Did you know that the Order for bringing PAs and AAs into regulation has wider implications? It will be a blueprint for regulating all roles in the future: both existing and new roles.
In late January, we launched a public consultation on two guides we’ve drafted to help reformed regulators with their new powers. The deadline for responding is 5pm on Monday, 15 April. Regulators will not be reformed at the same time. Currently, the General Medical Council (GMC) is first in line, but only in relation to the two new roles it will be regulating from the end of 2024 onwards. These are: Physician Associates (PAs) and Anaesthesia Associates (AAs) and these two roles are being brought into regulation under the Anaesthesia Associates and Physician Associates Order (AA/PA Order) 2024. This passed into law on 13 March 2024. As well as bringing AAs and PAs into regulation, the AA/PA Order will act as a blueprint for the reform of the other healthcare regulators we oversee.
At first glance, it does look like these draft guides are mainly for regulators. Though this is true, the guides relate to planned changes to rulemaking and the fitness to practise process. So these changes will have wider ramifications, potentially impacting public protection, transparency and accountability. This is why we think it is important to garner as many views on the draft guides as we can, including from patients, service users, registrants and employers.
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Rulemaking for regulators
Another change for reformed regulators relates to rulemaking. Reforms will give regulators greater freedom to decide how they operate, including the flexibility to set and amend their own rules. Our draft guide aims to help regulators make effective use of their new rulemaking powers in a way which prioritises public protection. It includes some principles on what good rules should aim to do or be, as well as emphasising how important it will be to consult with stakeholders for any proposed changes to rules. You can read through the draft guide here.
Have we got the factors right? Accepted outcomes in fitness to practise
Our first guide sets out the factors we believe regulators will need to take into account when deciding which route a fitness to practise concern should follow. Reformed regulators will have a new process introduced for dealing with concerns and complaints. Known as ‘accepted outcomes’ – this approach means that cases will be decided by the regulator and registrant reaching an agreement. A case examiner employed by the regulator will look at the facts of the case (via paperwork), reach a decision and then the registrant will be able to ‘accept the outcome’. If the registrant accepts the findings and agrees to the sanction (if there is one), the case will be closed with no need to go to a panel hearing or for the registrant and complainant to be cross examined at a panel hearing. We want to make sure that we have not missed anything in our guide so would welcome your views. You can read through the draft guide here.
There are many benefits to this approach, especially around length of time and the stress that these types of hearings exact on all the parties involved. However, we believe there may be certain types of cases where panel hearings will be necessary to ensure public protection. In the next stage of reform roll-out, we believe there should be more input sought from patients, service users and the public.
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We held a very helpful and informative roundtable with patients and their representatives about our consultation: it only served to remind us just how important it is to listen to those who have had direct experience of the fitness to practise process. It should not be underestimated how valuable this is. Not only that, it reinforced that we need to bear in mind that it is people at the heart of all these processes and the language and terminology used also needs to take this in to account. We also held a roundtable for organisations representing healthcare professionals including royal colleges, defence organisations and professional associations. The wide-ranging discussion covered a number of topics including the importance of countering unconscious bias and the need for decision-makers to have access to expert evidence.
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How to respond
The deadline to respond is 5pm on Monday, 15 April 2024. You can find out all you need to know about the consultation from our dedicated web page here. We've also prepared some FAQs and explainer animations. You can find these here or follow the links below.
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Our top three recommendations to government to help tackle some of the big challenges in health and social care: PSA manifesto
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We have recently published Making care safer for all: a manifesto for change. It identifies our priorities for the next UK government to help them deliver better and safer care for all. These include:
1. Fixing the safety gaps in our healthcare system: we recommend that the next government prioritises work to modernise the powers of the healthcare professional regulators; and ensures that public inquiries and reviews result in lessons being learned and, more importantly, those lessons being acted upon – we believe this could be achieved by expanding the role of the Patient Safety Commissioner. The need for inquiry recommendations to be implemented has also been highlighted by a review just published by the Expert Panel of the House of Commons Health and Social Care Committee. The evaluation shows the importance of following-up on government promises in the wake of inquiries into major healthcare failings.
