It’s been a challenging time for regulators and our Accredited Registers to assume the most effective and proportionate response to the current pandemic. Registers have needed to act quickly but thoughtfully to the changes caused by lockdown to ensure that registrants are supported, but also that the integrity of public protection is maintained. We spoke to three Registers to get their feedback and, in this blog, we discuss the challenges they have faced over the past three months and the insights they have gained during this period.
How did the registers respond?
David Kidney, Chief Executive of the UK Public Health Register (UKPHR), describes the confusion experienced in the initial lockdown phase. ‘Our registrants were immediately drawn into the fray, addressing the huge and diverse public health challenges arising from this deadly outbreak of coronavirus in the UK. From strategic leadership of community responses (Directors of Public Health and their Public Health Consultants) to front-line delivery of preventive services (public health practitioners) – even test, trace and isolate in the beginning until the Government judged that our country lacked the necessary capacity to continue this role.’
Registers have had to pioneer inventive responses to the pandemic, adopting unique approaches depending on the nature of their individual practice. For registers like UKPHR, whose registrants provide vital support to essential areas of healthcare, this has included making alterations to the registration and review process in order to maximise their ability to support the public. ‘We released specialists from the need for professional appraisal’, explains David Kidney, ‘all the appraisals due in the emergency are being treated as approved missed appraisals’. We also extended the registration cycle for specialists due for revalidation from five years to six years and postponed their revalidation for a year – we made the same extension for practitioners due their five-yearly re-registration. We also announced a temporary lifting of our CPD requirements for specialists and practitioners during the emergency, made temporary changes to annual renewal of registration during the summer, and set up a temporary register for public health professionals who had recently retired and wanted to return to help their colleagues get the pandemic under control.’
Non-essential services which consist of face-to-face consultations have now had to consider how they may continue to support members of the public remotely, as has been the case for the British Association of Sport Rehabilitators and Trainers (BASRaT). Oliver Coburn, their Reistrar, explains that ‘BASRaT acted quickly to issue guidance that face-to-face appointments should not take place, instead they should be replaced by virtual consultations. To support this challenging transition, BASRaT funded access to telehealth and exercise rehabilitation software for all its registrants. This quickly provided a practical solution and enabled registrants to continue practising safely; protecting both themselves and the public. Alongside this, BASRaT also produced guidance on the implementation of virtual consultations and hosted two webinars with experts in telehealth to provide registrants with the vital skills and knowledge needed to make use of this new way of working.’
To ensure that these services remain available to support public health in the future, registers have had to find ways of resuming training and assessment to a high standard. Coburn describes their response to this challenge: ‘To resolve the educational challenges and ensure the continuity and quality of teaching and assessment for students on BASRaT accredited courses, we’ve worked closely with programme teams at higher education institutions, providing them with the flexibility and guidance to make changes whilst still maintaining the standards needed for a practising healthcare professional. This was facilitated via a Microsoft Teams workspace that allowed programme teams from across the country to work together on effective solutions.’
Assuming alternative means of effective communication has been a huge area of development in 2020. This is important not only for boosting morale among teams, but also for essential planning toward the recovery phase and remaining connected with service users. The ARs detail the importance of collaboration during this time.
‘With public protection our foremost consideration, we worked closely with our partners in the public health system, including the relevant statutory regulator, the General Medical Council’, explains David Kidney. ‘We consulted the public health agencies in the four nations about proposed changes. We ran our proposed changes past the Professional Standards Authority.
‘We were making these changes in real time when everything was fast-moving and hectic, the pressure on everyone was immense and time was of the essence. We ramped up our communications with registrants, partner organisations and other stakeholders and we created a Covid-19 hub on our website where we brought together all the necessary information about these changes.’
Oliver Coburn also notes of the positive impact of successful communications between the Accredited Registers Collaborative. ‘It has been refreshing to see unprecedented collaboration between organisations. The 26 Registers making up the Accredited Registers Collaborative group have worked together on specific issues and BASRaT has been thankful to engage with other healthcare professional bodies and regulators on shared challenges throughout the COVID-19 outbreak.’
