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In the third of a series of articles on the Royal Pharmaceutical Society's modernisation programme, Christine Gray, project manager, looks at the ways in which other health care professions are responding to the drivers for change that have led to the development of the Society's programme |
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Medicine |
How other health care professions are responding to the drivers for change There is a political, professional and public consensus that reform of the processes of professional self-regulation in health care is necessary. The drivers for change that have led the Royal Pharmaceutical Society to develop its modernisation programme have also persuaded all the other major health care professions to consider reforming the structure and processes of their regulatory bodies. In March 2001 the General Medical Council published a paper setting out proposals for reforming its structure, constitution and governance.1 A two-tier structure was proposed, in which the GMC would have a small board chaired by a medical president and a larger council chaired by a lay chairman. The proposed smaller board would have had a ratio of 60:40 medical to lay members, with responsibility for the GMC's statutory regulatory functions. The proposed over-arching council would have had a ratio of 50:50 medical to lay members.2,3 Subsequent correspondence in the British Medical Journal indicated that these proposals did not have unanimous support among the leaders of the profession, and a compromise plan was put forward. It was proposed that there should be a single statutory body of 35 members: 21 professional members, of whom 19 would be elected, and 14 lay members, giving a lay membership of 40 per cent.4 Although this proposal has been agreed by the GMC, it has yet to be agreed by Government. A new revalidation process for doctors is also being developed, with the aim that this will be introduced for all medical practitioners by 2004. Revalidation will become a mandatory requirement for all doctors who wish to continue in active medical practice.5 The procedures for investigating and adjudicating on questions of fitness to practise will also be improved, mainly by clearer separation of these two functions. In 2000, in "Modernising regulation: the new Nursing and Midwifery Council",6 the Department of Health set out proposals to reform the structures and functions of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC), which is currently the regulatory body for nurses, midwives and health visitors. In April 2001, a new Shadow Nursing and Midwifery Council was appointed under a Section 60 draft Order (secondary legislation under the Health Act 1999). It is intended that the new council will replace the UKCC in April 2002. The Shadow Nursing and Midwifery Council has 23 members, of whom 12 are registrants and 11 are lay members. Of the 12 registrants, four are drawn from each of the professional groups of nursing, midwifery and health visiting. The lay members are drawn from education, National Health Service employers, non-NHS employers, and service users.7,8 The new council will have two policy committees, one dealing with registration standards and professional development, the other responsible for strategic resources and planning. There will be three statutory "fitness to practise" committees: an investigating committee, a professional conduct committee and a health committee. The council will be supported by an advisory network drawn from consumer groups, the professions regulated by the council and other relevant professions, such as medicine, education and the law. The Dentists Act 1984 prescribes the composition, responsibilities and functions of the current General Dental Council. The GDC's development programme includes: • Extending the scope of professional self-regulation • Extending the range of the council's powers and responsibilities • Improving the efficiency and effectiveness of existing procedures and building quality into new procedures. Extending the scope of professional self-regulation is seen as crucial for the General Dental Council. Dentists are now working with a significant group of support workers, or professionals complementary to dentistry, including dental nurses, dental technicians and others. The GDC would like to see statutory regulation introduced for these groups and has established a voluntary system based on its initial background work. A paper with proposals for a new GDC constitution was published in September 2001.9 The first dental Section 60 Order under the Health Act 1999 was laid in October 2001. This allows for greater lay involvement and introduces mandatory continuing professional development (CPD). The new GDC will comprise 29 members: 15 dentists, four professionals complementary to dentistry and 10 lay members. The Council for the Professions Supplementary to Medicine (CPSM) was established in 1960 to co-ordinate and supervise the activities of the boards of the 12 professions covered by the council: art therapists; chiropodists; clinical scientists; dietitians; medical laboratory technicians; occupational therapists; orthoptists; paramedics; physiotherapists; prosthetists and orthosists; radiographers, and speech and language therapists. Physiotherapists are the largest group regulated by the CPSM, numbering about 33,500. Proposals to reform the CPSM have been developed by the Government in parallel with those to reform the Nursing and Midwifery Council.10 The Government set out its proposals in "Modernising regulation: establishing the new Health Professions Council".11 The aims of the reforms include: • Giving wider powers to deal effectively with individuals who pose unacceptable risks to patients • Creating a smaller council, comprising elected registrants and a strong lay input • Linking registration with evidence of continuing professional development • Providing stronger protection of professional roles • Enabling the extension of regulation to new groups Under a draft Section 60 Order, a shadow council was appointed in April 2001 with 25 members — 12 were from the regulated professions, 12 lay members and a president. The president has been appointed by the Government in the first instance but will be elected by the council in future and could be either a lay or a professional member.12 The General Optical Council is the statutory regulatory body for optometrists and dispensing opticians. Like the other councils, the GOC is seeking legislative reform relating to professional registration, competence to practise, the constitution of statutory committees, and the disciplinary process.13 The General Optical Council has not yet produced proposals for reforming its structures and functions. Technicians or support workers in health services In recent years there has been a significant increase in the large, heterogeneous group of people employed in health services as technicians or support workers. These groups, particularly those involved in delivering technical services, require varying degrees of education and training to carry out the tasks delegated to them. At present, technicians and support workers represent a growing body of unregistered and unregulated practitioners. However, the Health Act 1999 allows for regulatory bodies to regulate professional support workers without the need for primary legislation. The professions and their regulatory bodies now have an opportunity to look at the position of their own group of support workers and consider how they should be regulated. Within pharmacy, the Royal Pharmaceutical Society's Council has already made the decision to move towards mandatory regulation of pharmacy support staff.14 The Royal Pharmaceutical Society differs from all other registration bodies in that it combines the functions of a professional body with those of regulation and statutory enforcement. When the National Health Service Plan was published in July 2000 the importance of pharmacy to the reformed services was fully acknowledged. The need for this role to be developed was further spelt out in a paper issued in September 2000, "Pharmacy in the future: implementing the NHS plan; a programme for pharmacy in the National Health Service.15 This paper also states: "there will be a high standard of professional regulation. The Royal Pharmaceutical Society's disciplinary procedures will be modernised and pharmacists will have to demonstrate that they are still competent if they wish to remain on the register." One obvious issue relates to the way in which problems arising when a pharmacist's fitness to practise is impaired by poor mental or physical health are handled and distinguished from those relating to misconduct or inadequate standards of professional practice. At present the Society does not have a health committee to handle such cases. The issues that have been recognised in other professions are also relevant to pharmacy — namely, the development of continuing professional development programmes, the identification of an appropriate committee structure that can assume responsibility for a modern system of professional self-regulation, and the training of technicians and support workers. Whatever form of committee or Council is agreed for taking this responsibility forward, it will need to address the relationships it will have with the Council for the Regulation of Healthcare Professionals (CRHP), with the other regulatory bodies and with the Society's professional functions. Although the consensus is that reform of the processes of professional self-regulation in health care is necessary, few decisions have been made categorically on what changes should be implemented. Pharmacy and some of the other health professions have the opportunity to put forward their own proposals for reform and restructuring, which will take account of a number of common principles. Achieving support from the individual professions is recognised as an important element in these reforms. The National Health Service Plan and "Pharmacy in the future" identify the importance of pharmacists and pharmacies in providing services to the public and health professionals. The regulation of the profession therefore has a relevance and prominence on the agenda for change in the NHS and health services more generally. The contribution of the pharmacy profession and the role of the Royal Pharmaceutical Society have been recognised as important and this presents a significant opportunity for both the profession and the Society.
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