Transcript Slide 1
Models of regulation and the development of an international regulatory community Regional Health Regulation Conference - Dubai 22 October 2014 Niall Dickson Chief Executive and Registrar, GMC Chair, IAMRA The origins of regulation Professional Self Regulation A product of the Enlightenment and the rise of Science A means of differentiating those whose practice was based on science Based on a compact between state and the profession The state recognised this group and gave them privileges In return they managed their own affairs Medicine was about individual mastery and application of knowledge John Marshall, GMC President, 1887-1891 The GMC: ‘should not seem overanxious to be at work since the spreading abroad of the shortcomings of any erring members of our honourable profession is a proceeding to be carefully restrained within precise limit.’ The origins of regulation Professional Self Regulation in the 19th and 20th century Responded to concerns – a reactive process Driven by the profession (seen by some as for doctors not patients) Involvement – for some doctors, one off catastrophic intervention Contact for most doctors at registration and retirement How regulation is changing Emerging models of regulation New compacts Between the state, the profession and the consumer Driven by patient safety and need for assurance Less based on unquestioning trust Recognise difference in quality and performance Acceptance that this is a team business Anticipate and respond to concerns Continuous process Analysis of data; closer working with front line services Involved at every stage in a doctor's career Works with the profession but driven for patients In UK oversight from the Professional Standards Authority and accountable to UK Parliament In the UK - arrival of system regulation Major variation in powers and functions National regulators (UK, India, Singapore) Provincial regulators (USA, Canada, Germany) Regulation by professional associations (Europe) Regulation by government departments (Sweden, Norway, UAE) Quasi-independent regulation 2003 – 2012 UK Powers vary enormously Registration (Entry to the register) Discipline (Exit from the register) Setting professional standards Overseeing undergraduate education/postgraduate education and or CPD Re-licensure or revalidation Structures and powers are changing 2003 – 2012 - Size of Council reduced from 104 to 12 members – half lay, half medical. just 2010 - Merger with PMETB - taking on responsibility for postgraduate training. June 2012 - Separation of adjudication function, creation of Medical Practitioners Tribunal Service. Dec 2012 - Revalidation for all doctors introduced Further plans for major reform in UK Currently the 9 health professional regulators in the UK covered by different legislation Acts are seen as out of date and overly prescriptive about how we fulfil our duties 2012 - The Law Commissions of the UK propose overarching legislation for all 9 regulators which will free them to innovate and more effective Tensions: Consistency vs flexibility Independence from govt Balance between autonomy and accountability Law Commission (2014), Regulation of Health and Social Care Professionals Differing regulatory models The UK model is one of many National and regional models influenced by historical, cultural, geographical, financial and political contexts State vs Independent Lay vs Professional Models of multi-professional regulation New Zealand – moving towards a single multi-professional regulator for all healthcare professions. Government already committed to making regulators share back office functions Australia – umbrella organisation, AHPRA, with national boards sitting underneath. Registers administered by one body but Boards operate independently USA – State medical boards independent of each other and federal government - some uni-professional, some multi-professional. Federation of State Medical Boards is a voluntary association of state medical boards UAE – Federal system. Each emirate government responsible for all health professions System and professional regulation combined Scandinavia – multi-professional state led regulation. Combines system regulation with regulation of individuals. France/Germany – regulation controlled by the profession Emerging themes The dominance of the professions is being challenged: Singapore – substantial media pressure for reform (and from parts of the profession itself) Hong Kong – government has commissioned inquiry into professional regulation by the Chinese University of Hong Kong Trust in professionals is being challenged – end of the age of deference Growing interest in lay involvement in regulation Consumers expect more assurance and more data Scepticism among governments (and in parts of the profession) about activists within professional associations: Hong Kong, AUS/NZ, and UK A growing view that regulation needs to be a societal responsibility International drivers for change Scandals in the media and resulting enquiries – Shipman/Bristol (UK), Patel (AUS) Cartwright (NZ) Exposure to other regulatory models Rising importance of healthcare in global economy Demand for efficiencies Global movement of health professionals Demands for workforce reform Rising patient expectations Transparency agenda and digital revolution Robert Francis QC, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, February 2013 Regulation under scrutiny Widespread interest in reform (a dynamic sector) Widely accepted that the purpose is protecting the public not the profession Interest in multi-professional regulation or at least in greater consistency Australia - Australian Health Practitioner Regulation Agency UK – Professional Standards Authority for Health and Social Care Legislative change is needed to reform structures UK - Law Commission Bill, 2014 Singapore – Allied Health Professions Act, 2011 Australia – Health Practitioner Regulation National Act, 2010 New models will emerge from countries building their regulatory mechanism Compulsory CPD becoming more common Regulation under scrutiny Interest in re-licensure/recertification/revalidation Greater separation of roles - investigatory and disciplinary functions i.e. Medical Practitioner Tribunal Service (UK) local accountability for disciplinary function (Australia) Appeal mechanisms (US) Data will drive interventions Opportunities for upstream intervention Risk based models not yet developed but will emerge IAMRA – An international community Purpose: To encourage best practice among medical regulatory authorities worldwide in protecting, promoting and maintaining the health and safety of the public by ensuring proper standards for the profession of medicine. Vision: Everyone around the world is treated and cared for by safe and competent doctors. Diversity of regulatory models: IAMRA does not promote one model of regulation but encourages exchanges of view and examples of best practice Ambitions of IAMRA More responsive to the needs and future direction of medical regulatory authorities worldwide Promote medical regulation as a means of protecting patients throughout the world Engage with and between members at different stages of regulatory development Provide opportunities to promote members’ work and share best practice IAMRA London 2014 - recognition that the world of regulation is changing - opportunities for learning from each other - no right model of regulation Thank you www.gmc-uk.org www.iamra.com [email protected]