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On 4 December 2017 the European Parliament’s internal market committee (IMCO) adopted its report on the Proportionality Directive. On the issue of the exemption of health professions from the Directive, the amendment was defeated by 20 votes to 15. However, the report does contain a number of declarations on the special status of health professions, such as “member states shall be granted a margin of

discretion that is sufficient to ensure a high level of human health protection”.

Leading up to the vote, a number of events had taken place bringing together European healthcare policy makers, workforce planners, practitioners and regulators to discuss the inclusion of health professions. One of these events was organised by the Standing Committee of European Doctors

IMCO vote on Proportionality Directive

Welcome to the first edition of 2018 of the Healthcare Professionals Crossing Borders (HPCB) update. We hope you had a restful holiday period. In the first edition for 2018 we provide an update on the European Parliament’s internal market committee vote on the inclusion of health professionals in the Proportionality Directive, the European Commission’s infringement proceedings on the RPQ Directive, the State of Health in the EU publication, digital prescription exchanges between Estonia and Finland, and the status of professional qualifications in the UK Withdrawal Agreement following Brexit.

We also look at Health First Europe (HFE)’s Declaration for patient safety in Europe, the British Medical Association’s (in conjunction with royal colleges and trade unions) open letter to the UK Prime Minister regarding the Working Time Directive, the European Commission’s 2018 health work plan and we break down the results of your feedback on the HPCB network and the Crossing Borders update.

Lastly, if you would like to contribute to the HPCB update or have any further comments about topics, publication dates or news please get in touch with us at HPCB@gmc-uk.org.

CONTENTS

IMCO vote on Proportionality 1EC RPQ infringements 2HPCB feedback and decisions 2

EU INSTITUTIONAL DEVELOPMENTSState of Health in the EU 3OSE conference 4How does regulation matter? 4Healthcare Quality Improvement conference 4 Estonia and Finland exchange 5RPQ in UK Withdrawal Agreement 5Letter to UK MP on WT Directive 6Declaration of patient safety 6MEPs vote on reform 72018 health work plan 7

EUROPEAN PARLIAMENT QUESTIONS Awareness of cross-border care 7Spanish nursing qualification 7Romanian dental qualifications 8

EUROPEAN NETWORKS UPDATEEPF universal health coverage 2030 8ENMCA meeting 9PGEU new Secretary General 9

DEVELOPMENTS IN EUROPEAN REGULATION GPhC new standards 10UK regulation reform 10UK MAP consultation 11SoMEP and EEA data 11HCPC FtP Annual report 12HCPC guidance on confidentiality 12

AROUND THE WORLD IAMRA Symposium 12WMA Revised Declaration 13Australia Professional Performance Framework 14Primary care nurses roles 14Nursing Now! update 15Events and Newsletters 16

February edition Issue 41

Crossing Borders Update

For further information please contact: Olivia Guthrie, HPCB, 350 Euston Road London NW1 3JN Tel: +44 020 7189 5162 Email: hpcb@gmc-uk.orgContinued on next page >

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(CPME) together with the Council of European Dentists (CED) and the Pharmaceutical Group of the European Union (PGEU). Entitled ‘Economics vs Health? EU Proportionality Test for Health Professions’, the event brought together stakeholders, representatives of the European Commission and members of the European Parliament and focused on the impact of the proposed Directive. The full discussion can be streamed via this link.

In order to ensure that citizens will fully benefit from adequate and proportionate rules, IMCO members adopted an amendment requiring member states to ensure that judicial review is available in national law in respect of the legislative, regulatory or administrative provisions restricting access to or pursuit of regulated professions falling within the scope of this Directive. The European Parliament will now enter into negotiations with the Council.

The European Commission has referred Belgium, France and Germany to the European Court of Justice (ECJ) over their failure to notify the complete transposition of the revised recognition of professional qualifications (RPQ) Directive.

The revised Directive should have been transposed into national legislation by 18 January 2016. In September 2016, the Commission sent reasoned opinions to the Belgian,

French and German authorities but the countries have still have not notified the EC of their complete transposition of the Directive.

The Commission will call on the ECJ to impose a daily penalty of €22,260.48 for Belgium, €53,287.52 for France and €62,203.68 for Germany from the day of the judgement until the Directive is fully enacted and in force in national law.

European Commission opens infringement proceedings on RPQ implementation

In the autumn edition of the HPCB Crossing Borders update we requested your feedback on the relevance of the HPCB update and wider network. Thank you to those who responded.

In light of your responses, the HPCB secretariat has decided to change the frequency of the Crossing Borders update to three times a year, once every four months, with this being our first edition for 2018. We have taken on board some of your suggestions regarding the content of the newsletter and we will work to provide in depth analysis of your suggested topics. If you would like to contribute to future editions of the update or would like to be added to the HPCB authors email please get in touch at HPCB@gmc-uk.org.

We are also yet to find a host for our next event. The HPCB network is run by volunteers who contribute to the newsletter and who use their experience in EU matters to input into policy recommendations. HPCB conferences are useful occasions to bring together healthcare competent authorities to share experiences and to learn from best practise examples from across the professions and Europe.

However they can only take place if competent authorities volunteer to host them. The last HPCB conference took place in London in October 2016 and we are keen to hold another conference at the end of 2018/start of 2019. If your

competent authority is interested in hosting the next HPCB conference, please contact the HPCB secretariat for an informal chat.

HPCB feedback and decisions

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The Health at a Glance: Europe prepared by the OECD, gives a horizontal starting point (latest version November 2016)

28 Country Health Profiles adapted to the individual context and specificities of each EU country, assessing the strengths and challenges in their respective health systems

A Companion report published along with the Country Health Profiles draws cross-cutting conclusions, links common policy priorities across EU countries, and explores the cope for mutual learning

At the close of the two-year cycle health authorities in EU countries can request voluntary exchanges with the experts behind the State of Health in the EU to discuss findings and potential policy responses.

