The Health Professions Council

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(No Transcript)
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The Health Professions Council Regulatory
Developments in Clinical Science and
Technology Dr. Christopher H. Green UK elected
hpc member for Clinical Scientists
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What could this mean?
Topics...

• Review and possible changes to Regulators
  themselves Foster Report
• Possible changes in registration procedures for
  Clinical Scientists
• Possible registration of aspirant groups,
  particularly emerging technologies
• Regulatory Developments in the hpc itself-
  possible changes in elections / appointments to
  Council

RefHPC/MJS/HPC/June 2005
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Possible Regulatory Developments
Topics...

• Review and possible changes to Regulators
  themselves Foster Report
• Possible changes in registration procedures for
  Clinical Scientists
• Possible registration of aspirant groups,
  particularly emerging technologies
• Regulatory Developments in the hpc itself-
  possible changes in elections / appointments to
  Council

RefHPC/MJS/HPC/June 2005
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Reminder of the Principles of Professional
Regulation
Introduction Principles...

• Self regulation
• Professionally led
• Statutory regulation
• UK model

RefHPC/MJS/HPC/June 2005
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HPC is an independent regulator of healthcare
professionals
Introduction...
Introduction Independent...

• Reports to Privy Council
• Not part of Department of Health
• Not part of NHS, (E,NI, S W)
• Body Corporate

RefHPC/MJS/HPC/June 2005
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Primary, Secondary Tertiary legislation
Introduction PST Legislation...

• Health Act 1999
• Chapter 8
• Health Professions Order 2001
• 1st April 2002
• Statutory Instrument No. 254
• Recall the Old CPSM 12 Boards 1961
• Rules
• 9th July 2003
• Standards Guidance

RefHPC/MJS/HPC/June 2005
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HPO 2001 Rules
Introduction OIC ...
RefHPC/MJS/HPC/June 2005
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Nine UK Regulators of Healthcare Professionals
Introduction Nine Regulators...

• General Chiropractic Council
• General Dental Council
• General Medical Council
• General Optical Council
• General Osteopathic Council
• Health Professions Council
• Nursing and Midwifery Council
• Pharmaceutical Society of NI (NB Foster)
• Royal Pharmaceutical Society of GB (NB Foster)

RefHPC/MJS/HPC/June 2005
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Other related Regulators
Introduction Other Regulators...

• General Social Care Council
• England, NI, Scotland Wales
• Council for Healthcare Regulatory Excellence
  (CHRE)
• 1st April 2003
• Appeals against Lenient decisions
• Coordination best practice
• The president of each of the nine regulators sits
  on CHRE
• Foster Report suggests enhanced role for CHRE

RefHPC/MJS/HPC/June 2005
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Complementary Roles
Introduction Complementary Roles...

• Professional Body IPEM
• Body of knowledge/ Learned Society
• Promotion of profession
• Curriculum framework
• Trade Association HPA
• Terms conditions
• Regulator HPC
• Sets and maintains standards
• Approves programmes
• Keeps a Register
• Fitness to Practise
• Continuing Professional Development (CPD)

RefHPC/MJS/HPC/June 2005
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Regulator must be separate
Introduction Separation...
Regulator HPC
Trade Association HPA
Professional Body IPEM
RefHPC/MJS/HPC/June 2005
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(but pharmacistists arent separate, see comment
in Foster Report)
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Further Separations

• In Investigative and Disciplinary cases, the
  Regulator should not be judge and jury (e.g.,
  public perceives doctors on GMC looking after
  their own).
• Currently done by Investigative panels reporting
  to Council through Investigative committee.
• This function may move to the Council for
  Healthcare Regulatory Excellence (CHRE) under
  Foster Report.

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HPC main objective
Objective...

• To safeguard the health and well-being of
  persons using or needing the services of
  registrants
• Health Professions Order 2001
• Article 3 (4)
• Recall how the HPC meets this Objective

RefHPC/MJS/HPC/June 2005
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There is an Integrated process of setting
maintaining standards
4 Standards 5 Processes...
RefHPC/MJS/HPC/June 2005
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The Council has Statutory Non-Statutory
Committees
SO Committees...
Council
Health
Investigating
Education Training
Conduct Competence
Registration Now disbanded
Approvals Now disbanded
Finance Resources
Communications
Remuneration
Audit
RefHPC/MJS/HPC/June 2005
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Standards of Education Training
Standards ET...

• Light Touch regulation (really?)
• Six components
• Level of qualification for entry to the
  register MSc
• Programme admissions procedures IPEM
• Programme management resources ,,
• Curriculum ,,
• Practice placements ,,
• Assessment ,,
• Seems a very long process to me

RefHPC/MJS/HPC/June 2005
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Standards of Proficiency
Standards Proficiency...

