Right to reply: Regulators need robust tools for unsafe business practices

The Professional Standards Authority responds to the CCA’s warning in P3pharmacy of a looming regulatory ‘landgrab’

At the PSA, we oversee the work of health and care professional regulators such as the GPhC and PSNI by setting standards for them and reporting on their performance. We also accredit registers of unregulated healthcare practitioners. Our mission is to protect the public by raising the standard of regulation and registration of people working in health and care. We are independent, and accountable to the UK Parliament.

Last September, we launched our Safer Care for All report. It examines the state of professional health and care regulation in the UK today and explores unresolved challenges. We look at how professional regulation, and in some cases the wider system, might need to adapt to meet these challenges. In November, we held a virtual conference to explore the report’s findings.

One lively session focused on chapter two of the report, which talks about keeping pace with the ways care is funded and delivered. It looks at new and disruptive factors in health and care, including the rise of online care, and new technologies such as AI and robotics.

It also examines some potential conflicts of interest that can arise where there are commercial interests in care delivery. It asks whether regulators should be more willing to intervene where commercial practices run counter to the best interests of patients, and whether regulators should have greater purview over the businesses within which their registrants work.

Private provision

We were fortunate to hear from a range of speakers in the session, including Malcolm Harrison, chief executive of the Company Chemist’s Association (CCA). Mr Harrison set out a robust case for the benefits to patients of commercial interests in the pharmacy sector, and followed this up with an article in the December issue of P3pharmacy. We’re grateful to him and welcome the challenge that he provided.

We recognise that private provision, and in particular high street pharmacies, form an integral part of the healthcare landscape. Millions of people rely on their local pharmacy for essential services, and almost all receive a high level of safe and effective care. We also recognise that there are significant and demonstrable benefits to consumers of choice and competition, including improved efficiency and technological innovation.

Changing landscape

It is thanks to some of the innovations driven by the private sector that the face of health and care in the UK is changing. Technology is transforming how we deliver care, and the techniques and services on offer. Remote and virtual consultations have become widespread, and people can now access a range of services online.

The rise of virtual care has the potential to improve access to the health sector and make it more convenient for users, but it may also create circumstances in which poor or illegal practice become more likely. For example, evidence suggests that online healthcare businesses are underperforming against their ‘physical’ competitors and sometimes engage in risky practices like failing to perform proper identity checks before issuing prescriptions and working with prescribers based outside the UK.

Part of the job of regulators is to be alive to the changes coming down the track and ensure we have the knowledge, skills and powers to respond with agility. We absolutely do not want regulation to hold innovation back – instead, it needs to set the framework for a safe environment in which innovators can thrive.

The hard sell?

Our report also calls for a review of healthcare business regulation and reiterates our long-standing position that healthcare professionals and high street premises should be regulated together.

Some of the issues we identify in the provision of healthcare by high street providers include ‘hard sell’ tactics that seem to prioritise profit over the best interests of both patients and registrants. Where there is evidence that providers have not put the best interests of users first, regulators should be more willing to act. We appreciate that some will see a more interventionist approach as placing more burdens on businesses. However, we work on the principle that regulation should be ‘right touch’: only used where necessary and proportionate to the level of risk.

Regarding the suggestion that the GPhC should be given more powers to regulate pharmacy businesses, we recommend that the Government use the current programme of regulatory reform to consider the adequacy and effectiveness of the current regime.

 We believe a more robust approach from regulators to dealing with business practices that fail to put patients first would be in the best interests not only of patients, but of all pharmacy businesses who do the right thing.

Public trust and confidence in the pharmacy sector is valuable; more proactive regulation contributing to protecting and upholding that confidence would be beneficial. We look forward to working with all stakeholders as we take forward our work.

www.professionalstandards.org.uk