is our education system fair to healthcare students?

The conduct of Dr Shipman and the events that led to the Bristol Inquiry are two events that have contributed to the unprecedented legislative change in the organisation and procedures of the healthcare professions. Almost without exception, these professions have had to change their fitness to practise procedures to ensure that the members are fit to practise and to ensure public protection.

However, what is the position with students in terms of protecting the public during the course of their studies? How do we prepare students for entry to their respective future professions? What is the position of the student who early in their course commits an act that puts a patient unnecessarily at risk? How is that student dealt with, when they eventually apply to join the profession? The present position, it is suggested, needs urgent attention, if the system is to be fair to patients and students.

The problem is twofold. Firstly, the student, who at some stage in their course commits an act, which may put at risk patients and place a doubt as to whether the profession will admit that student at the end of their studies. The doctor who in the first year of his course commits a criminal offence, may be in a position to continue his studies, but may be refused registration by the General Medical Council (GMC) when he completes his course a number of years later. Since July 2006 legislation now allows the GMC to require proof of fitness to practise before a UK graduate can be registered as a doctor.

Secondly, it is clear that insufficient attention is given at an early stage of their course to train students as to professional standards. They need, it is suggested, to be taught a clearer sense of professional responsibilities at an early stage of their studies; the purpose of regulation and the role of the professional regulators.

As to the first problem a number of Higher Education Institutions are now forming fitness to practise committees, with designated procedures to consider the student, who behaves in a way that places patients at risk, or the students entry to the profession at risk. It is vital that these procedures are compliant with Natural Justice and Human Rights Legislation to mention but two aspects.

There is considerable evidence that many of the present higher education procedures for dealing with fitness to practise students are subject to clear challenge, particularly as to their procedures, leading to an unfairness to students. There is an urgent need for Higher Education Institutions to audit their present procedures or create new procedures. Unless this happens, there will be a growth as to the number of challenges to the present systems and procedures, a reflection of what has happened with registrants in a number of healthcare professions.

The GMC completed a consultation on Guidance to Student Fitness to Practise in April 2007. The consultation makes a number of helpful, and far-reaching proposals on how student procedures should change.

The recent Government White Paper (Trust Assurance and Safety – The Regulation of Health Professions in the 21st Century) published in February 2007, whilst making significant further proposals for the regulation of health professionals, devoted only a few paragraphs to students. The White Paper suggests, that the purpose of regulation and the procedures of regulation, be taught in all pre-registration profession, education and training. The White Paper asks the question whether students should have a closer relationship with their future regulators prior to qualification, but the regulators are not going to report back until 2008.

In October 2006, the Council for Healthcare Regulatory Excellence (CHRE) published a report entitled, ‘Student Fitness to Practise project’. One of the recommendations was to conduct a survey of education providers, local student fitness to practise arrangements and to share best practice. It is suggested that this is slow progress. We do need to see the same energy devoted to students’ procedures as has happened with their registrant counter parts.

One solution is to require students to register with the professional body at the inception of their course. It is difficult to understand why both the White Paper and the CHRE do not provide more support for this suggestion. The separation of the educational and future regulation role during a student’s career is unhelpful. It may lead to unfairness. Registration at the inception of the course means that the student has an immediate relationship with their regulator. The education role and the regulation role is then clearly defined. The opticians now register their student Opticians and the General Teaching Council is likely to register student teachers in 2008. It is hoped this may be a continuing trend.

There has been a huge investment by the Government and healthcare regulators that is continuing to bring about change in the regulation of the healthcare professions. Healthcare students deserve much more urgent attention, both as to the teaching of professional standards and procedures and in their treatment as future healthcare professionals.

Stephen Murfitt is head of Blake Lapthorn's Litigation and Dispute Resolution department and specialises in professional disciplinary work.