Regulation

A robust regulatory framework is important for assuring a basic standard of healthcare. The regulation of medical professionals and healthcare providers is a central component of quality improvement in most countries.

Regulation occurs through professional bodies that oversee maintenance of standards of training and practice within healthcare professions, but also increasingly through government agencies.

Organisational regulation of healthcare in England comprises two main elements: (1) regulation of the quality and safety of care offered by healthcare providers, currently undertaken by the Care Quality Commission (CQC), and (2) regulation of the market in healthcare services, currently the responsibility of Monitor and the Department of Health.

There is limited evidence that regulation improves quality and safety but regulation is probably important for setting and maintaining essential standards. We know from international comparisons that there is no agreement on the best way to regulate healthcare systems, but regulation must be appropriate to the particular structure of each system.

There is some evidence that regulation may exert effects through potential reputational damage, loss or gain of organisational or personal kudos and risk to senior leaders’ positions. Although this might be effective in achieving standards, this needs to be set against unintended consequences such as gaming, falsifying data or measurement fixation.

Healthcare regulation is bureacratic and expensive; in the US it may cost in excess of $500 billion and yield one-third as much in benefit.

Governments are trying to balance increased accountability of health services with improved quality and local innovation in service design and delivery while reducing the overall costs of regulation and are experimenting with risk-based approaches to achieve this.

UK professional regulators

Regulators determine the qualifications required for licensing, maintain professional registers, provide codes of practice and ethics to members, investigate more serious complaints about individual practice and discipline those who fail to meet standards set.

  • General Chiropractic Council (GCC) –chiropractors
  • General Dental Council (GDC) –dentists, dental nurses, dental technicians, dental hygienists, dental therapists, clinical dental technicians and orthodontic therapists
  • General Medical Council (GMC) –doctors
  • General Optical Council (GOC) optometrists and dispensing opticians
  • General Osteopathic Council (GOsC) –osteopaths
  • General Pharmaceutical Council (GPhC) –pharmacists, pharmacy technicians
  • Health and Care Professions Council (HCPC) –arts therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dieticians, hearing aid dispensers, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, practitioner psychologists, prosthetists/orthotists, radiographers, social workers, speech and language therapists
  • Nursing and Midwifery Council (NMC) – nurses, midwives
  • Pharmaceutical Society of Northern Ireland (PSNI) –pharmacists

UK healthcare regulators

England

  • Care Quality Commission (CQC)
  • Monitor

Scotland

  • Healthcare Improvement Scotland
  • Care Inspectorate

Wales

  • Care and Social Services Inspectorate Wales
  • Healthcare Inspectorate Wales