• Threshold standards for entry to Register
• Two components
• Shared
• Profession specific
• Three standards
• Expectations of a Health Professional
• Skills required for application of practice
• Knowledge

RefHPC/MJS/HPC/June 2005
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Standards of Conduct, Performance Ethics
Standards CPE...

• Apply to registrants prospective registrants
• Conduct, (4)
• 3. Maintain high standards of personal conduct
• Performance, (8)
• 10. Keep accurate patient, client and user
  records
• Ethics, (4)
• 14.Behave with integrity honesty
• HPC booklet available currently under review

RefHPC/MJS/HPC/June 2005
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Standards Brochure...
RefHPC/MJS/HPC/June 2005
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Standards of CPD
Standards CPD...

• HPC will require registrants to undertake CPD
  before renewal of registration, current done by a
  declaration.
• Implementation July 2006 already done
• Auditing profiles July 2008 July 2009 for us
• Will implementation mean more that just a
  declaration?
• Yes, a sample, probably initially 5 dropping to
  2½ will be taken of all registrants in group to
  be audited.

RefHPC/MJS/HPC/June 2005
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Possible Regulatory Developments
Topics...

• Review and possible changes to Regulators
  themselves Foster Report - done
• Possible changes in registration procedures for
  Clinical Scientists
• Possible registration of aspirant groups,
  particularly emerging technologies
• Regulatory Developments in the hpc itself-
  possible changes in elections / appointments to
  Council

RefHPC/MJS/HPC/June 2005
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Clinical Scientists

• A clinical scientist is an appropriately
  qualified and trained scientist working in health
  care who
• gives scientific and clinical advice which has a
  direct bearing on the management of patients
• applies scientific methods to maintain the
  efficacy, quality and safety of investigative or
  therapeutic techniques
• introduces and advances new scientific and
  clinical procedures for patient benefit
• is registered with the Health Professions Council
  (HPC).
• Clinical Scientist is a title protected under
  law and anyone not registered using it
  fraudulently will be prosecuted.
• How do we compare with others on the Register?

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162,000 registrants,13 Professions
Process Number of Registrants...
RefHPC/MJS/HPC/June 2005
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Clinical Scientists

• There are only about 5000 clinical scientists as
  opposed to 35000 or so physiotherapists. Whereas
  the latter have their own protected title,
  Medical Physicists join in with Biochemists,
  Clinical Geneticists, etc., and are collectively
  known by the protected title Clinical
  Scientist. Each professional group has banded
  together to form the Association of Clinical
  Scientists, which has the task of awarding the
  Certificate of Attainment, which permits entry
  to the HPC Register.
• Compare with other Groups-
• Physiotherapist - 3 year degree, straight onto
  hpc Register
• Clinical Scientist - 3 year degree, 1 year MSc,
  training Scheme placement, portfolio etc,
  Certificate of Attainment by ACS which
  permits entry to hpc Register. Currently 4
  years reducing to 3.

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Compare with Doctors

• 5 year degree to get MBBS
• 1 years pre-registration (as House Officer)
• Thereafter, post-registration as Senior House
  Officer, then Special Registrars, etc. Working to
  obtain MRCP, FRCS, MRCR, MRCPath, etc, regarded
  as qualification for Consultant status. NB,
  biochemists, Clinical microbiologists, etc. can
  also study for MRCPath.
• Specialist (higher) registration, however is
  through the Joint Committee on Higher Medical
  Training (JCHMT), and the Postgraduate Medical
  Education and Training Board (PMETB) Not
  connected with GMC.
• That may all change, too (Donaldson Report)

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Clinical Scientists

• My own view for Clinical Scientists has always
  been that it should be-
• 3 year degree,
• 1 year MSc,
• 1 year Training Scheme placement
  (pre-registration year)
• Straight on to HPC register.
• Thereafter, doctor equivalent pathway could
  be-
• Studying for Membership of IPEM ticket for
  later consultant post.
• Higher registration in specialist modalities
  such as Radiotherapy or Nuclear Medicine
  (equivalent of registration with JCHMT or PMETB)
• Ditch portfolio etc, and Certificate of
  Attainment!

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Clinical Scientists

• The Association of Clinical Scientists has
  recognised twelve different modalities of
  practice for registration, being-
• audiology
• cellular science
• clinical biochemistry
• clinical genetics
• clinical embryology
• clinical immunology
• clinical microbiology
• clinical physiology
• haematology
• histocompatibility and immunogenetics
• medical physics and clinical engineering
• developing sciences.

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Association Of Clinical Scientists

• The Association Of Clinical Scientists would
  still have a role in advising the HPC on which
  MSc courses and placement schemes were suitable,
  and could moderate and advise on the higher
  registration modalities, but I suggest that the
  gatekeeper role for HPC registration could be
  given back to the HPC

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The Register
Process The Register...

