Jenny Hughes and Ian Smith

Introduction

Most countries, usually by legislation, will control and regulate their healthcare professionals. Why do they do this? First, imagine the situation where anybody could call themselves a pharmacist, dentist, nurse, dietitian without the need for any relevant qualifications, skills and knowledge or integrity. Then, imagine if these self-named healthcare professionals could set-up in premises to offer services, advice and medicines. Would you want such an individual to drill your teeth, prescribe medicines or offer advice? Most certainly not is probably your reply. For this reason, all countries want their healthcare professionals to be suitably qualified, highly competent and with integrity. But how is this achieved? The normal process is to put in place an independent regulation system.

Healthcare regulation systems

Regulation aims to provide properly qualified and competent healthcare professionals. In the UK, although this is not dissimilar to other countries (see below), a system of regulatory bodies has been established. These bodies are independent of the profession they are regulating. The Professional Standards Authority for Health and Social Care, until recently the Council for Healthcare Regulatory Excellence (CHRE), scrutinizes and oversees the work of the individual regulatory bodies for healthcare and social work. In this role, it considers good examples of regulatory practice in one regulatory body and disseminates to all the other regulatory bodies. In addition, it will review and report on individual regulatory bodies on a regular basis.

Regulatory bodies may regulate just one profession, for example, the General Medical Council (GMC) regulates only medical doctors. Some regulatory bodies will regulate two professions, for example, the Nursing and Midwifery Council (NMC) regulates both nurses and midwives, which share a common pre-registration educational training. Other regulatory bodies regulate the whole of the professional team, for example, the General Dental Council (GDC), which regulates dentists, dental nurses, dental technicians, clinical dental technicians, dental hygienists, dental therapists and orthodontic therapists. Similarly, the General Pharmaceutical Council (GPhC) regulates the whole of the pharmacy profession, namely pharmacists and pharmacy technicians along with the premises in which they work. For healthcare professions with relatively small numbers of members, compared with some of the other professions, for example, medicine and pharmacy, it would not be efficient or cost-effective to have an individual regulatory body and so the Health and Care Professions Council (HCPC) has been established. This regulatory body covers about a dozen professions, including dietitians, paramedics, physiotherapists, radiographers and social workers.

In other countries, a similar system of regulation occurs. For example, in South Africa, pharmacists must register with the South African Pharmacy Council, which is the statutory, regulatory body. Its objectives include the control, promotion and maintenance of standards of pharmaceutical education and pharmacy practice. It also plays a role in the control and maintenance of the professional conduct of registered pharmacists. In Saudi Arabia, the Pharmacy Board of the Saudi Food and Drug Authority acts as the regulatory and registration body for pharmacy. In very small countries such as Bermuda, which does not offer its own pharmacy degrees, overseas trained pharmacists are employed, usually, with US, Canadian or UK degrees. They are required to undertake a 1-month pre-registration training to acquaint themselves with the Bermudan system before taking a pre-registration examination. Success in the examination will allow the individual to register as a pharmacist with the Pharmaceutical Council of Bermuda.

In many countries and in many professions, in addition to the regulator, there will be a professional body. For example, medical doctors have the British Medical Association (BMA) as their professional body. Similarly, pharmacists in England, Scotland and Wales are regulated by the GPhC and have the RPS as their professional body (see Ch. 14). Professional pharmacy organizations exist in South Africa, including the Pharmaceutical Society of South Africa, to professionally represent pharmacists. Similar professional bodies exist alongside the regulator in other countries and states, such as, New Zealand, Australia and Texas.

In Northern Ireland, the Pharmaceutical Society of Northern Ireland (PSNI) is both the regulator and the professional body. This dual system of regulator and professional body used to exist in the rest of UK and New Zealand up to a few years ago.

The work of regulatory bodies

The aim of any regulatory body is to protect the public by ensuring that their registrants are competent and remain competent to undertake their professional roles. Most regulatory bodies have a council which is made up of representative members from the profession and lay members, usually in an equal number. These members may be elected or, as is the case with the GPhC, can be appointed. The GMC, GPhC and GDC have a Chief Executive and Registrar who leads the organization. The Pharmacy Act of 2010 set-up the GPhC as the regulator for pharmacy.

A consideration of regulatory bodies shows that there are a number of common tasks.

Maintaining a register of members

All regulators maintain an up-to-date register of members, with members’ names and addresses and date of first registration. These registers are available to employers and the public, so that a person, who claims registration, can be checked. In addition, these registers may include further relevant qualifications, for example, the NMC will identify specialist practitioners and nurse prescribers. The register of the GPhC will identify, by annotation, any further qualifications or responsibilities that the registrant has. Currently, these are qualifications as an independent and/or a supplementary prescriber. They will also indicate if the registrant is a superintendent pharmacist. A superintendent pharmacist has overall responsibility for all pharmaceutical issues within that organization. Any person who is registered with a regulatory body is allowed to use the legally ‘protected title’ of that body, for example, pharmacist, pharmacy technician, nurse, physiotherapist, etc. If the person is not registered with the regulator, it is an offence to use the ‘protected title’. Normally, a registrant of a regulatory body has to renew their registration on an annual basis and pay a fee. The fee is used to pay the administration costs of the regulatory body.