The Pharmaceutical Journal
Vol 275 No 7359 p109-110
23 July 2005

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How other health care professions manage their non-practising members

As the debate over the new Register and retention fee structure continues for members of the Royal Pharmaceutical Society, Zoë Gross looks at what other health care professions are doing for their members who have retired, who are working overseas or who have non-practising status

Following the move to a Register of practising and non-practising pharmacists at the beginning of this year, many members of the Royal Pharmaceutical Society, including retired and overseas members, have had to decide into which of these two categories they fit. Those pharmacists aged 60 or over and not working in any occupation could choose to register as non-practising members or leave the Register. Those who are retired but undertaking occasional locum jobs have had to pay a practising pharmacist’s fee, where previously they could have registered as part-time members and paid a reduced, part-time fee. Overseas pharmacists (not resident or working in Britain) had to move into the practising category if they were to continue working as pharmacists and remain on the Society’s Register — a fee increase of £156 from last year.

The move has led to some debate for a small number of other pharmacists, including those who do not work with patients and those whose jobs do not require them to be a pharmacist, but for whom being a pharmacist adds value to their work. These pharmacists currently fit into the Society’s definition of practising. But whether in the future such pharmacists should in fact carry the status of non-practising rather than practising, because they do not have any contact, face-to-face or otherwise, with patients, will depend on how the Society continues to define “practising” and “non-practising”.

So what do other health care professional bodies do about registering such members and how do they define non-practising? Similarly, what are they doing about registering retirees and members who have moved abroad and their retention fees? This article looks at what the various regulatory bodies are doing for doctors, dentists, nurses and midwives, veterinary surgeons and optometrists.

Doctors

Currently the General Medical Council does not differentiate between doctors who practise medicine and those who do not — doctors qualified in the UK are either registered with the GMC or not. Essentially, for a doctor to participate in unsupervised medical practice in the NHS or private practice in the UK, full GMC registration is required. Once registered, they can work as medical practitioners in the UK. However, this system is about to change following ongoing reviews following the Shipman Inquiry.

Under the new terms, registered doctors will be issued with a licence to practise at a fee of £290 per year (the same as the current annual retention fee effective from April 2005). Privileges such as the right to prescribe prescription-only medicines will be attached to the licence and doctors wishing to retain their licence will need to revalidate periodically. The GMC says that its plans to change the system are to ensure that patients have the confidence that all licensed doctors are up to date and fit to practise.

The new system will view doctors working overseas who want to remain on the UK Register and retain a licence to practise in the UK in the same way as any other doctor — they will need to prove to the GMC every five years that they are remaining up to date and are fit to practise. However, according to the GMC, technically, doctors registered with the GMC working overseas, retired doctors and doctors not practising medicine will not need a licence to practise because they are not providing medical services in the UK. There will be a concession of £100 per year for such doctors who wish to retain a connection to the GMC by holding registration without a licence. A doctor holding registration only, and not a licence, may not practise medicine or prescribe any drugs in the UK.

There is currently a lower income discount for doctors working part-time in the UK whose annual income is under £19,700.

Dentists

All dentists are required by law to be registered with the General Dental Council to practise dentistry in the UK and are charged an annual retention fee (£396 for 2005). According to the GDC, the register of dentists “is not simply a list of those who can call themselves a dentist. It is a list of professionals who are recognised under the law to be properly trained, qualified and fit for current practise and subject to regulation.” There are no separate categories or reduced fees for particular groups such as retirees, or members who are working overseas or who no longer practise dentistry, and these members would have to hold full registration to stay on the register. A spokesman for the GDC told The Journal: “The GDC has considered in the past offering discounted fees for certain groups, such as part-time workers or retired dentists and it was agreed that such discounts would, in effect, be subsidised by all registrants paying the full fee. As GDC regulation confers a right to practise, irrespective of employment status or age, the Council decided against this as it cannot justify offering a reduction to one group at the expense of another.”

However, dentists planning career breaks from NHS dental practice and intending to return to NHS practice after a break can join the “Keeping in touch scheme” and are then entitled to a refund (currently £261) on the annual retention fee. In addition, dentists going overseas can chose to leave the register and apply for restoration on return, for which, among other GDC requirements, they would have to demonstrate that they have been undertaking continuing professional development.

Nurses and midwives

Like the GMC and GDC, the Nursing and Midwifery Council has no separate registration sections for practising or non-practising members. Nurses and midwives licensed to practise in the UK are required to pay one fee, renewable every three years (£129 effective from August 2004), regardless of whether or not they are practising. According to a spokesman for the NMC, once a nurse or midwife is on the register, they are “on there for life”.

