Outdated fitness to practise investigations 'must change', warns government

Fitness to practise investigations are outdated, according to a government consultation that sets out plans to adopt a 'more preventative and supportive' model.

The government said regulators ‘continue to be hampered’ by a legislative framework that is more than 150 years old and has not kept pace with changes in the health and social care system.

It added that the current model deals with complaints in a reactive way, with a strong emphasis on dealing with concerns about the minority at the expense of supporting the vast majority.

Fitness to practise investigations are ‘lengthy and frustrating’ and do not support early identification and resolution of concerns, it said.

The consultation document said: ‘The emphasis on dealing with concerns about registrants after issues have been raised limits the ability of the regulators to support the professional practice of their registrants before problems occur.

Safety investigation

‘Similarly, it can inhibit professionals from taking part in safety investigations because of a fear that information from such processes could lead to a fitness to practise referral.

‘While fitness to practise must remain a key function for the regulators, giving them powers to handle fitness to practise cases in a proportionate way will allow for a more preventative and supportive approach.’

The consultation proposes greater flexibility and discretion over how to process and investigate fitness to practise cases – for example by making the triage process more robust and increasing the use of dispute resolution and mediation to manage concerns that do not require full investigation.

The consultation invites opinion on 24 different questions, and also asks whether the number of bodies that regulatory the health and social care sector should be reduced, and what powers should they have.

It asks how they should be configured if the number were reduced. Nine regulatory bodies, including the GMC – which regulates GPs – are included in the consultation.

The others are regulators that look at other professions, and include the General Dental Council, the General Pharmaceutical Council and the Nursing and Midwifery Council.

It asks as well whether the Professional Standards Authority for Health and Social Care (PSA) should still be able to appeal against fitness to practise decisions.

Loss of expertise

But one medicolegal organisation warned that consolidating specialist regulators into more general bodies could result in expertise being lost.

Dr Pallavi Bradshaw, senior medicolegal adviser at the Medical Protection Society, said: ‘We will be reviewing the detail in this consultation carefully – an amalgamation exercise which could result in the specific expertise of each profession’s regulator being lost would be concerning.

‘Any new regulators, replacing the existing nine, would need to be able to distinguish between the hugely differing roles within the many professions they would oversee.'

MDDUS senior lawyer and practice development manager Joanna Jervis said: ‘We welcome the publication of this long awaited and wide-ranging consultation, which picks up on the recommendations of the Joint Law Commissions’ report on the Regulation of Healthcare Professionals in March 2014.

‘We will be responding in detail to the consultation questions, focusing in particular on the difficulties which may be posed by a reduction in the number of healthcare regulators, as is proposed.

‘We agree that the current regulation of healthcare professionals is outdated, slow and in need of reform.

‘We welcome, in particular, the proposals on autonomy and greater freedom for the regulators. Reform in this area is vital to allow the regulators to function more effectively without the need to go through archaic legislative processes to achieve changes to operational practices.

‘We support steps that make the complaints and regulatory processes less stressful for our members and more transparent for patients. Early local action is key to defuse most complaints. In our experience, complaints that are dealt with quickly and efficiently are far more likely to be resolved.’

Selected consultation questions

Q5: Do you agree that there should be fewer regulatory bodies?
Q7: Do you have views on how the regulators could be configured if they are reduced in number?
Q10: Do you agree that the PSA's standards should place less emphasis on the fitness to practise performance?
Q11: Do you agree that the PSA should retain its powers to appeal regulators' fitness to practise decisions to the relevant court, where it is considered the original decision is not adequate to protect the public?
Q17: Do you agree that the regulatory bodies should be more accountable to the Scottish Parliament, the National Assembly for Wales and the Northern Irish Assembly, in addition to the UK Parliament?
Q21: Should potential savings generated through the reforms be passed back as fee reductions, be invested upstream to support professionalism, or both? Are there other areas where potential savings should be reinvested?

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