2. Tackling the health and care workforce crisis: we recommend that the next government supports the delivery of the NHS Long Term Workforce Plan and manages the risks to safety and public confidence by developing a regulatory strategy to sit alongside it.
3. Improving workplace culture in health and care: we recommend that the next government supports robust action to address discrimination in the workplace; and takes steps to enhance the professional development and accountability of senior managers in the NHS.
In addition to our recommendations, we also outline what professional regulators are doing to tackle some of the big challenges our sector is currently facing.
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Healthcare inquiry recommendations
must be followed up.
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Speaking of workforce challenges, we held our seventh annual seminar on Regulatory developments and the Welsh context on 19 March. The theme for this year’s event was ‘the role of professional regulation in retaining and building the health and care workforce’. Key issues that were considered on the day included:
- How can we ensure new and international registrants get the right support and what more can regulators do?
- How can we build on work to develop compassionate leadership to develop more compassionate regulation?
- How can regulation better support innovation and new ways of working?
The seminar was held online and we had almost 100 participants from across Wales and beyond. The event was opened by a keynote address from Eluned Morgan, MS, Minister for Health and Social Services. We were delighted to have a range of engaging and insightful speakers from organisations including Health Education and Improvement Wales, Social Care Wales, the Welsh Government, and Welsh Health Boards. Professor Keshav Singhal from BAPIO Wales gave a particularly illuminating presentation detailing his personal experience of what it is like to arrive in a new country, unfamiliar with the culture and food (and the weather). He outlined how a well-planned, practical induction, as well as support from the employer/wider team, can help settle both new and international registrants into their workplace. We hope to publish a blog with more details and a round-up of our discussions on our website later this month.
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Exploring the potential of a common code of conduct for health and care professionals
In addition to setting out the significant challenges facing health and social care in Safer care for all, we also wanted to identify and put forward solutions. As a result of this, and, to take forward our findings on challenges facing the workforce, we plan to begin a scoping review later in 2024. This will focus on the benefits or drawbacks of developing a common code of conduct for health and care professionals. A common code could extend to roles covered by the accredited registers, and, in light of recent calls for greater accountability, non-clinical senior managers, too.
To prepare for the wider scoping review, we commissioned an external research organisation to explore the perspectives of the public, users of health and care services and health and care professionals on the potential value, benefits, and risks of a common code of conduct. At this stage, we are only looking at the possible pros and cons of a common code of conduct and we recognise that there are different ways of achieving consistency in conduct across health and care professions. This research is designed to inform and contribute to our thinking and next steps in our policy work.
The research is exclusively qualitative and covers a diverse sample of approximately 80 participants. The final report is due to be published shortly and we will share findings with our stakeholders in a variety of ways. As part of the broader project exploring the potential of a common code of conduct, we plan to engage with patient groups, employers, workforce and education bodies, as well as regulators and the accredited registers.
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Promoting safer care for all: carrying on the conversations
Drawing on the commitments we made in our 2022 report Safer care for all, we’ve spent 2023/24 bringing together key stakeholders to discuss the topics encapsulated in the report. Through these events we aimed to try to identify solutions to some of the tricky problems still impacting on the quality and safety of care for patients and service users. These events have varied in size and purpose, but we’ve been grateful to all who attended and contributed for their insights, enthusiasm and commitment to bringing about improvements.
As well as the immediate follow-up, here at the PSA we’ll be thinking about what more we can do in all these areas to continue to progress and tackle these difficult issues and picking up further actions within our 2024/25 Safer care for all action plan. Summaries of each event are below.
