Approved Practice Settings

Accepted in principle.
The General Medical Council has undertaken a fundamental review of Approved Practice Settings. This review considered Approved Practice Settings in the context of the General Medical Council’s functions and how they promote assurance and patient safety. Since Approved Practice Settings was introduced in 2007, the General Medical Council has acquired significant powers relating to quality assuring medical training environments the Responsible Officer regulations have come into force and revalidation has begun. Revalidation is the process by which licensed doctors are required to demonstrate on a regular basis that they are up to date and fit to practise. It represents a major step forward in the quality assurance of practising doctors.
The General Medical Council review has found that these new powers have superseded Approved Practice Settings as a source of regulatory assurance and has recommended that the legal provisions that deal with Approved Practice Settings should be reviewed as part of the Law Commission review of the regulation of health and social care professionals. This will however take time, and in the meantime there is an opportunity to align the Approved Practice Settings requirements with those in the Responsible Officer Regulations. In effect, this would mean that newly registered doctors or doctors recently restored to the register must, while in the UK, practise in circumstances where they have a connection to a designated body, which is an organisation that will provide regular appraisal and help with revalidation.

Following the recommendations made about approved practice settings in the Report, the GMC committed to undertaking a fundamental review of the scheme in 2013.

The review concluded that the GMC should embed the approved practice settings arrangements within the wider statutory framework of the Responsible Officer Regulations. In effect, this prevents doctors who are newly registered or recently restored to the register from practising if they do not have a prescribed connection to a designated body and Responsible Officer (RO) under the regulations. A prescribed connection ensures that a doctor is working for an organisation that has established clinical governance and oversight including monitoring clinical effectiveness and quality assurance of its services. All doctors in postgraduate training are placed in providers that are designated bodies and themselves have a prescribed connection to an RO within the relevant Deanery. The new arrangements were introduced in June 2014.

Following the General Medical Council’s fundamental review of Approved Practice Settings (APS), new APS requirements were introduced in June 2014. These align the APS regime with the Responsible Officer Regulations. Doctors subject to APS requirements must now hold a prescribed connection to a designated body in order to practice in the UK. Designated bodies are, for the most part, organisations that employ or contract with licensed doctors. Designated bodies are under a statutory duty to have systems in place to support the continuous evaluation of all doctors with a connection to their organisation. They must have an appraisal system in place for these doctors and support them with their revalidation.

This ensures that these doctors are subject to the clinical governance arrangements required for revalidation, such as regular appraisals based on the General Medical Council’s core guidance for doctors, and are no longer restricted to practising in a specific physical setting and should be clearer for doctors and the organisations that they employ or contract with them.

The Care Quality Commission has a key responsibility in the overall assurance of levels of safety and quality of health and adult social care services. The Care Quality Commission already has powers to enter and inspect premises under the Health and Social Care Act 2008, section 62(2), which states ‘A person authorised by the Commission may enter and inspect any premises which are, or which the person reasonably believes to be, regulated premises’. This will normally be a health or care home setting.

The Law Commission’s report and draft Bill were published on 2 April 2014. The Law Commission made 125 recommendations intended to simplify and modernise the UK law relating to the regulation of health care professionals and, in England only, the regulation of social workers. The Government responded to this report on January 29th 2015 and legislation will be brought forward when Parliamentary time allows.

Accepted by the Government in principle.

The General Medical Council undertook a review of the Approved Practice Setting scheme in 2013. The review concluded that it should be replaced by a new scheme which was aligned with the existing statutory duties for healthcare organisations, namely the Responsible officer Regulations. This prevented newly registered or recently restored doctors from practicing in circumstances where they did not have a ‘prescribed connection to a designated body’. The new Approved Practice Setting requirements were introduced in June 2014.

In the February 2015 Culture Change report, the Government referred to the role of the Care Quality Commission in the overall assurance of levels of safety and quality of healthcare services, it already having powers to enter and inspect premises.