In the current era, there is an increasing focus on the role of medical and other healthcare professionals in sport. In a high performance environment where results are critical and margins are everything, significant pressure can be placed on the team doctor to ensure that a player is match fit or an athlete is able to race. The doctor's duties are to the athlete as their patient, not to a coach, manager or performance director. Organisations need to consider the structure that a team doctor sits in and who they are answerable to in terms of line management and ultimate professional accountability. For large organisations, there are obvious benefits in separating out the provision of primary care medical services and medical performance support.
Some organisations employ a doctor directly, whereas others engage their services via contractual arrangements. It is critical to understand the regulatory environment medical services are provided in to ensure that the organisation is compliant with their regulatory and due diligence responsibilities. This concept has been frequently referred to as "medical governance". UK Sport has made it very clear in recent weeks that it has high expectations in relation to how this area of provision is managed and any failings could directly impact on the funding of a national governing body. If CQC regulation is not appropriate and healthcare professionals are contracted in, it is still critical for sports organisations to understand and ensure those they engage to provide services are properly registered and regulated.
Regulation by the Care Quality Commission ("CQC")
Sports organisations are providing sophisticated medical services that focus on both primary care and performance related services. The CQC regulate entities that provide medical care by classifying categories of provision as "regulated activity", however with the exception of the English Institute of Sport ("EIS"), there are very few sports organisations that have obtained CQC registration. The general requirement under the Health and Social Care Act 2008 is that if you carry out regulated activity, you must be CQC registered. There are several narrow exceptions to this requirement. CQC registration ensures the provider is compliant with the wider requirements of service delivery around medical records, the procurement of medicines and prescribing and the focus is on athlete centred care.
To become CQC registered, an application must be made providing details about the applicant, the regulated activities applied for, and the locations where the service will be provided. The CQC assess each applicant and, to grant registration, must be satisfied about the organisation's fitness and compliance with the requirements of the relevant regulations and enactments. In the majority of cases providers must have a registered manager as a condition of their registration who must also apply and satisfy the CQC about their suitability and meet with the other requirements of the relevant regulations and enactments.
More recently the CQC have become interested in the ethos of the organisation starting at the top with the Board. There is the longstanding requirement for the Board to appoint a nominated individual as the designated point of contact, however there is also a general requirement for directors to be fit and proper. This focuses on those who do not necessarily provide clinical care but who shape the organisations direction of travel. There is also a provision that looks at whether a director has been responsible for or privy to any serious mismanagement in the delivery of regulated activity.
The benefits of CQC regulation
For organisations that aren’t involved in the exclusive delivery of healthcare, the policy infrastructure and management of regulated healthcare professionals can be challenging. Obtaining registration and regulation by the CQC requires time and investment; however the organisation can seek comfort in the fact that in order to obtain registration, there must be proper processes in place to ensure that medical staff are working in line with professional requirements. It also ensures there is consistent delivery throughout the wider medical team ensuring that too much responsibility and accountability does not rest with one individual. Issues around medical governance have been highly prominent in the UKAD "jiffy bag" investigation that affected both Team Sky and British Cycling. This was concluded by UKAD last month with no action being taken. Whilst CQC registration does not ensure that doctors make proper medical records, it does ensure that the infrastructure and monitoring is in place to help prevent this becoming a systemic issue through audit, peer review and board level accountability. There would also be periodic inspections by the CQC, the frequency of which would be determined by the risk profile of the organisation.
The CQC monitors the risk profile of a registered entity through intelligence and mandatory disclosure obligations in the event of an adverse incident. Should there be an investigation by another agency such as UKAD, it is common for MOU's to exist around co-operation, support and information sharing. A CQC registration application will only be successful if there is a commitment from the top of the organisation given there is board level accountability for the regulated activity. There also needs to be constant audit, appraisal and reflection in relation to the service, those receiving it and those tasked with delivery. This approach is line with the calls for more scrutiny in relation to the interaction of coaches and medical staff with athletes and the ongoing work around athlete welfare. In addition, it provides public accountability and transparency given the CQC publish inspection reports on their website.