The role of health professionals in tackling health inequalities
In Safer care for all, we looked at the impact of inequalities on patients, service users and registrants, and on public confidence more widely. We also took a closer look at what professional regulation (and beyond) could do to tackle inequalities in health and care. We held this event on 14 December 2023. More than 90 participants joined us online to explore whether health and care professionals in the UK should have an explicit responsibility in supporting action to address these disparities as they do in other countries. And, if so, whether regulators need to reinforce such a role through their training, standards and guidance.
The event was attended by colleagues from the NHS, patient organisations, professional bodies, regulators and employer bodies. You can find out more about what our discussions encompassed here.
Barriers to complaints
We started the new year off with our joint online seminar on tackling barriers to complaints with the Parliamentary and Health Service Ombudsman (PHSO). The event followed on the heels of an earlier in-person event with patient and service-user organisations held in Edinburgh in September 2023.
The event brought together over 100 stakeholders from across the health and social care sector to discuss and explore the barriers that currently exist and can prevent patients and service users from complaining. Along with our PHSO colleagues, we wanted to share examples of innovative actions to widen and improve access to complaints services and to encourage and promote further joint work to tackle barriers to complaining. The event gave us much food for thought and we will look to continue this work in 2024/25. You can find out more about the event here.
Accountability, learning and public safety roundtable
In Safer care for all, we committed to ‘bring people together to find ways for the HSIB England’s ‘safe spaces’ approach, and other initiatives for improving safety culture, to support candour and accountability. This will include patients, service users and families, professionals, regulators and many others.'
We started this work by hosting a roundtable on 5 March with the intention to help bridge some of the policy and implementation gaps identified in this chapter of Safer care for all. The roundtable aimed to identify several challenges associated with accountability. You can find out more in the event write-up here.
How can regulation research contribute to safer care for all?
In November we held our first research conference since the pandemic. This was an in-person event, bringing together over 150 regulators, accredited registers, researchers and other stakeholders to discuss current research projects touching on different aspects of professional regulation and registration. The themes of the day were drawn from our Safer care for all report. It was a full and busy day of stimulating presentations and lively discussion, the learning from which will inform our ongoing work on the themes of Safer care for all. In particular, in 2024-25 we will be taking forward a programme of work on different aspects of sexual misconduct in health and care. You can find out more, including presentations and highlights from the dedicated web page.
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Louise Wallace is a Professor of Psychology & Health at The Open University and is one of the researchers behind the Witness to Harm study into the experience of witnesses in the fitness to practise process. Professor Wallace has also presented on key findings from the project at some of our recent events including our research conference and our Accredited Registers seminar.
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Fitness to Practise Appeals update
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In the past few months, we have concluded 14 appeals of regulator final fitness to practise decisions. We decided to appeal these decisions based on our belief that they were insufficient to protect the public. The cases we have appealed cover a range of issues, including cases involving:
- A registrant who was convicted of causing death by careless driving
- A registrant who was convicted of assault and failed to disclose this to their regulator
- A registrant who was convicted of neglect of their own baby
- A registrant convicted of dishonesty offences
- A registrant who recorded a vulnerable patient and played the recording to colleagues
- A registrant who breached interim conditions
- A registrant who made anti-semitic and offensive comments whilst leading a public event
- Two registrants who were alleged to have provided poor care whose cases were stayed (paused)
- Two registrants who supplied excessive quantities of controlled drugs
- Three registrants who physically abused patients.
You can find out more details about these cases on our website.
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Regulator fitness to practise backlogs
We published our final performance review of the year on 28 March. It was a periodic review for Social Work England. Social Work England did not meet Standard 15 – our Standard on fitness to practise timeliness.
Social Work England is not alone in this. Six out of the 10 regulators we oversee currently don’t meet Standard 15. All six of these regulators are experiencing backlogs in dealing with fitness to practise cases.
The regulators who don’t meet Standard 15 are:
- the General Dental Council
- the General Pharmaceutical Council
- the Health and Care Professions Council
- the Nursing and Midwifery Council
- the Pharmaceutical Society of Northern Ireland
- Social Work England
We have escalated the GDC, HCPC, NMC and GPhC not meeting this Standard to the Secretary of State for Health and Social Care and the Health and Social Care Committee. You can find out more out our escalation policy here. This is a cause for concern and continues to be an organisational priority for the PSA and the regulators.
