Examination of Witnesses (Questions 540-544)
MR MARC
SEALE, MR
FINLAY SCOTT
AND MS
SARAH THEWLIS
15 JUNE 2006
Q540 Dr Taylor: I have to declare
an interest, one of my daughters claims to be a nurse consultant!
I shall have to chase her up on this! Thank you very much. You
have already covered the point about regulation not being a constraint
and rather being a facilitator. The last question is to Finlay.
Is it right to say that the medical profession has become more
regulated than other professions recently?
Mr Scott: I think if you ask most
doctors they almost certainly would say so. I think the serious
point is to recognise, as we have tried to do through our four-layer
model, that doctors are not only regulated by the GMC but regulation
takes different forms, including regulation of where they work
or their employer. I think the aim has to be, whether it is in
the context of revalidation or any other initiative by the GMC,
to ensure that we can achieve the desired impact with the minimum
burden. I think some of the thinking that has been emerging over
the last 12 or 15 months around risk-based regulation from the
Hampton Report, is extremely helpful, and it will enable us in
developing revalidation, once Ministers have made their decisions,
to approach revalidation on a basis that allows us to target much
more closely the effort required to be confident that a doctor
is up to date and fit to practise. That is why, as part of our
ongoing programme of reform and modernisation, we are proposing
to collect scope of practice data about doctors who hold a licence
to practise so that that data can both be made available to employers
in the context of workforce planning and to members of the public,
and will also inform our approach to regulating individuals and
groups of doctors.
Q541 Dr Taylor: Sorry to backtrack,
can I just go back to the emergency care practitioners for one
moment because I am still not clear? Are Marc and Sarah saying
that you would keep nurse emergency care practitioners under your
regulation and ambulance trained ones under your regulation?
Mr Seale: I think the issue of
who regulates them is completely irrelevant. I do not think that
regulators should be having turf warfare between who regulates.
What is important is that they are regulated, and whether you
put them all in the nurses—or indeed if the dental regulator
was to regulate them—it does not matter, as long as they
are regulated.
Q542 Dr Taylor: So somebody will
do it?
Ms Thewlis: Yes.
Q543 Dr Taylor: Who?
Ms Thewlis: Without wishing to
second guess what is coming out of the Foster Review, they have
talked about this concept of almost having a host regulator. I
would see the emergency care practitioners, Marc would have responsibility
around the education and the quality side of it, and there may
be some nurses who take the decision that they want to actually
not be regulated by the Nursing and Midwifery Council now, but
they would rather be regulated by the Health Professions Council.
If they did not make that decision and we had a fitness to practise
issue that came up where somebody had concerns about the standard
of care, then obviously within our legislation we are able to
bring in what we would call an expert witness of due regard for
somebody saying, "Is this appropriate care that is being
given?" So I think that is the sense we want to get across—that,
as Marc says, it is not who does it; it just needs to be done.
I think one of the things that has been very helpful, I hope we
have given a sense that we do actually collaborate and we do not
have turf wars around this, because I think the public need to
know that there is an effective system of regulation in there
and we have part responsibility for that—the individual
profession does—but, as Finlay said, there are other groups
as well.
Mr Scott: The same issue arises
in relation to other groups such as surgical care practitioners
and medical care practitioners. Essentially there are two models
that have been on the table. One is where you would have a single
regulator responsible for any one of those groups and then individuals
who were already registered with another regulator would have
a choice of double registration or of switching their registration.
The second model, which is the one that Sarah has just touched
on, is where you have a lead regulator but those who are already
regulated, ie registered with another regulator, could remain
regulated in that way, and then their existing regulator would
take the standards from the lead regulator. It is not a very easy
concept to describe, but I think it is fair to say on balance
that it is the one that the community of regulators thinks would
work most effectively.
Q544 Chairman: By implication that
would mean that probably the statute that covers all your three
areas of regulation may have to be a bit more flexible at the
moment.
Mr Scott: Perhaps it would help
if I tried to illustrate what I was clumsily trying to explain?
If you take, not emergency care practitioners but, say, surgical
care practitioners, as has already emerged from the evidence both
from us and others, there are essentially two sub populations—those
who qualify perhaps as nurses or some other healthcare profession
and those who, from the outset, seek to qualify as a surgical
care practitioner. One model is that, say, the GMC would be the
lead regulator for surgical care practitioners, but nurses who
went on to qualify as surgical care practitioners could choose
to remain regulated by the NMC. We would lay down the appropriate
standards under that model. In that the event that the nurse,
now surgical care practitioner, had her or his competence challenged
the NMC would handle that in accordance with the standards that
we had laid down.
Mr Seale: It might be useful to
link this debate back to workforce planning. What is going on—and
it is beginning to accelerate this change—is the traditional
model of doctors, nurses and physiotherapists is beginning not
to work, because I think what is happening is that new skills,
new technology, new drugs, et cetera, start off in a very small
group of individuals who are skilled in doing that and gradually
that skill goes down through the workforce. At the same time you
can actually now come into the workforce at a particular level
with that new set of skills and what the regulators have to do
is to capture those new individuals with the new skills as it
trickles down through the system. Currently it is not quite working
correctly but I think all the regulators want to see it work effectively.
That will mean that as demands are put on the workforce those
skills could then flow through the individuals.
Chairman: Thank you very much for that.
We are likely to have this inquiry running to later this year
if not into next year, so if you have any further thoughts in
this area please do not hesitate to contact us and we will be
more than happy to receive them. Can I thank all three of you
for coming along, and I am sorry about the delay.
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