Robust regulation – not penny pinching

Proposed merger of nine regulators should focus on fairness and accountability, not cost-cutting, says Medical Protection Senior Medicolegal Adviser Dr Pallavi Bradshaw

The Department of Health (DH) has, in its document Promoting professionalism, reforming regulation, announced proposals to merge the nine healthcare regulators in the UK. While there are undoubted efficiencies to be gained by doing this, it’s absolutely vital that we do not lose sight of the value of fair, robust regulation. 

A fair, proportionate system of health regulation is in everyone’s interests, be it patients, doctors or taxpayers in general. After the Shipman Inquiry in 2004, the GMC was given powers to suspend doctors on an interim basis, revalidation was introduced and – in 2012 – the Medical Practitioners Tribunal Service was established as an impartial adjudicator in fitness to practise cases. Regulation was strong, the public reassured; for that to remain the case, there should be a solid foundation of effective triage, investigation and decision-making. 

At MPS we support hundreds of healthcare professionals through GMC and GDC fitness to practise investigations every year, providing advice and legal representation from the outset right through to the hearing. We also provide a confidential counselling service to our members going through the distressing process. The physical and psychological impact investigations have cannot be underestimated, particularly if they are handled poorly.

A merger that meets all needs

Now the DH is consulting on proposals to merge the following regulatory bodies, and in addition give them greater flexibility in the way cases are handled:

• General Chiropractic Council
• General Dental Council
• General Medical Council
• General Optical Council
• General Osteopathic Council
• General Pharmaceutical Council
• Health and Care Professions Council
• Nursing and Midwifery Council
• Pharmaceutical Society of Northern Ireland.

It is clear that the GMC feels constrained by the legal framework of the Medical Act 1983, and that the government has an ambition to create a regulator, or small group of regulators, that is proportionate and responsive. But this must not be at the expense of fairness to the professionals they regulate, nor to transparency. The safeguards that legislation brings to registrants, whose careers and livelihoods are at stake, must not be forgotten. 

In addition, any amalgamation exercise should avoid loss or dilution of the specific expertise of each profession’s regulator.  Any new ‘super’ regulators, replacing the existing nine, would need to be able to distinguish between the hugely differing roles within the many professions they would oversee, and have an appreciation of the different pressures across the professions.

Now more than ever, the regulators need to be sensitive to these pressures and I am encouraged that the DH acknowledges this. Regulators must take into account how their actions affect the morale of the wider profession, and actually question whether the standards they set for doctors – both within clinical practice and their private lives – are realistic in modern practice and society.

The emphasis has to be on patient safety, but surely it is in the public interest to only investigate and sanction those doctors who truly pose a threat?

The greatest failure of all would be to simply see this consultation as an exercise in cost-cutting and not address the real problems in the current system. We have an opportunity to create a system that patients, healthcare professionals and the government alike can have confidence in. It is an opportunity that should be seized.