Review of complaints & compliments The Medical Profession (Responsible Officers) Regulations 2010 and the Medical Profession (Responsible Officers) (Amendment) Regulations 2013, set the criteria which designates organisations. The GMC has a tool which enables doctors to determine which organization they have a prescribed connection to. This is available at: https://www.gmcuk.org/doctors/revalidation/designated_body_tool_landing_page.asp In summary, Trainees Scotland NHS Education for Scotland Wales & Northern Ireland Postgraduate Deanery England LETB GPs on the Performers List The organization that manages the list e.g. England – NHS England Northern Ireland – Health & Social Care Board Employees of one NHS Trust The NHS Trust Other Depends on: Number of organisations worked for and proportion of time in each Basis on which employed The Role of the Responsible Officer Designated Bodies have a responsibility to appoint a Responsible Officer (RO). The RO has an important statutory role in medical regulation, as set out in Medical Profession (Responsible Officers) Regulations 2010, as amended by the Medical Profession (Responsible Officers) (Amendment) Regulations 2013, or in Northern Ireland, to the Medical Professions (Responsible Officers) (Northern Ireland) Regulations 2010. The organisation has a statutory requirement to provide the RO with the necessary resources to fulfil these duties. The Role of a Suitable Person A Suitable Person is a registered medical professional approved by the Registrar as suitable to fulfil a role similar to that of RO. The GMC (Licence to Practise and Revalidation) Regulations Order of Council 2012 “(the Licence to practise regulations”) also allow doctors with no prescribed connection to a designated body to identify a ‘Suitable Person’ to make recommendations about them subject to our approval. A Suitable Person carries out the same functions as an RO in respect of making revalidation recommendations. Revalidation Recommendations The Responsible Officer makes a revalidation recommendation every 5 years. However, the decision regarding revalidation rests with the GMC. Recommendations available to ROs are: Positive Deferral Non-engagement In the event of a non-engagement recommendation, the GMC will liaise with the doctor. Should the doctor continue to refuse to engage with the appraisal/revalidation process, then the GMC will administratively remove the doctor’s license to practice. Stats to date: https://data.gmc-uk.org/gmcdata/home/#/ Doctor Revalidation Summary Nurse Revalidation The NMC introduced revalidation in April 2015. Requirements include: Portfolios are not submitted to the NMC. Instead, nurses complete a series of declarations that the requirements have been met and have a discussion with a ‘confirmer’. According to NMC information: Revalidation for nurses and midwives is not about Fitness to Practise. Revalidation is about helping you demonstrate that you practise safely and effectively and according to the NMC Code; encouraging a culture of sharing, reflection and improvement. More info is available at: http://revalidation.nmc.org.uk/ Nurse Revalidation Summary The NMC was established under the Nursing and Midwifery Order 2001 (‘the Order’); a series of orders made by the Privy Council and Rules made by the Council which sit underneath the Order. All the NMC legislation was created under powers in the Health Act 1999, and is secondary legislation. The NMC has undergone some recent changes. Previously there were two committees – the Conduct and Competence Committee and the Health Committee. These have recently been amalgamated into a single Fitness to Practise Committee. The NMC Case Examiners now have the power to give advice, issue warnings and recommend undertakings. The NMC Code (https://www.nmc.org.uk/standards/code/) published in January 2015, sets out the professional standards that all nurses, midwives and nursing associates must uphold. The 4 key themes are: Prioritise people Practise effectively Preserve safety Promote professionalism and trust The Council Is made up of 12 members – 6 lay people and 6 nurses or midwives. Appointments are by the Privy Council. Fitness to Practise Proceedings The overarching objective involves the 3 limbs: Protect the public Maintain public confidence in the professions and the NMC Declare and uphold proper professional standards of conduct and performance Consensual panel determination If a registrant wishes to resolve their case by consent, they must accept the facts of the allegation and that their fitness to practise is impaired. The appropriate level of sanction will then be agreed. It avoids unnecessary full hearings and the need for witness evidence. The Panel consists of three members: If the proceedings relate to a nurse, then one of the members must be a registered nurse; if the proceedings relate to a midwife, then one of the members must be a registered midwife There must be 1 lay member Potential sanctions include Caution order – the registrant is allowed to continue practising unrestricted, but is cautioned for their behaviour. The caution can last for 1 – 5 years. Conditions of practice order – restricts the registrant’s practise for up to 3 years and must be reviewed by a fitness to practise panel before it expires. A bank of conditions of practice is available at: https://www.nmc.org.uk/ftp-library/sanctions/thesanctions/conditions-of-practice-order Suspension order – prevents the registrant for practising for a specified length of time Striking-off order – the registrant’s name is removed from the register and they are not allowed to work as a nurse or midwife within the UK. A striking-off order cannot be made on the first hearing for the following: health cases, lack of competence cases or cases where fitness to practise is impaired by not having the necessary knowledge of English. More information is available at: https://www.nmc.org.uk/ftplibrary/sanctions/ The relevant legislation is the Dentists Act 1984 and the Health and Social Care (Safety and Quality) Act 2015. As per the other health professional regulators, the overarching objective is ‘protection of the public’ which involves the 3 limbs: To protect, promote and maintain the health, safety and well-being of the public To promote and maintain public confidence in the professions regulated