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Research and policy update

Research and Policy: the year in Stats

We have had a very busy year and you can read more about our work during 2016/17 in our Highlights as well as our key statistics for the year. Some of the work we started in 2016/17 is continuing and two subjects we published reports on last year are still very much in focus.

Dishonesty: proposing a typology of six kinds of dishonest act across professions

We have just published our recent research report, looking at the subject of dishonesty. Researchers Professor Ann Gallagher (University of Surrey) and Mr Robert Jago (Royal Holloway University of London) examined cases of professional misconduct that included an allegation of dishonesty from our database of fitness to practise cases. In the report, they propose a typology of six kinds of dishonest act that can apply across professions.

This research contributes to our ongoing programme of work to understand the impact of regulation and to develop strategies to prevent or reduce incidence of professional misconduct in future. It builds on the report we published last June into Attitudes to dishonest behaviour by health and care professionals. The report discusses the ethical and professional arguments relating to honesty and dishonesty.

This research involved analysing 151 cases involving a charge of dishonesty and set out:

  • To identify the prevalence of particular acts of dishonesty in three categories
  • To see if any patterns emerged in relation to the environmental circumstances in which these acts of dishonesty were perpetrated
  • To identify any patterns related to dishonesty in particular health and care professions
  • To identify any patterns related to the personal circumstances of those committing dishonest acts
  • To consider whether the data can suggest future preventative interventions, regulatory or otherwise, of different dishonest acts across the categories.

The full report is available on our website.

Professional identities and regulation

We published our initial literature review last year looking at whether professional identity has any bearing on patient safety. The literature suggested that it did. However, there was not as much evidence to suggest what role professional regulation has on acquiring strong professional identities. We commissioned research to look at this topic in more detail. Conducted by Dr Simon Christmas and Professor Alan Cribb, this study confirms that a strong professional identity benefits patient care, but reaffirms that regulation’s role is less clear-cut.

The qualitative research involved 16 in-depth interviews with practitioners on statutory registers, accredited registers and a voluntary register, working in community and private settings in the UK (pharmacists, physiotherapists, psychotherapists and acupuncturists). The research found that practitioners can gain validation of their own professional identity through a common body and the standards they need to adhere to.

Though this new research answers many of the questions we raised in the literature review, it also sparks more questions of identity and regulation. We will publish a further paper at the end of the summer to consider how this work complements the literature review and explore the policy implications of Dr Christmas’ research for regulators and the wider health community.

You can read the full report on our website or see our infographic drawing out some of the key findings.

Next steps for primary care in Wales

One of our policy officers, Daisy Blench, recently attended this Policy Forum seminar in Cardiff. It gave us a useful snapshot of a health service experimenting with a range of approaches seeking to address the challenges and pressures on primary care that are replicated throughout the UK: rising demand, high workloads, GP shortages and shortfalls in funding. However, as one of the speakers highlighted, Wales is a small country and therefore a unique environment to pilot innovative, local solutions.

One of these solutions has been the creation of ‘clusters’ (currently numbering 64). Clusters are intended to bring together a number of neighbouring GP practices covering between 30,000 and 50,000 patients, to share resources and ensure that the service needs of the local population are met. Though the cluster model has met with a mixed reception, the project is continuing. Looking at maximising the benefits of this approach, best practice is being shared and new models of care are being developed. Projects to upskill and utilise the primary care team, introducing more specialist roles are all underway.

However, there are ongoing challenges and difficulties:

  • delivering a high-quality service with limited resources
  • innovating with heavy workloads was also raised, with calls for protected time for GPs
  • going against the traditional perception of GPs being the first point of contact for patients.

The need to better utilise other parts of the health and care sector was also discussed with particular reference to the role that can be played by the third sector, wider social care services and the private sector including some of those practitioners on accredited registers. This ties in with how patients want to be more involved (and informed) in making decisions about their own care. This means that communication with patients is crucial when innovating as it will become increasingly important to explain the benefits of triage and bringing in roles with specialised skills. However, local/personal relationships are key for referring onward with confidence. Greater awareness around the assurances offered by the accredited registers programme is needed to help mitigate these concerns.

Overall it was a useful opportunity to hear about some of the challenges being faced by primary care in Wales and see some of the changes being taken forward to ensure that services continue to meet the needs of patients and service users.