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Roles and regulation

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IT IS still not clear when the Government might seek to introduce a new Veterinary Surgeons Act, but the rcvs for one is keen to move things forward. As reported at the bva Council meeting earlier this month (VR, July 15, 2006, vol 159, p 64), the College recently submitted proposals to defra on how veterinary activity should be regulated in the future, following much soul-searching within the profession about what a new Act should achieve. Among reasons given for revising the Act are that changes have been and continue to be made in the way other professions are regulated, and that veterinary regulation needs to stay relevant and up to date. Proposals since put forward by the Department of Health (doh) on the future regulation of doctors and other healthcare professionals are clearly of relevance in this context, and it is interesting to see how the proposals compare.

The doh's proposals are set out in two reports: one, ‘Good doctors, safer patients’, by the Chief Medical Officer (cmo), deals specifically with the regulation of doctors, and aims to address shortcomings in the regulatory process identified by the independent inquiry into the murders committed by the gp Harold Shipman. The other is the result of a parallel review undertaken by the doh of the arrangements in place for the regulation of other human healthcare professionals ‘in order to provide consistency of approach and in recognition of the blurring of traditional job roles in healthcare’. Both reports have been issued for consultation, with comments invited by November 10.

It would be wrong to draw too many parallels between the human and veterinary fields, because there are significant differences between them, not least in terms of resources and the number of people involved and the fact that most human healthcare professionals are employed by the nhs. Nevertheless, the veterinary profession is unlikely to be untouched by developments in the human field; the Government's desire for a consistent approach may not be confined to those treating people and some of the ideas could ultimately be applied more widely. Having said that, there are some striking similarities between the proposals put forward by the rcvs and those now emanating from the doh. This is most notable in relation to setting and ensuring compliance with standards, and plans to separate the two. Under the rcvs proposals (see VR, April 15, 2006, vol 158, p 493), veterinary professional standards would, as now, be determined by the rcvs Council. However, the role of monitoring and ensuring compliance with those standards would be performed by a new and separate board, which would investigate complaints and enforce mandatory practice standards. The proposed board would have the power to deal with complaints by giving a warning or advice, with any complaints not disposed of in this way being adjudicated by an independent committee.

The cmo's proposals for the medical profession would also result in roles being separated, with the General Medical Council (gmc) playing a lesser role than at present. In the words of the cmo, ‘As the complexity of medicine and the system in which it operates increases, the gmc cannot reasonably be expected to fulfil the roles of complaint recipient, processor, investigator, prosecutor, judge and jury.’ Instead, it is proposed that the gmc, along with newly created local affiliates, would be responsible solely for the assessment and investigation of complaints, with cases being adjudicated independently. The burden of proof required in disciplinary cases would be lowered from the ‘beyond all reasonable doubt’ required in criminal cases to the civil standard based on the balance of probability. It is also suggested that the gmc's educational role should be transferred to the Postgraduate Medical Education and Training Board.

All of this is very much in line with the recommendations resulting from the Shipman inquiry. It is, however, in sharp contrast to what was recommended in 2001 in the report of the Kennedy inquiry into the deaths of babies undergoing heart surgery in Bristol between 1984 and 1995. This argued that, for each group of healthcare professions, there should be one body charged with overseeing all aspects of professional life.

Parallels can also be drawn between the doh's attempts to ensure a consistent approach across the healthcare professions and the rcvs proposals for regulating the activities of veterinary nurses and paraprofessionals, although given the structures that already exist in the medical field it would be difficult to push this comparison too far. Where there is a clear similarity is in moves towards regulating the whole medical/veterinary team.

The cmo proposes an elaborate system of revalidation for doctors based around licences to practise, which would have to be renewed periodically, and a new system of nhs appraisals. The rcvs proposals, meanwhile, are based on licenses to practise and mandatory cpd. The cmo's proposals could not be applied in a veterinary context and are likely to prove controversial among doctors. The trick, in both fields, will be to provide the necessary assurances while not imposing a system that is so burdensome and expensive as to be unworkable.

It is too early to judge the extent to which the cmo's proposals will be adopted, but they give a clear indication of the way in which medical regulation is heading. One might question whether current attitudes tend to devalue the role traditionally performed by professionals and whether this is desirable. Given the diversity of the professions, one might also ask whether a ‘one size fits all’ approach can ever be appropriate. For all that, the rcvs proposals seem very much in tune with current thinking.

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