'It will be much easier for NHS organisations to deal effectively and constructively with clinical performance problems'

The reform of health professional regulation envisages a much bigger role for managers, says Kieran Walshe.

It sometimes seems as if the Department of Health has forgotten how to 'do' policy. The financial crisis earlier this year was, more than anything else, the product of a host of uncosted, poorly thought through, mutually incompatible policy initiatives.

But a sign that the policy process is getting back on track is the quiet revolution in the way health professionals are regulated that has been put in train (news analysis, pages 12-13, 10 August). The DoH published simultaneously its long-awaited proposals for reforming the General Medical Council and for changes to non-medical regulation - the eight other regulatory bodies that oversee nurses, dentists, pharmacists, therapists and a host of other professions.

Managers should pay attention to these reforms for at least two reasons. First, they will make it much easier for NHS organisations to deal effectively and constructively with clinical performance problems. Second, they envisage a much larger role for NHS employers in co-regulation - working closely and co-operatively with professional regulators at a local level.

Complex proposals

The changes result in part from recommendations from the Shipman inquiry which was highly critical of the GMC, but are mainly based on two reviews, undertaken by chief medical officer for England Professor Sir Liam Donaldson and DoH former director of workforce Andrew Foster. The proposals are complex and detailed, but four points are worth highlighting.

First, every clinical professional will have to demonstrate their continuing competence to practise if they are to stay licensed. Research showed that the public assumed such systems were already in place, though in fact none of the health professions currently have arrangements for periodic competence reviews after initial qualification. Professor Donaldson's report pointedly notes that a typical airline pilot will face competence checks around 100 times during their career - while a doctor can practise for 40 years with no checks at all.

Second, the professional regulatory bodies will no longer be run by councils of elected professionals. They will have boards, largely or wholly appointed by the Public Appointments Commission to represent a range of interests. This is a crucial change in governance, which will remove an inherent conflict between public interest and professional self-interest which has blocked reform in the past.

Third, there will be a new emphasis on 'commonality' between the regulatory bodies, which will move towards having the same standards of care, administrative processes and sanctions. It is proposed that all cases of conduct or performance problems will be dealt with by a single, independent tribunal rather than by panels set up by each regulator separately.

Fourth, NHS Employers will play a crucial part in regulation, with local GMC 'affiliates' handling many issues for doctors and only the more serious or unresolved performance or conduct problems being dealt with at a national level. Information gathered by NHS organisations will be vital in relicensure.

New law needed

All this will require new primary legislation, and although the review reports do not say so, the sensible way forward would be to produce a single new Health Professions Regulation Act to replace the patchwork of different laws in place at present.

Some of the proposals will be controversial - howls of rage have already been heard from some parts of the medical profession - and legislating to implement the reforms will take time. But the end result will be a system of regulation which is fit for purpose now and in the future.

Kieran Walshe is professor of health policy and management and co-director of the Centre for Public Policy and Management at ManchesterBusinessSchool