Managing extended practice: Is there a place for ‘distributed regulation’?

Background

Health professionals are increasingly extending their practice into areas overseen by other regulators, such as podiatrists undertaking surgery, or into areas that are currently unregulated, such as nurses performing acupuncture. These extended roles can deliver benefits for patients and the public and provide development opportunities to professionals, whilst enabling health services to react flexibly to the increasing pressures being imposed upon them.

The Secretary of State for Health and Ministers in the Devolved Administrations asked the Professional Standards Authority (then CHRE) to provide advice and recommendations on how regulators might respond in these circumstances. This paper outlines how thinking around ‘extended practice’ has evolved, identifying the risks associated with the extension of practice and assessing how regulators currently deal with these circumstances.

We were also asked to consider a proposed model of ‘distributed regulation’ as a response to these issues. Under this approach, professionals who extend their practice into another profession’s domain would be subject to a set of standards agreed by all the regulators. Instead of requiring professionals to be dually registered, meeting the standard would be indicated by a marking or ‘annotation’ on their original register entry.

Summary

This report looks at how regulators manage risks when health professionals extend their practice, either into areas overseen by other regulators or into currently unregulated areas. The report identified two main risks associated with this kind of extended practice: professionals being unclear as to the standards they should be working to; and regulators not being equipped to manage fitness to practise issues in these areas. We concluded that these potential risks could be managed through existing means, rather than by introducing a proposed model of ‘distributed regulation’.