Fitness to practise

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In medical law and medical licensing, fitness to practise is a concept in the regulation of medicine regarding whether a health professional or social worker should be allowed to work. While fitness to practice can include matters of technical competence, including qualifications the concept also contains questions about the implications of the health of professional and their ethics. [1]

Contents

Concerns regarding a professional's fitness to practice are often addressed by professional bodies, though sometimes the decision-making process of these bodies is legislated. [1] :2 The decisions can involve quasi-judicial proceedings, that are constrained in some countries by judicial review on the grounds of procedural fairness.

Some countries maintain a register of people who are allowed to work in a particular healthcare field, and through legislation these titles are "protected" so that individuals not on this register (or removed from this register) cannot use a this title.

A professional deemed to not be fit to practice may no longer be able to practice.

Goals of regulating fitness to practice

Professional bodies say that they regulate fitness to practice to ensure public trust, protect the public interest, to ensure life-long competence and to improve healthcare outcomes. [2] :5 Authors who write on the topics are often interested in the quality of care, patient safety, and risk of medical errors, and more generally the social contract between the medical professions and society. [2] :4

Regulation by country

United Kingdom

In the United Kingdom, the Health and Care Professions Council, Nursing and Midwifery Council and the General Medical Council have a legislatively mandated role in controlling the behavior of health care professionals. [3] :2 Social work is regulated by the General Social Care Council. [4] :311

The General Medical Council's role in regulating fitness to practice is regulated by the 1983 Medical Act. [5]

There are around 1200 hearings each year regarding fitness to practice. [4] :313 The General Medical Council carries out hearings through the Medical Practitioners Tribunal Service. [3] :5

A GMC fitness to practice hearing begins with a complaint, the GMC will then investigate the case and decide whether to refer the case a to the MPTS, a case may be dismissed by the GMC. [6] :2 The GMC investigation involves giving the doctor an opportunity to respond, before obtaining expert evidence and written witness statements for involved parties, as well as carrying out assessments of a doctors competence or health. [6] :11 The GMC may then choose to suspend the doctor pending a decision at a MPTS trial. [6] :12 MPTS cases are held in public unless they involve matters of a doctors health. [6] :19 An appeal to the High Court of Justice can be made if a doctor disagrees with the outcome. [6] :30 If a doctor is convicted of a criminal offence the GMC will treat the conviction as proof of the offence. [6] :28

United States

In the United States fitness to practise is regulated by medical boards. These boards generally have medical and non-medical members. [1] :2 Many states have separate boards for professionals with qualifications from Doctor of Osteopathic Medicine(DO) and Doctor of Medicine (MD) qualifications. [1] :2

Before the 1970s most regulation was self-regulation but this changed due public pressure. [1] :3

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<span class="mw-page-title-main">Medical license</span> Occupational license that permits a person to legally practice medicine

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<span class="mw-page-title-main">Nursing and Midwifery Council</span> British healthcare regulator

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<span class="mw-page-title-main">General Medical Council</span> Healthcare regulator for medical profession in the UK

The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by controlling entry to the register, and suspending or removing members when necessary. It also sets the standards for medical schools in the UK. Membership of the register confers substantial privileges under Part VI of the Medical Act 1983. It is a criminal offence to make a false claim of membership. The GMC is supported by fees paid by its members, and it became a registered charity in 2001.

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In the United Kingdom and Australia, revalidation refers to a mechanism used to "affirm or establish the continuing competence" of health practitioners, whilst strengthening and facilitating ethical and professional "commitment to reducing errors, adhering to best practice and improving quality of care". Medical practitioners, nurses and midwives practicing in the UK are subject to revalidation to prove their skills are up-to-date and they remain fit to practise medicine. It is intended to reassure patients, employers and other professionals, and to contribute to improving patient care and safety. The Medical Board of Australia is currently engaged in a review and trial of revalidation of medical registration in Australia.

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<span class="mw-page-title-main">History of medical regulation in the United Kingdom</span> Aspect of history

Medical regulation ensures that medicine is only practised by qualifed and suitable people and can be used to prevent competition and increase financial compensation. The history of regulating doctors in the UK dates back around 600 years. The earliest licensing procedures were administered by the Church, with professional associations and universities also playing a role. Modern regulation of doctors is carried out by the General Medical Council.