What we are doing to resolve this
While we recognise that this is an issue for the regulators to solve, we are committed to helping them improve their performance and reduce their backlogs. We discussed this at a recent workshop with the PSA’s Board. In our role as an oversight body, we can:
- continue to investigate and gather details of the regulators’ performance and report findings to the public and stakeholders;
- continue to report serious non-compliance to the Secretary of State and Health and Social Care Committee via our escalation process;
- facilitate learning and help guide the regulators to meet the Standards (by giving general advice);
- share knowledge and help them come up with solutions (finding good practice to share, encouraging the regulators to continue to share learning and the PSA can also host forums and workshops to do this);
- ensure that the regulators each have plans to deal with the backlogs, and that these are monitored effectively through regulators’ governance structures; and
- assure ourselves that sufficient resources are applied by the regulators to the issue.
What are the regulators doing?
You can read through our individual review reports to find out more details of what steps the regulators are taking to deal with backlogs. You can find all of our most recent reviews here.
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Recent reviews published
Since we sent out our last e-newsletter, we have published performance reviews for:
- the General Medical Council: the GMC met all of the Standards of Good Regulation and you can read through our shorter Monitoring Report here
- the General Dental Council: we also published one of our shorter Monitoring Reports for the GDC, who met 16 out of 18 of our Standards
- the General Optical Council: we also published a Monitoring Report for the GOC who met all of the Standards. We were pleased to be able to report that the GOC had continued to improve its timeliness in fitness to practise and met the relevant standard on this – Standard 15
- the Pharmaceutical Society of Northern Ireland: the PSNI met 15 out of 18 of our Standards. In our shorter Monitoring Report, we’ve outlined concerns about the PSNI supplying information to us as well as the accuracy of its register and timeliness in progressing fitness to practise cases.
- Social Work England: we published one of our longer Periodic Reviews for Social Work England who met 17 out of 18 of our Standards, failing to meet Standard 15 on timeliness of fitness to practise cases.
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Accredited Registers update
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Welcome to three new Accredited Registers
Since our last newsletter, we have accredited three new Registers:
- the British Occupational Hygiene Society (BOHS)
- the Institute of Trichologists (IoT) and
- Athena Herd Foundation CIC (Athena Herd).
Each brings a new type of role to the Accredited Registers programme, increasing its diversity and assurance. You can read a snapshot about each organisation below. Their more detailed accreditation reports can be found on our Accreditation decisions webpage under the name of each Register.
BOHS
The BOHS is the leading body for occupational hygiene in the UK and was awarded Royal Chartered status in 2012. Occupational hygiene describes the prevention of ill-health in the workplace by managing health risks, for example by controlling worker exposure to harmful substances. In the UK there are 1.7 million people suffering from work-related illness with 40,000 or more suffering from work-related chronic obstructive pulmonary disease (COPD) alone, and 13,000 deaths annually from occupational lung disease (source: Health and Safety Executive). Employers can be held to account by the Health and Safety Executive if they fail in their responsibilities to protect workers from workplace hazards, which underlines the importance of having an independent Register that can provide assurance of the quality of occupational hygiene services.
IoT
The history of the IoT dates back to the 1902, when a group of like-minded doctors, scientists and hairdressers came together to found the College of Diseases of the Hair, later to be known as the Incorporated Institute of Trichologists. Trichologists seek to help clients with a range of hair and scalp conditions including female and male pattern hair loss and the symptoms of alopecia areata. Trichologists will refer clients to others in the medical community such as GPs if they think further tests are needed such as biopsy or if the treatments need to be prescribed. The IoT estimates there are approximately 165 trichologists practising in the UK, meaning that its Register could cover up to 80% of the workforce.