Retired nurses and midwives who are no longer practising do not have to pay the regulatory body’s fee to remain on the register. Similarly, nurses and midwives who go abroad to practise do not need to pay their retention fee to stay on the register and, as long as they remain on the register and practise during that time, they will not need to prove their fitness to practise on returning to the UK. However, the NMC advises that it is financially worthwhile to pay the retention fee every three years if its members intend to return to practise in the UK after a period of five years in order to avoid having to pay a readmission fee, which comes into play at that time.

Optometrists

The General Optical Council’s register is currently in a state of change. It has no separate sections for practising and non-practising members. Although optometrists and dispensing opticians continue to be registered separately, as from the beginning of this month, individual registrants have to be insured to remain on the register and as of 1 January 2007, both dispensing opticians and optometrists will have to have achieved the required continuing education and training (CET) points to renew their registration. There is still a single annual retention fee (£169 effective from April 2005) for all members as there are still no subsections for particular member groups.

Commenting on not having separate sections for practising non-practising members, the GOC’s registrar and chief executive, Peter Coe, says: “The GOC’s view is that everybody on the register is entitled to practise and, therefore, they have to meet all the obligations for registration.” In terms of retirees, he says that if people have retired and want to remain on the appropriate register, then they would have to renew their registration, have insurance cover and abide by the CET regulations. But Mr Coe points out that what a lot of people traditionally regarded as retirement just does not happen nowadays and many people simply now reduce either their sessional commitments or the number of days they work.

Even if registrants are working part-time, they still have to pay the full fee and undertake the same amount of CET as their full-time counterparts. Mr Coe says that the GOC gets “a smattering of correspondence during the year from people who say ‘It is not fair that I should have to pay the same amount of money as somebody else. I am only going to do one or two sessions a week’.” However, he says that there is in fact “an argument that the GOC has not responded to which is that you should do even more [CET] in order to be as up to date and as expert as you need to be when handling a patient.” The GOC is particularly concerned about the quality assurance issues for people who do little clinical work in the course of the year. In terms of GOC-registered optometrists and dispensing opticians practising solely overseas, Mr Coe adds that those who are insured to work overseas but do not have insurance to practise in the UK can remain on the GOC’s database. However, their data will not be publicly available and it would not be possible for them to work in the UK without taking appropriate and adequate cover.

Veterinary surgeons

Like the Royal Pharmaceutical Society, the Royal College of Veterinary Surgeons, uses the terms “practising” and “non-practising” in its register of members. In addition, “practising” is not limited to those in practice but includes members using their professional qualification in any way. Unlike the Society’s Register, the veterinary register is further broken down into a number of other categories and the list of practising members is divided into home, overseas and Irish-practising, each with its own retention fee.

The register also has a restricted practising list, “temporary list”, for applicants who are not eligible for full registration and are not employed in general practice. Temporary registrants are not allowed to call themselves members of the RCVS and can only be on this list if they are employed in veterinary schools or research institutes or if they are in full-time postgraduate study at such an institution.

So what does the RCVS do about registering those who work overseas and retirees? The RCVS has a separate section for veterinary surgeons practising outside the UK only. These members are not permitted to work in the UK and on returning to work in the UK their indemnity insurance may be invalid unless they change their membership status back to home-practising.

In terms of retirees, as for pharmacists, veterinary surgeons have to pay a non-practising retention fee of £40 (Society £46) to remain on the register. However, according to Corrie McCann, RCVS head of finance, the RCVS council agreed at a meeting in March that, as of April 2006, those over the age of 70 who are not practising or engaging in any activity which is veterinary-related, will no longer have to pay this fee. “They would continue to receive voting papers for RCVS council elections and the annual report, but would not receive the register of members or RCVS News, our thrice-yearly publication,” she says. Nevertheless, Ms McCann adds: “The decision is still subject to advice over equal opportunities and age discrimination issues and has to be approved by the Privy Council. Practising members over 70 years would continue to pay the full fee.”

In conclusion, it would seem that in some respects, other health care professional bodies offer greater flexibility than the Society. Could expanding the Society’s Register of practising pharmacists in a way similar to that for veterinary surgeons be the way forward, or are the structures used by others, such as the GMC’s new system, the answer? Maybe the Council will reconsider the Society’s Register in the light of other regulators’ structures.