• Skill levels modalities of care
• Renew registration every two years
• Standards of Practice health
  self-certification
• Public vs. Private

RefHPC/MJS/HPC/June 2005
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162,000 UK International Registrants
Process Register Registrants Home
Countries...
RefHPC/MJS/HPC/June 2005
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Possible Regulatory Developments
Topics...

• Review and possible changes to Regulators
  themselves Foster Report - done
• Possible changes in registration procedures for
  Clinical Scientists - done
• Possible registration of aspirant groups,
  particularly emerging technologies
• Regulatory Developments in the hpc itself-
  possible changes in elections / appointments to
  Council

RefHPC/MJS/HPC/June 2005
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Emergence of aspirant groups or new professions
Process Register New Professions...
A SET SP
Time
RefHPC/MJS/HPC/June 2005
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Aspirant groups
Process Register Aspirant Groups...

• Number of professions not restricted
• Dozens of Aspirant Groups examples below
• Operating Department Practitioners
  7,500 (10/04)
• Applied Psychologists 15,000 (12/05)?
• Dance Movement Therapists 300
• Medical Illustrators 400
• Clinical Perfusionists 300
• Clinical Physiologists 5,000
• Clinical Technologists 5,000
• Max Fax 400
• Health Care Scientists 17,500 Est.

RefHPC/MJS/HPC/June 2005
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Two stage assessment process
Process Register Aspirant Groups...

• HPC
• Assess aspirant group by reference to ten
  criteria, described in next two slides.
• DoH
• Public consultation process.
• Amends legislation.
• HPC can recommend regulation even though no
  application received.

RefHPC/MJS/HPC/June 2005
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Ten reference criteria to assess aspirant group
by

• At least 1 criterion of invasive procedures,
  clinical intervention with potential for harm,
  exercise of judgement by unsupervised
  professionals.

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Ten reference criteria to assess aspirant group by

• Discrete area of activity displaying some
  homogeneity.
• Defined body of knowledge.
• Evidence of efficacy.
• At lease 1 established professional body a/c for
  significant proportion of occupation.
• Voluntary register(s)
• Defined routes of entry to the profession.
• Independently assessed entry qualifications.
• Conduct performance and ethics standards.
• Disciplinary procedures to enforce those
  standards.
• Commitment to CPD.

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Closure of Title
Process Register Titles...

• Closure of function - GOC
• Eye test
• Definition and job demarcation
• Closure of Title HPC
• No limit to scope of practice
• Titles
• Limited number of protected titles aids public
  recognition
• Market Research indicates that the public
  requires specific titles to be protected

RefHPC/MJS/HPC/June 2005
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Grandparenting
Process Register Grandparenting...

• Process starts as new titles are protected
• Sets aside existing educational requirements
• Applicants must demonstrate lawful, safe
  effective practice
• Two or three year window
• 200 fee at present will go up.

RefHPC/MJS/HPC/June 2005
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Aspirant Groups

• At a recent presentation by the HPC aspirant
  group manager, there were 52 new aspirant groups,
  including 9 different Psychotherapy groups, ye
  gods!
• What they need to do is to get their act
  together, and form an Association of Clinical
  Psychotherapists, and have one protected title
  and seat on council.
• When Dance Therapists come on board, it has
  already been agreed that they will be subsumed
  into the Arts Therapists Group.

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Aspirant Groups

• AND HERE THEY ALL ARE, THE ALPHABETICAL LIST OF
  APPLICANT GROUPS/SPECIAL INTEREST GROUP YE
  GODS!
• OrganisationProfession/Practitioners1Acupuncture
  Regulatory Working GroupAcupuncture2The Alliance
  of Private Sector Chiropody Podiatry
  PractitionersFoot Health Practitioners3Artists in
  Mental HealthArtists in Mental Health4Association
  of Child PsychotherapistsChild Psychotherapists5As
  sociation of Dance Movement TherapistsDance
  Movement Therapy6Association of Operating
  Department PractitionersOperating Department
  Practitioners7Association of OsteomyologistsOsteom
  yologists8Association of Professional Ambulance
  PersonnelAmbulance Practitioners, Advanced
  Ambulance Practitioners and Ambulance
  Technicians9British Academy of AudiologistsAudiolo
  gy10British Association for Counselling
  PsychotherapyCounselling Psychotherapy11British
  Association for Nutritional TherapyNutritional
  Therapy12British Association of Play
  TherapistsPlay Therapists13British Association
  for Psychoanalytic Psychodynamic
  SupervisionPsychotherapists Counsellors14British
  Association of Sports Rehabilitators
  TrainersSports rehabilitators trainers15British
  Confederation of PsychotherapistsPsychotherapists1
  6British Orthopaedic AssociationOrthopaedic
  Technicians17The British Psychological
  SocietyApplied Psychologists18British Society of
  Clinical HypnosisHypnotherapy/Clinical
  Hypnotherapy19British Society of
  EchocardiographersEchocardiography20British
  Association of Tissue BankingTissue
  Banking21Cambridge Society for PsychotherapyPsycho
  therapists Counsellors22College of Health Care
  ChaplainsHealth Care Chaplains23The College of
  Psychoanalysts UKPsychotherapists
  Counsellors24The Commission for Healthcare
  Regulatory ExcellenceHealthcare Assistants in the
  Prison Service25Confederation of Analytical
  PsychologistsPsychotherapists
  Counsellors26Craniosacral Therapy Association of
  the UKCraniosacral Therapists27Diabetic
  RetinopathyDiabetic Retinopathy28Hospital Play
  Staff Education TrustHospital Play Staff
• Theres another24, but I dont think well bother
  with those!

