The Professional Standards Authority (PSA) was created 20 years ago to oversee UK health regulators. The PSA oversees 10 healthcare regulators (including the GPhC and PSNI) across the UK and as part of its remit must submit an annual report to Parliament on how well these 10 regulators have discharged their duties.
As a stakeholder representing more than 35,000 members the PDA regularly engages with the PSA concerning a variety of issues around healthcare regulation. In a number of recent submissions, the PDA has highlighted issues around inequalities (especially fitness to practice), the role of AI and technology, and the common issues faced by all ‘high street’ healthcare regulators especially in terms of ownership by large corporate entities.
The PSA has now produced a report which identifies and proposes solutions to some of the regulatory challenges in health and social care, including certain health regulators such as the GPhC.
It is welcome that a number of the matters raised by the PDA and other equally significant issues are discussed in the report and that the PDA is directly quoted several times within the report. In the report the PDA said, “treatment of pharmacy owners is in stark contrast with (GPhC’s) treatment of individual registrants…”
The report continued, “People working for optical chains were more likely to report feeling under pressure than those working for an independent optician. Similarly, the PDA’s 2021 Safer Pharmacies Survey found that 46% of respondents stated that patient safety was placed above ‘commercial or other operational considerations’ only half the time or less. While it should be clear that complying with professional standards must be the priority, it may be challenging for individual registrants to make this case, particularly where targets are set at a distance by a large corporation, and store managers may not be registrants and therefore not subject to the same professional standards.”
The PSA report, Safer Care for All, looks at the regulatory landscape for health and social care, reflecting on the impact that the Covid-19 pandemic has had, alongside that of devolution, NHS reforms and in the wake of several high-profile failings. The report highlights that, “when concerns are raised, they often fall between organisations, or are left unaddressed due to jurisdiction issues or insufficient powers.”
The PSA considers that a new framework is needed which is focused on safety that spans organisational and sectoral boundaries and makes a call to action to work collaboratively to tackle key patient safety issues
The report focusses on four main themes:
Tackling inequalities
The PSA recognises that there are still unequal and unfair outcomes for protected groups in aspects of professional regulation. They also acknowledge that there is lot still to be understood about how such inequalities affect all-important complaints mechanisms when care has gone wrong, or indeed what this could tell us about biases in care itself. It notes that where data does exist, the statistics on health outcomes is shocking, for example black women being 4 times more likely to die during childbirth than white women.
The PSA also calls for professional regulation to work to address its own issues, and support professionals to help tackle inequalities in the design and delivery of care and for the regulatory sector to get better at hearing diverse voices, and collecting, analysing and sharing data.
Regulating for new risks
The report notes that sometimes, the way that care is funded and delivered is implemented with limited focus on the risks and impacts on patients and service users. Through reform of the regulators, the PSA sees an opportunity to address known problems, and potentially increase future agility, as well as requiring more reliable ways to horizon scan in anticipation of changes. The report notes the increasing use in healthcare of robotics, nanotechnology and Artificial Intelligence (AI). The report acknowledges the concern across primary care including optical, dental and pharmacy services around online service providers failing to meet basic standards. The PSA makes a significant recommendation to the government to, “Review the adequacy and effectiveness of the powers of regulators with a role in regulating businesses.”
Facing up to the workforce crisis
The PSA’s report says that it is time to rethink the contribution of professional regulation to workforce planning as ‘engrained attitudes to professional regulations and qualification’ are not helping to address workforce shortages, which are putting patients and service users at risk across the UK. The report states, “In the past, we have held the firm view that professional regulation should not be drawn into adapting standards to respond to workforce issues. We now view this stance as unsustainable …”
This is potentially a far reaching and high impact viewpoint with significant potential which needs careful consideration.
The report notes that inequalities faced by healthcare staff may be a factor in why people are leaving healthcare professions but in general it does not propose solutions to the retention crises across all healthcare professions.
Accountability, fear, and public safety
Professional regulation should be clearer about its role, to reduce unnecessary anxiety and inappropriate complaints. The report acknowledges that some healthcare professions fear that even a single error could end their career and are concerned about the impact that this has on recruitment, retention, professional wellbeing and defensive practice.
One of the conclusions in this chapter notes the need for regulators to be proactive and do more, “Professional regulation is neither the cause of, nor the solution to, toxic workplace cultures – this is the preserve of the employer. But it does need to do more to become part of a just culture without compromising safety.”
The overarching key takeaway recommendation from the report highlighted by the PSA is the appointment of an independent Health and Social Care Safety Commissioner (or equivalent) for each UK country. These commissioners would identify current, emerging, and potential risks across the whole health and social care system and bring about the necessary action across organisations.
The PDA welcomes the report from the PSA and the inclusion of issues which have been raised by members. The PDA will continue to engage with members, regulators and the PSA with a view to improving appropriate regulation and patient-safety.
Learn more
- PDA calls for regulation of the business behaviours of pharmacy owners who damage the reputation of the profession
- Light touch regulation of pharmacy owners endangers pharmacy
- PDA responds to the PSA’s proposed changes to regulator performance reviews
- Professional Standards Authority Consult on their regular performance review process
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