Public views on three aspects of health professional regulation

In this research we found that ‘expanded’ tended to signify taking on more responsibilities, while ‘specialist’ was interpreted as focusing on a particular area. 'Advanced’ was less clear though assumed to mean ‘more qualified’ and associated with career progression. Patients did not typically investigate claims of advanced-type status, especially in NHS settings. 

When it came to sanctions, ‘warning’ was considered a more appropriate term than ‘caution’ which was seen to be softer and not a formal part of a disciplinary process. ‘Striking off’ was very much the dominant and best understood term in the public vocabulary, compared to ‘erasure’, which was unfamiliar and implied the record might be removed from the register altogether – but did not communicate the fact that the person might legitimately be able to return to the register. Removal was seen to be more flexible with the possibility of moving perhaps to a different part of the register and of returning to the register in due course.

Finally, on the third topic, patients tended to be sympathetic about a professional having health issues, though preferred not to be made aware of it, and expected professionals to recognise when their health was affecting their practice and take appropriate action. Employers were expected to manage conditions through changes to the working environment, but regulators were only expected to intervene when an issue was not being managed. For independent practitioners, patients might expect to have to raise a concern. Generally, patients do not feel equipped to go to the regulator with a concern.

Purpose

We wanted to find out more about how the UK public understands advanced practice and sanctions terminology to advise on how this might be amended in the future. We also sought to explore how the public views health conditions in a health professional and how they expect these conditions to be managed.
We recruited Research Works to find participants and design and carry out the research.

Background

The NHS Next Stage Review: A High Quality Workforce in 2008 called for ‘nationally agreed standards for advanced levels of practice’ by health professionals. We commissioned this research to know more about how members of the public understood the terminology around advanced practice. 

We also took the opportunity to explore public expectations of how regulators, registrants and employers manage health issues affecting professionals, public opinions about the terms used to describe ‘cautions’ or ‘warnings’ and ‘striking off’ of ‘removal’.

Research brief

We asked Research Works to explore:

1) What patients and the public understood by the terms ‘advanced’, ‘specialist’ or ‘expanded’ when they are being treated by health professionals? Specifically:

• Should patients and the public (or employers on their behalf) be able to check claims of ‘specialists’ or ‘advanced’ healthcare professionals?
• Do the terms have different meanings in different settings?
• Can you be ‘advanced’ and not directly involved in the treatment of patients?

2) The terminology which should be used in a number of situations:

• ‘Cautions’ or ‘warnings’ in cases in which there is a need to indicate to a registrant, and more widely to the profession and the public, that their conduct or behaviour fell below acceptable standards, but when there is no need to take action to remove or restrict a registrant’s right to practise.
• ‘Erasure’, ‘Striking Off’ or ‘Removal’ in relation to the most severe sanction, removing the registrant from the register. When a registrant is erased from a register there is a general expectation that it will normally be for life and that the registrant will not be able to practise again – although registrants can apply for restoration to a register after a specified period of time.

 3) The public’s perception of health issues amongst health professionals and its expectations of how regulators, registrants and employers manage health issues. Specifically:

• public attitudes to the management and assurance regarding ongoing physical or mental health conditions of a health professional
• what the public expects to happen so that they are assured a health professional is practising safely and effectively whilst having a disability, illness or disease
• how the public would feel if they knew their health professional had a health condition and is managing the condition so that it does not affect the safety or effectiveness of their practice with patients
• if a health professional manages their work so that they meet their regulatory bodies’ standards of conduct and competence, should they still have a duty to disclose their condition to their regulatory body?

Findings

The research found that patients tended to be sympathetic about a professional having health issues, though preferred not to be made aware of it. Levels of tolerance declined however for mental health issues and addictions. People felt that professionals were responsible for recognising the impact that a health condition had on their fitness to practise. Employers were also expected to manage conditions through changes to the working environment and duties, but regulators were only expected to intervene when an issue was not being managed. For independent practitioners, patients were more likely to feel responsible for raising concerns. Generally, patients were unclear about where to go to complain about a health professional and did not feel equipped to go to the regulator with a concern.
 
With respect to terminology, ‘expanded’ tended to signify taking on more responsibilities, while ‘specialist’ was interpreted as focusing on a particular area.’ Advanced’ was less clear though assumed to mean ‘more qualified’ and associated with career progression. Patients did not typically investigate claims of advanced-type status, especially in NHS settings. To encourage this, they would need to understand the importance of checking the status of a professional, what checks they can carry out outside the register, and when and how to check the register.

When it came to sanctions, ‘warning’ was considered a more appropriate term than ‘caution’ which was seen to be softer and not a formal part of a disciplinary process. ‘Striking off’ was very much the dominant and best understood term in the public vocabulary, compared to ‘erasure’, which was unfamiliar and implied the record might be removed from the register altogether – but did not communicate the fact that the person might legitimately be able to return to the register. Removal was seen to be more flexible with the possibility of moving to a different part of the register and returning to the register.

Next steps

This research fed into in a number of different reports. The sanction terminology research informed our work on harmonising sanctions. We published a report on advanced practice which incorporated the findings about advanced practice status. The work on health was useful to our consideration of health conditions in the registration process.