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HPC committed to the protection of professional
titles
Process Protected Titles...

• Article 39 Criminal offence
• Communicate sanctions for misuse
• State Registration or SR
• The use of the phrase or abbreviation to be
  actively discouraged once Grandparenting
  completed
• HPC will prosecute

RefHPC/MJS/HPC/June 2005
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Possible Regulatory Developments
Topics...

• Review and possible changes to Regulators
  themselves Foster Report - done
• Possible changes in registration procedures for
  Clinical Scientists - done
• Possible registration of aspirant groups,
  particularly emerging technologies - done
• Regulatory Developments in the hpc itself-
  possible changes in elections / appointments to
  Council

RefHPC/MJS/HPC/June 2005
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Structure of Council
SO Council...

• One Registrant member of Council from each
  profession
• Each Registrant has an Alternate
• Elected by Registrants from July 2005
• One less Lay member c.f. Registrant
• RL-1
• Public appointment
• If President is a Registrant
• Add a Lay a Registrant Council member

RefHPC/MJS/HPC/June 2005
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UK Wide remit
SO UK Remit...

• Four Home countries
• At least one Registrant member from each of the
  four Home Countries
• At least one Lay member from each of the four
  Home Countries

RefHPC/MJS/HPC/June 2005
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Restructuring of the Health Professions Council

• The Governments position and priorities

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Government principles

• Patient safety is the guiding reason for
  regulation, not professional interest.
• The regulator should contain some members elected
  by the regulated professions to provide
  professional buy-in.
• As the HPC is a UK-wide body, there must be
  minimum representation from all four home
  countries guaranteed.

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Government principles

• The chosen election scheme should be as
  democratic as possible, once four country
  representation has been guaranteed.
• The election scheme should provide the most
  efficient model possible, achieving the best
  balance of continuity and introduction of new
  members.
• The election scheme should be as open and
  transparent as possible.

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BUT

• At a recent Council meeting it was noted that
  Council had already agreed to discontinue
  elections, and have wholly appointed registrant
  members.
• When I expressed surprise, a member informed me
  that it had all been agreed at a Council Away
  Day.
• I then informed him be email that this
  agreement to abolish elected representatives
  had therefore been taken by un-elected members
  before the first elections in July 2005 had even
  taken place.
• The governments position on the previous two
  slides had been given after July 2005, and after
  the above Council Away Day.
• I think the re-structuring of Council is not
  finalised, and the debate continues.

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Stakeholders
Communications Stakeholders...

• Carers
• ClientsPatientsUsers
• Consumer Associations
• Employers
• Government
• Higher Education Institutions

• Members of the Public
• Professional Bodies
• Registrants
• Regulators
• SIPGs
• Trade Unions

RefHPC/MJS/HPC/June 2005
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Current Issues
Issues Current...

• Structure of the Register size of Council
• Health Disabilities
• Returners to practice
• Less than two years
• Between two five years
• More than five years
• Review standards
• Post registration qualifications

RefHPC/MJS/HPC/June 2005
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Current Issues (contd)
Issues Current...

• Extending Regulation
• Supervised Assistants
• Non-professional healthcare workers
• Mitigating the necessity to register with two UK
  regulators of healthcare professions

RefHPC/MJS/HPC/June 2005
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Future Issues
Issues Future...

• Post Shipman Foster review NOW OUT
• Revalidation
• Regulation of Teams
• Regulation of Complementary Medicine
• Flexible workforce Flexible regulation
• The desirability for reducing the number of UK
  Regulators of health professionals
• Unitary regulator
• Communications, Energy, Financial

RefHPC/MJS/HPC/June 2005
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