PEPs - Clinical Quality and Evidence

Module 5 - Clinical Governance

Personal and system regulation

All professionals working in healthcare in the Western world are subject to regulation of some form. The definition of a professional (any person who is answerable to an overarching organisation which set its own standards) relates to the standards to which that person must perform. Thus, we as doctors are bound by the rules set down by the General Medical Council (GMC) which was established by Parliament to perform this role. The equivalent for nurses is the Nursing and Midwifery Council; many of the other professionals we work with are regulated by the Health Professionals Council (HPC). The GMC has articulated its vision of the behaviours expected of doctors in its handbook, Good Medical Practice ¹.

In 2011 the Royal College of Physicians of London published a discussion document ² on the topic of professionalism. In this paper professionalism is defined and the attributes that go with it defined. The King’s Fund has produced a similar document ³ on this issue with input from many sources including medical students. This is not a sterile debate as some of the recent problems relating to the failure of delivery of healthcare in England relate to the failure of doctors to behave as professionals.

In England there is an overarching regulator of healthcare, the Care Quality Commission (CQC) ⁴ . CQC currently regulates all public and private hospitals, mental health institutions, care homes and ambulance trusts. From April 2013 it has also begun to regulate general practices. Each of the devolved governments has their own regulator. These regulators oversee the organisation delivering healthcare. There have been three system regulators in England over the past decade, indicating an evolving consensus of what we require from such a regulator. The current English regulator has adopted an inspectorate style approach in relation to the overseeing of health and social care provision. It bases its inspections around the outcomes it would expect to see from providers.  As before, the paramount importance of those who run these provider units remains fundamental.

  1. Good medical practice (2013) - General Medical Council
  2. Medical professionalism and leadership - Royal College of Physicians
  3. On Being A Doctor - Redefining medical professionalismfor better patient care - The Kings Fund
  4. Care Quality Commission