Accredited Registers have in some cases also demonstrated continued support to members of the public as well as registrants, even when the extent of their ability to practise is hindered. ‘We have kept our support line open to encourage registrants to find creative, non-therapeutic ways of interacting online with their clients’ notes Jeffrey Hugh Thomas, Chief Executive of Play Therapy UK (PTUK). ‘PTUK’s Facebook page has been a useful way of disseminating news and encouraging the registrants to come together, support each other and pool ideas.’
As the UK moves into the next phase of its response to Covid-19, there remains some confusion about the status of the 88,000 practitioners on Accredited Registers, which has limited their ability to contribute to the Covid-19 response and in some cases led to financial hardship. Regulations and guidance on restrictions to practice vary across the four UK countries.
One of the main challenges due to the varying nature of occupations is how individuals were to interpret the guidance. One such organisation was the British BASRaT, as their registrar Oliver Coburn writes, ‘Many were excluded from Government support, largely due to healthcare practices not being on the list of businesses required to close, this meant they could not access the business grant scheme. Other registrants are small company directors who pay themselves little or no salary and rely on dividends, meaning they could not furlough themselves. This financial pressure left many registrants with a choice between losing their income and protecting the public; or remaining open and introducing a risk of harm to themselves and others. This placed even greater emphasis on the need for BASRaT to provide guidance and support.’
Jeffrey Hugh Thomas explains that there was also ‘extra costs of additional time for [their] registrants’ support line to service a higher level of enquiries because of confusion caused by government announcements.’
The Professional Standards Authority has written to the four UK governments to highlight the experience of AR practitioners, and to ask that consideration is given to recognising accredited registers within future guidance on Covid-19. We will continue to emphasise the role that practitioners can play within the Covid-19 recovery phase, as part of an integrated health system.
Insights and potential for the future
As the UK transitions into the recovery phase, Accredited Registers will begin to assume more responsibilities and feel a return to some extent of their original roles. There are some key learning points to be taken from the past four months as we plan for the next steps in this pandemic and beyond.
‘The speed at which organisations have had to adapt and react during Covid-19 has been unprecedented’, notes Coburn. ‘Thankfully, with robust processes in place and by utilising modern technology, BASRaT has been able to keep pace with the change. Overall it demonstrates the agility of Accredited Registers and shows that high regulatory standards can continue to be met during periods of rapid adaptation.
‘There are positives to be taken from recent events and hopefully, the collaboration and adaptability demonstrated by organisations will continue moving forwards.’
David Kidney describes what this experience has taught him, as well as his hopes for the future of regulation. ‘There will be much talk of transitions as we all try to resume ways of working (some potentially changed forever) without the ever-present threat of pandemic and increased risk of premature death. Regulation is but one cog in this transition, but we will be planning to reapply the regulatory standards that we adjusted during the emergency. We will enthusiastically consider where we can lock in any new ways of working that were forced on us during this time, but which can endure afterwards.
‘Our approach to right-touch regulation demands no less of us than that we examine whether there are more effective, more proportionate ways to perform our regulatory functions and keep the public protected from harm.
‘I am impressed with the ways in which our registrants have risen to the deadly challenge of the coronavirus. They certainly have my thanks.
‘Going forward, it would make sense for public health leaders to be involved in planning for future public health emergencies. I feel certain that registrants will want to be involved and I am sure they will contribute to better quality decision-making. It would also make sense to do more work on developing a bigger public health workforce with the necessary range of skills and capabilities. As one of the significant regulators in this space, UKPHR stands ready to contribute to, and support, this developmental challenge.’
We at the Authority believe the Accredited Registers programme can play a role in easing pressures on the NHS and the public during the recovery phase, and beyond. The ability for GPs to refer directly to Accredited Register practitioners, for example, enables assured access for services such as counselling. While guidance has differed across the four UK health administrations, and in some cases, there has been confusion – this time has also taught us that meaningful change is possible. We will use this experience to inform our thinking as part of the strategic review of the accredited registers programme, which launched last month. The Terms of Reference for the review can be found here.