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.
In our response to the consultation on the future of professional regulation in healthcare, we have said change is long overdue - but warned against reform that would see the creation of a ‘super regulator’ or a similar large scale amalgamation which could result in a lack expertise and understanding of the distinct professions. It said there was a strong case for the GMC to remain the regulator for doctors as they carry out complex work with varying portfolios that carry high degrees of risk, and undertake considerable and ongoing specialist education and training.
After the important question of what organisation should regulate doctors, no issue is of more fundamental importance to the reform debate than fitness to practise. We have called for the government to make a number of reforms so the GMC and GDC’s powers so they are able to improve their processes. For example, we have called for the GMC to have more discretion to not investigate in cases where the allegations clearly do not require action. The vast majority of GMC investigations are closed without action, meaning that over a thousand doctors go through a needless, stressful and slow process each year.
However, while there is clearly scope to improve legislation, so the GMC can reduce the burden on health professionals, any additional freedom given to the regulators to reform their processes must be accompanied by safeguards which ensure their processes are transparent, fair and consistent and the need to adequately consult with stakeholders. 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?
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.