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Regulation rethought

03 Oct 2016 | Professional Standards Authority
  • Discussion paper
  • Right-touch
  • Thought Leadership

Our proposals for a transformation of the regulation of health and care professionals, published in October 2016.


In Regulation rethought the Authority sets out its proposals for a transformation of the regulation of health and care professionals, suggesting how the ideas in its earlier paper Rethinking regulation could put into practice. The proposals are primarily focused on public protection and professional responsibility. They are intended to create clarity for patients, and allow greater flexibility of approach for regulators, employers, policy makers and others shaping the workforce.

The proposals

The public often find the regulatory system baffling and hard to navigate, particularly when they have a concern or complaint and want to report it in the right way; the role of the regulator is easily misunderstood. Employers have to engage with multiple regulators in order to check their workers’ registration, report concerns and support revalidation and continuing professional development. People in multi-disciplinary teams work to different standards and may be subject to different decisions by different regulators for the same or similar events for which they have individual and shared responsibility.

They may be subject to different sanctions which patients, employers and registrants find hard to reconcile. Educators too are affected by multiple regulators with different standards and quality assurance mechanisms. This may inhibit their ability to train practitioners who are centred on patients’ needs, with shared values, and who can work across professional boundaries within health and care. Team roles and functions may change as population needs, technological innovations or service requirements alter.

Those striving to re-design service delivery, integrate care, or introduce new working practices may be frustrated and delayed by the difficulties inherent in flexing scopes of practice or creating new roles, because of protected titles and boundary protection by particular professions. Those seeking to bring about change are also seeking independent assurance about the standards and competencies of those who are not subject to statutory professional regulation. Regulation is often cited as a barrier to innovation, although that is not always so, whereas its position should be one of enabling both change to practice and flexible roles in the workforce.

Our proposals are intended to support the achievement of the ambitions of the Five Year Forward View, and other plans for workforce and service change across the UK. In particular the flexibilities we propose may be of value in the discussions currently taking place about new roles in the NHS, such as physician associates and nursing associates and about the role of regulation in the devolved Greater Manchester Health and Social Care Strategic Partnership. Fitness to practise processes are lengthy and costly in both financial and personal terms. The confrontational nature of proceedings and the stress that hearings engender can affect the health and wellbeing of all concerned. The approach inherent in our existing fitness to practise arrangements runs counter to our growing understanding of the situations where things go wrong, and the inter-connections between workplace, leadership, culture, systems, human factors and human behaviour. Regulators would prefer to shift their focus and expenditure, as a number are now trying to do, towards the prevention of harm and the maintenance of standards, building on these insights to achieve greater effectiveness, efficiency, and a reduction in harm to patients.

Read the full report below.