Athena Herd
Athena Herd Foundation CIC was established in 2021, although the genesis for the organisation was from 2014 onwards. Athena Herd registers equine facilitated workers. Equine facilitation is the term for a range of roles that involve working with horses to develop self-awareness. It is often combined with other therapeutic approaches, such as counselling, to provide an ‘experiential learning’ process. This approach is premised on an understanding of the horse as an intelligent animal, with which the learner can develop a strong non-verbal relationship. Athena Herd is the first Register to provide animal-assisted therapies that we have accredited, but the apparent growing popularity of this type of therapy (source: Rodriguez-Martinez et al, 2021) gives the potential for more, in future.
Overall, as of April 2024 this brings the total number of Accredited Registers to 28, covering over 125,000 registrants. This represents a 25% increase in the number of registrants over the past 12 months.
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Alliance of Private Sector Practitioners
The Alliance of Private Sector Practitioners announced its decision to withdraw from the Accredited Registers programme from 31 March 2024. From this date, the Alliance and its registrants are no longer able to display our Quality Mark.
The Alliance’s full renewal assessment against our Standards for Accredited Registers was due to be finalised by the end of March. We will complete this assessment and publish the outcome in due course on our website.
We thank the Alliance for its commitment to the Standards for Accredited Registers, since it first joined the programme in 2013. We wish colleagues and the organisation the very best for the future.
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Dealing with concerns and complaints
This was the theme for our annual Accredited Registers seminar held in-person on 28 February. We welcomed a range of speakers who presented on a variety of topics.
These included Professor Kevin Bampton from the British Occupational Hygiene Society (an AR), who presented a session on restorative justice; Professor Louise Wallace from the Open University, who presented a session on the Witness to Harm research project (read Louise's thought-piece on compassion in complaints here); Dr Adrian Whittington, NHS England lead for the psychological professions who led a session on suicide prevention; and Sian Hughes and Arvinder Dhaliwal from the Solicitors Regulation Authority, with a presentation on the overrepresentation of Black, Asian and minority ethnic solicitors in the fitness to practise process.
Delegates also went into three breakout sessions; two of these were led by our own Registers. The sessions covered a) suicide prevention, b) a new process for dealing with cautions and convictions and c) working with the Advertising Standards Authority to deal with exaggerated, illegal and dishonest social media advertising.
The presentations were all well-received, there was a great deal of engagement and enthusiasm during the Q&A sessions after each presentation.
We are planning to publish a blog by one of our speakers Professor Kevin Bampton on restorative justice in the near future, so please keep an eye out for this on our website.
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UK Board of Healthcare Chaplaincy is looking for a Lay Director (voluntary role)
One of our Accredited Registers, the UKBHC, is looking to add at least one volunteer Lay Director to its existing team. This is a volunteer opportunity for anyone who can demonstrate commitment to supporting the highest standards of safe and effective Chaplaincy/spiritual care in UK health and social care. You can find out more about the UKBHC here. The UKBHC would particularly welcome interest from applicants who have experience and skills in governance and communication. You can find out more about the role by emailing admin@ukbhc.org.uk.
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Call out: help us shape our new website
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We have just started a project to re-develop our website. Are you interested in helping us? We are looking for volunteers to provide input, especially in the second phase when we will be working on the new look and navigation. If you would like a sneak peek or help us shape how it evolves, please let us know. You can get in touch by emailing comms@professionalstandards.org.uk and we can send you more details about what form this will take, what will be involved and when it is likely to happen.
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And one last thing: do you want to continue to receive this newsletter?
We hope you do, but, if not, you don’t need to do anything. However, if you would like to carry on receiving these updates, you will just need to fill in this form here.
(You should have received an email from us about moving your details across to our new and improved database and giving you the option to re-subscribe in February). If you have signed up to receive our e-newsletter since 28 February, there is no need to do this as we will already have your details. Please remember that you can unsubscribe at any time by emailing engagement@professionalstandards.org.uk and you can also read through our privacy policy here.
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