In the UK, reform is coming to the regulation of health professions. The oversight body, the Professional Standards Authority (PSA), has issued a guidance document on the reforms to rule-making by health profession regulators. Of particular note is the fact that regulators will be able to make operational rules without obtaining government approval. Examples of the types of rules covered by this guidance include:
• The type of information that should be posted on the public register,
• Continuing professional development and quality assurance requirements,
• The procedure for processing applications for registration,
• The complaints, discipline, and reinstatement process, and
• Standards of practice for registrants.
The guidance is intended “to provide good practice guidance to regulators to help them make the best use of their new powers.”
The two main themes of the PSA guidance are consistency and consultation.
In terms of consistency, the PSA identifies two primary dimensions:
• Consistency with the principles of right-touch regulation (e.g., that the rules should be proportionate to the public interest being served and that the rules should not unnecessarily duplicate the work of other regulators); and
• Consistency with approaches taken by other regulators unless there are valid reasons for differences (e.g., differences might be justified where there is a higher or lower risk of harm to the public by the actions of registrants in various professions).
In terms of consultation, the PSA urges regulators to be creative in identifying groups that might be affected by a proposed rule. In addition to registrants, their service users, their employers and their funders, regulators should consider consulting with:
• Any groups at risk of experiencing disproportionate outcomes
• Professional associations
• The wider education sector
• Sole practitioners working in private practices
• Trainees
• Students
The PSA also suggests that regulators consider the nature of the rule (e.g., whether it is a minor or substantial change from what exists) and its potential impact (e.g., on “human rights or equality, diversity and inclusion implications or opportunities”). That analysis could impact the nature of the consultation (e.g., formal vs. informal) as well as which groups should be consulted. The PSA describes formal consultation as follows:
Formal public consultation would involve publishing a consultation document and enabling responses from anyone. It can also involve face-to-face discussions, workshops etc, which can be a valuable way of getting meaningful engagement with people who might not otherwise respond. It would result in changes being made on the basis of the feedback received, with a published report setting out what people said and how they responded.
In the guidance document, the PSA expresses concern about the cumulative burden of multiple consultations, especially by several regulators at the same time. Some groups, such as patient organizations, might have limited capacity to respond. The PSA suggests staggered consultations or joint consultations by regulators.
The PSA also suggests some other best practices for consultations:
As consultation is an important element of demonstrating accountability to stakeholders, it is good practice to keep a record of decisions made on whether to consult and how consultation responses were evaluated. It is also good practice to provide a report back to those who took part in a public consultation.
Finally, the PSA suggests that regulators be sure to “establish appropriate internal governance for developing, making and amending rules.”
While the PSA’s guidance is admittedly at ahigh level, it identifies important considerations for all regulators engaged in policy making.
