At the end of 2017 the Department of Health consulted on the regulation of four types of medical associate profession. The consultation proposed the statutory regulation of physician associates (PAs) and sought further information on statutory regulation of Physician's Assistants (Anaesthesia) (PA(A)s). However it proposed not introducing further regulation for Surgical Care Practitioners (SCPs) and Advanced Critical Care Practitioners (ACCPs) at present. This came while DH and the NMC were also consulting on the upcoming regulation of Nursing Associates.
The consultation set out the roles of the four types of medical associate and their current regulatory background. While there are voluntary registers for PAs and PA(A)s, SCPs and ACCPs must be regulated by one of the existing statutory regulators before being accepted for the further training to become a SCP or ACCP.
The consideration of whether statutory regulation should be introduced for each of the professions was based on an assessment of the risk each profession presents, considering the interventions made, the context in which they are made, and the degree of accountability for their actions. This risk was then considered in the context of what assurances can be given by regulation of the profession. All of this was done by considering the framework proposed in the Professional Standards Authority's paper "Right-touch assurance: a methodology for assessing and assuring occupational risk of harm".
The consultation proposed that statutory regulation for PAs should be introduced, either by the General Medical Council or Health and Care Professions Council, as they make autonomous treatment and diagnostic decisions and can undertake invasive actions such as diagnostic interventions. However at this stage SCPs and ACCPs should not be statutorily regulated at this stage, as all individuals becoming SCPs and ACCPs are already required to be registered healthcare professionals (such as nurses or operating department practitioners). In addition, there are very few individuals working in these roles, meaning further regulation was unlikely to be proportionate.
However, the consultation asked for further evidence and views on whether PA(A)s should be made subject to statutory regulation. The risks presented by PA(A) practice appear to vary across sites, as their supervision and responsibility is decided at a local level and their (currently voluntary) regulator cannot enforce its recommendations. The consultation sought further evidence on the level of autonomy PA(A)s work under and the type of assurance/regulation respondents think appropriate.
This consultation came shortly after the decision that nursing associates will become a regulated profession under the Nursing and Midwifery Council. DH and the NMC have recently consulted on the changes to the Nursing and Midwifery Order 2001 necessary to incorporate these changes. DH appears to be keen to address concerns around the skills mix in healthcare settings by new professions, and to increase the flexibility of regulated roles. In practice, the increase in the number or regulated professions will not necessarily lead to more individuals working in healthcare, but rather more of them being regulated in one way or another. It is important to remember that a substantial part of the healthcare workforce is not regulated by statute, but are instead either unregulated or are part of a voluntary register.
These consultations also came while DH consults on much broader changes to health and care professional regulation. While professional regulation has never stood still, it seems that the sector can expect to continue living in a state of flux in 2018.