We were asked by the Secretary of State to report on the regulatory issues arising from advanced practice.
As the delivery of healthcare changes, some professionals are taking on responsibilities not traditionally associated with their roles. This could potentially pose a risk to public protection that regulators should manage. We found that risks to patient safety come from professionals taking on roles and responsibilities which they lack the competence to carry out safely and effectively or where they practise with inadequate safeguards. This means that regulatory bodies need to consider the risks to patients in the context of other established safety arrangements, for example, through employers’ safeguards. If an area of practice develops within a profession which poses different types of risk to patients and requires new standards of proficiency to be performed safely, regulatory bodies need to act. However, action should not be taken if there is no additional risk from a new role.
The underlying purpose of this work has been to examine whether ‘advanced practice’ is a regulatory issue. We believe that much of what is often called ‘advanced practice’ across many of the health professions does not make additional statutory regulation necessary. Often what is termed advanced practice reflects career development within a profession and is appropriately governed by mechanisms other than additional statutory regulation. The existing provisions of the regulatory framework mean that, whatever the level or context of a professional’s practice, they are always accountable to their regulatory body for their practice. All health professionals have duties from the core Code/Standards documents of their respective regulatory body only to practise where they are capable of doing so safely and effectively. The activities professionals are undertaking do not lie beyond the scope of existing regulation.
The core focus of regulatory bodies is professionals’ fitness to practise. Where the nature of a profession’s practice changes for some professionals to such a significant extent that their scope of practice is fundamentally different from that at initial registration – rather than more subtly evolving over time – regulatory bodies may need to consider whether action is necessary to assure the professional’s fitness to practise in the context of a very different nature of practice where risk to the public is evident. Such cases would be where the standards for practising proficiently in these roles are significantly different to those assessed against at initial registration, going far beyond ordinary progression within a given scope of practice, and where the risks to patients from these roles are of a qualitatively different nature from those ordinarily associated with the practice of the profession. However, much of what is often called advanced practice appears to represent career development within a profession over time and not a fundamental break with a profession’s practice such that the risks to patient safety are not adequately captured by the existing standards of proficiency and ethical duties – which set a framework in which a professional can develop and extend their practice within a profession’s scope of practice.
Primary responsibility for the governance of new roles designed to meet the needs of the service provision environment should rest with employers and commissioners. Employers and commissioners should ensure there are robust organisational governance arrangements surrounding all types of practice that those they employ undertake. This provides the most effective means of controlling for risks to patient safety from an individual professional’s practice and provides a proportionate local response. Additional intervention by regulatory bodies would only contribute to public protection were the arrangements in place inadequately controlling the types of practice professionals were undertaking.