Guidance for new regulators

1
Guidance for new regulators (aka A view from the
analysts couch or How I fooled the conference
organisers)
2

• Understanding Medical Regulation
• A guide to good practice
• Eleanor Thompson
• HLSP Institute
• www.iamra.com
• www.hlspinstitute.org
• Project funded by the UK Department for
  International Development, in which support was
  given to the Albanian Order of Physicians to
  establish its role as a professional body and to
  become an effective partner with the Albanian
  Ministry of Health

3
Purpose

• The purpose of medical regulation is to ensure
  public confidence in the medical profession by
  endeavouring to guarantee that clinical care is
  of high quality.
• Brian Salter, 2000

4
Purpose

• The purpose of healthcare regulation is to ensure
  safety and quality for patients.
• It involves all matters affecting the performance
  of the individual and covers initial education,
  training, appraisal, continuing professional
  development and, where relevant, disciplinary
  action.
• Report of the Bristol Inquiry, 2001

5
Purpose

• To protect, promote and maintain the health and
  safety of the public by ensuring proper standards
  in the practice of medicine
• Medical Act 1983 (as amended)

6
Functions

• Controlling entry to the medical register
• Setting the educational standards for medical
  schools
• Determining the values and principles that
  underpin good medical practice
• Taking firm but fair action against doctors when
  standards have not been met

7
(No Transcript)
8
A general overview of medical regulation
From Understanding medical regulation a guide to
good practice HLSP Consulting 2005
9
Ensuring proper standardsGood Medical Practice

• Good clinical care
• Maintaining good medical practice
• Teaching and training
• Relationships with patients
• Working with colleagues
• Probity
• Health

10
Inverse square law

• The magnitude of an effect (usually a force) at a
  point is inversely proportional to the square of
  the distance between that point and the object
  exerting the force.

11
Four layer model

• Personal regulation.
• Team based regulation.
• Workplace regulation.
• National regulation.
• Plus
• International co-operation

12
Principles of regulation

• Proportionality
• Accountability
• Consistency
• Transparency
• Targeting
• Hampton Report,
• Reducing administrative burdens effective
  inspection and enforcement
• March 2005

13
Risk based regulation

• If regulators operate effectively, and use the
  best evidence to programme their work,
  administrative burdens can be reduced while
  maintaining or even improving regulatory
  outcomes.
• Risk assessment is an essential means of
  directing regulatory resources where they can
  have the maximum impact on outcomes.
• Regulators should use the resources released
  through risk-based assessment to provide
  improved advice, because better advice leads to
  better regulatory outcomes.
• Hampton Report, HM Treasury, March 2005

14
Models a false antithesis?

• Deterrence
• Focussed on wrong-doing and punishment
• Rooting out bad doctors
• A complaints led approach
• Compliance
• Focussed on an assumption of integrity and the
  competence on most professionals
• Designed to encourage improvement

15
Modern medical regulation

• Independent, accountable regulation must
• Put patient safety first
• Support good medical practice
• Promote fairness and equality
• and value diversity
• Respect the principles of good regulation
• proportionality,accountability, consistency,
• transparency and targeting

16
Key characteristics

• Patient safety at the heart of regulation
• Independent
• Integrated framework with interlocking functions
• Coherence between professional regulation and
  workplace regulation
• Objective, fair, accessible and transparent to
  command the confidence and support of those
  receiving and providing healthcare
• Suited to the local context

17
Confidence and support

• Any effective regulatory system must command the
  confidence and support of all those affected by
  it, whether as recipients or providers of
  services. This is particularly true in the case
  of medicine because patients must be able to
  trust doctors with their lives and health.
• GMC, November 2006

18
Confidence in regulation public
Confidence in way doctors are regulated - public
Fairly confident
53
Not very
confident
13
Not at all
confident
Very confident
Don't know
6
23
5
19
Regulation today

• Regulation is a dynamic process it should not
  stand still. It must be scrutinised, challenged
  and improved to ensure it takes account of our
  changing society and the changing healthcare
  environment.
• GMC, November 2006

20

• You've got to accentuate the positive
• Eliminate the negative Latch on to the
  affirmative
• Don't mess with Mister In-Between

21
Now here, you see, it takes all the running you
can do, to keep in the same place. If you want to
get somewhere else, you must run at least twice
as fast as that!
Lewis Carroll
22
(No Transcript)