To promote and maintain proper professional standards and conduct for members of the professions The Dentists Act 1984 gives powers to: Grant registration Set standards regarding education & training in the UK Set standards of conduct, performance and ethics Investigate complaints against dental professionals and where appropriate take action through fitness to practise processes Set CPD requirements The GDC regulates Dentists and dental care professionals Clinical dental technicians Dental hygienists Dental nurses Dental technicians Dental therapists Orthodontic therapists It also holds 13 specialist lists and funds the Dental Complaints Service (DCS), which helps patients complain about private dental treatment. Dental Practices also come under the independent regulations of Health and Social care: England: Care Quality Commission Northern Ireland: Regulation and Quality Improvement Authority Scotland: Healthcare Improvement Scotland Wales: Healthcare Inspectorate Wales The Council Is made of 12 members – 6 registrants and 6 lay members. It is responsible for strategy and direction. The Council is assisted by committees: Standing committees – look at policies and processes Statutory committees – carry out mainly regulatory functions Fitness to Practise https://www.gdc-uk.org/about/what-we-do Stage 1- triage Stage 2 investigation and assessment Stage 3 – hearing before a Practice Committee The Practice Committee Hearing – the objective is to determine whether the case is ‘well founded’ i.e. whether The facts as set out in the allegation are found proved The facts amount to the ‘grounds’ as set out in the allegation (e.g. misconduct/deficient performance) The registrant’s fitness to practise is impaired as a result Potential outcomes No action A reprimand for 1 year Conditions of practice – imposed for up to 3 years. Suspension – for up to 12 months Erasure – cannot apply for restoration for 5 years More info available: https://www.gdc-uk.org/professionals/ftp-prof/facingcomplaint The HCPC was established in legislation by the Health and Social Work Professions Order 2001, made under section 60 of the Health Act 1999. The Council The Constitution Order 2009, made by the Privy Council sets out the composition of the Council. The Council consists of 6 registrant and 6 lay members. There are 4 statutory committees and 2 non-statutory committees. There are 15 regulated professionals Arts therapists Biomedical scientists Chiropodists/podiatrists Clinical scientists Dieticians Hearing aid dispensers Occupational therapists Operating department practitioners Orthoptists Paramedics Physiotherapists Practitioner psychologists Prosthetists/orthotists Radiographers Speech and language therapists Investigation of fitness to practise concerns The first step is determining whether or not the concern meets the ‘standard of acceptance’. If this standard is met, an allegation is drafted and then considered by a panel of the Investigation Committee. Outcomes of an Investigation Committee hearing include: More information is needed or the allegation should be amended There is ‘a case to answer’ and the case will be referred to a final hearing There is ‘no case to answer’ – if this is the determination, and another concern of a similar nature is received within 3 years, then the initial concern may be taken into consideration. The Health and Care Professions Tribunal Service This was established in July 2016 and launched in April 2017. Whilst it remains part of the HCPC, the aim is to enhance the separation between the investigatory and adjudicatory functions. The Panel is typically composed of: A registrant of the same profession A lay person A panel chair (may be lay or a registrant from one of the HCPC professions) Steps include: Whether the HCPC has proved the facts as set out in the allegation Whether the facts amount to the ‘grounds’ set out in the allegation Whether fitness to practise is impaired as a result. Sanctions Indicative Sanctions Policy: https://www.hcpcuk.org/resources/policy/sanctions-policy Potential outcomes include No action or order mediation Caution the registrant (a warning on the registration for up to 5 years) Set conditions of practice Suspend for up to 12 months Strike the registrant from the Register http://www.hcpc-uk.org/ Candidates should be familiar with ethical guidance as issued by the GMC, GDC, NMC and HCPC. Links are provided in the summary table. SUMMARY REGULATION OF HEALTHCARE PROFESSIONALS Regulatory Body GMC Regulated Doctors professionals NMC GDC Nurses Dentists and dental care professionals Nursing associates Midwives Clinical dental technicians Dental hygienists Dental nurses Dental technicians Dental therapists Orthodontic therapists Key legislation Medical Act 1983 Health Act 1999 as amended 2015 Nursing and Midwifery Order 2001 Dentists Act 1984 Council composition GMC (Constitution) Order 2008 6 lay and 6 registrants 6 Lay & 6 Medical 6 lay and 6 nurses/midwives Health and Social Care Act 2015 Fitness to practise hearing Medical Practitioners Tribunal Service Fitness to Practise Committee Hearing Practice Committee Hearing Outcomes Outcomes Outcomes No action No action No action Caution order (1-5 yrs) Reprimand 12 months Warning (2 yrs) Conditions of practice order (up to 3 yrs) Conditions up to 3 yrs Undertakings (up to 3 yrs) Suspension order Suspension up to 12 months Striking off order Erasure The Code: Professional Standards for behaviour and conduct Standards for the Dental Team Conditions (up to 3 yrs) Suspension (up to 12 months) Erasure Standards Good Medical Practice Ethical guidance available at https://www.gmc- https://www.nmc.org.uk/standards/guidance/ https://www.gdcuk.org/ethicaluk.org/professionals/standards/gd guidance/ethicalguidance guidance-fordoctors Whistleblowing The GMC have published a decision making guide - Raising and Acting on Concerns: https://www.gmcuk.org/ethical-guidance/learning-materials/raising-and-acting-on-concerns-flowchart The Public Interest Disclosure Act 1998 provides statutory protection for whistle-blowers. NHS staff are covered by the Act. In order to gain protection provided by the act: The disclosure must be made in good faith The whistle-blower must reasonably believe that the information is substantially true The disclosure should be made to the right prescribed person