The General Pharmaceutical Council (GPhC) is the body responsible for the independent regulation of the pharmacy profession within England, Scotland and Wales, responsible for the regulation of pharmacists, pharmacy technicians and pharmacy premises. It was created, along with the Royal Pharmaceutical Society, in September 2010 when the previous body responsible for regulation, the Royal Pharmaceutical Society of Great Britain, was split so that representative and regulatory functions of the pharmacy profession could be separated.

<span class="mw-page-title-main">Medical Act 1983</span> United Kingdom legislation

The Medical Act 1983 is an Act of the Parliament of the United Kingdom which governs the regulation and credentials of the medical profession, and defines offences in respect of false claims of fitness to practise medicine.

The Professional Standards Authority for Health and Social Care (PSA) oversees the nine statutory bodies that regulate health professionals in the United Kingdom and social care in England. Where occupations are not subject to statutory regulation, it sets standards for those organisations that hold voluntary registers and accredits those that meet them.

The Medical Practitioners Tribunal Service (MPTS) is a tribunal in the United Kingdom that adjudicates on complaints made against doctors, making independent decisions about their fitness to practise. This includes imposing sanctions for decisions about violations of ethical principles.

<span class="mw-page-title-main">Donald Irvine (physician)</span>

Sir Donald Hamilton Irvine was a British general practitioner (GP) who was president of the General Medical Council (GMC) between 1995 and 2002, during a time when there were a number of high-profile medical failure cases in the UK, including the Alder Hey organs scandal, the Bristol heart scandal and The Shipman Inquiry. He transformed the culture of the GMC by setting out what patients could expect of doctors and is credited with leading significant changes in the regulation of professional medicine and introducing the policy of professional revalidation in the UK.

The Australian Health Practitioner Regulation Agency (AHPRA), infrequently spelt as the Australian Health Practitioners Regulation Agency is a statutory authority founded in 2010 which is responsible, in collaboration with the Medical Board of Australia, for registration and accreditation of health professionals as set out in the Australian legislation called the National Registration and Accreditation Scheme. As of 2018, approximately 586,000 health professionals were registered with the AHPRA, containing 98,400 medical practitioners (which includes general practitioners, medical specialists and some hospital workers), and 334,000 nurses and midwives. This rose to 825,720 registered health professionals in 2021.

References

  1. 1 2 3 4 5 Horowitz, Ruth (2013). In the public interest : medical licensing and the disciplinary process. New Brunswick, N.J.: Rutgers University Press. ISBN   978-0-8135-5428-0. OCLC   830022784.
  2. 1 2 Horsley, Tanya; Lockyer, Jocelyn; Cogo, Elise; Zeiter, Jeanie; Bursey, Ford; Campbell, Craig (April 2016). "National programmes for validating physician competence and fitness for practice: a scoping review". BMJ Open. 6 (4): e010368. doi:10.1136/bmjopen-2015-010368. ISSN   2044-6055. PMC   4838739 . PMID   27084276.
  3. 1 2 Worsley, Aidan; Shorrock, Sarah; McLaughlin, Kenneth (2020-09-01). "Protecting the Public? An Analysis of Professional Regulation—Comparing Outcomes in Fitness to Practice Proceedings for Social Workers, Nurses and Doctors". The British Journal of Social Work. 50 (6): 1871–1889. doi:10.1093/bjsw/bcaa079. ISSN   0045-3102.
  4. 1 2 Worsley, Aidan; Beddoe, Liz; McLaughlin, Ken; Teater, Barbra (2020-03-01). "Regulation, Registration and Social Work: An International Comparison". The British Journal of Social Work. 50 (2): 308–325. doi:10.1093/bjsw/bcz152. ISSN   0045-3102.
  5. "Medical Act, 1983, Part V".{{cite web}}: CS1 maint: url-status (link)
  6. 1 2 3 4 5 6 The GMC's fitness to practise procedures (PDF). General Medical Council.