The State of Health in the EU is a two-year initiative undertaken by the European Commission that provides policy makers, interest groups and health practitioners with factual, comparative data and insights into health systems

in EU countries. The cycle is developed in cooperation with the Organisation for Economic Co-operation and Development (OCED) and the European Observatory on Health Systems and Policies.

State of Health in the EU

EU institutional developments: Proportionality Directive, UK EU exit, state of health in EU, professional services, declaration for patient safety

The research is undertaken by health experts and is designed to inform and support policy making, not to make recommendations. The cycle is aligned to the policy

objectives set out in 2014 Commission Communication on effective, accessible and resilient health systems.

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Launched on 23 November 2017, the two year State ofHealth in the EU cycle consists of four main stages:

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In Brussels on 9 November 2017 the European Commission hosted the Professional services: how does regulation matter? conference. The conference focused on the lessons learned from the mutual evaluation of regulated professions (2014-2016) and examined the objectives and results from the services package adopted in January 2017. The conference was web streamed and is available in English, French and German here.

Speakers included keynote addresses from Mr Arup Banerji, World Bank Regional Director for the European Union and Mr David Halpern, Chief Executive, the UK Behavioural Insights Team (BIT). Panel discussions focused on empirical evidence and modern regulation in professional services.

More information on the conference can be found here.

Professional services: How does regulation matter?

On the 17 November 2017 the European Social Observatory (OSE) held a conference in Brussels on regulating health professions in a European perspective. The conference was held in conjunction with the Belgian National Institute of Health and Disability Insurance (NIHDI), the European Observatory on Health Systems and Policies and the Federal Public Service Health, Food Chain Safety and Environment.

The conference concentrated on the major reform of regulatory framework for health professions in Belgium, and focused on the experience of other EU member states and explored in more detail how EU integration affects the organisation and regulation of health professions.

Keynote addresses included: health workforce planning in Belgium; potential obstacles for free movement for health professionals; and maintaining skills and ensuring fitness to practise in European countries. Speakers specifically concentrated on the impact of professional mobility on

national workforce planning policies and how member states can ensure quality and patient safety in a European and international context.

The conference background document and full programme including videos, photos, abstracts and slides can be found online here.

Regulating health professionals in a European perspective

The International Forum on Quality and Safety in Healthcare is one of the world’s largest Forums for healthcare professionals committed to improving patient care and safety. On 2-4 May 2018 the Forum will be hosted in Amsterdam, The Netherlands at the Amsterdam RAI Exhibition and Convention Centre.

The previous International Forum in London in April 2017 connected over 3,000 healthcare leaders and practitioners from over 70 countries, providing an inspirational setting to meet, learn and share knowledge in our common mission to improve the quality and safety of care for patients and communities across the world.

The International Forum on Quality and Safety in Healthcare

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As part of the Forum, there is a conference that will be held on 2 May 2018 on the role of Health and Care Regulatory/Supervisory agencies in Healthcare Quality and Improvement. This aspect of the Forum is free and you do not need to sign-up for the International Forum to attend. The conference is a follow up to two previous meetings (Gothenburg 2016, London 2017) and a plenary held in

2015. The conference will be hosted by the Dutch Health and Youth Care Inspectorate.

The programme for the whole event can be found here with more information on how to book your space and early bird registration for the Forum.

Estonia and Finland have announced that from summer 2018 country borders will no longer be an issue with digital prescriptions exchanges. Finnish digital prescriptions will be valid in Estonian pharmacies from summer 2018 and in the summer of 2019, Estonian digital prescriptions will be available in Finnish pharmacies. Estonia and Finland already possess the necessary technical readiness for the exchanging of data and the exchanging of such information could serve to inspire the Nordic countries and Baltic States to further develop cross-border eServices.

In 2016, the Prime Ministers of both countries signed a joint declaration on an initial roadmap for launching data exchange and eServices between Estonia and Finland. As part of this roadmap, they also agreed specific action plans would be completed for launching automatic data exchange in various fields including population registers, ePrescriptions and social benefit data.

The plan allows for the databases of both countries to be mutually available, thus supporting cross-border access to digital prescriptions, before progressing to full medical records. The initiative will aim to increase the quality of healthcare in both countries.

Digital prescription exchange between Estonia and Finland

Agreement was reached in December 2017 on the provisional terms of the UK’s withdrawal from the EU, including provisions for citizens’ rights.

Under the agreement, consensus was found on legacy rights for the recognition of professional qualifications (RPQ). It was agreed that recognition of decisions made in both the UK and EU27 before EU exit will be respected. It was also agreed that any applications for the recognition of a qualification, or compensation measures, that are underway as of Brexit will benefit from legacy RPQ rights for the remainder of that application process.

The future status of the RPQ regime post EU exit was not covered in this agreement and will be subject to discussions on the future trade relationship between the UK and EU which will begin shortly. Details of the transition period will also be subject to these new negotiations, but are likely to include a continuation of the RPQ framework for the two year period (i.e. up until the end of March 2021). The UK Government has confirmed that it will push for a continuation of the RPQ regime in the trade agreement, post transition period. The EU is expected to agree and publish its negotiating mandate for this next stage of talks in March 2018 and this will give an indication of whether it will support the UK wish for a continuation of the RPQ framework.

Negotiators will now begin to draw up a Withdrawal Treaty based on the provisional agreement that will need to be approved by the European Parliament and UK Parliament.

Status of professional qualifications in UK Withdrawal Agreement

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Health First Europe (HFE) has launched the Declaration for Patient Safety in Europe. The declaration calls for health authorities, policymakers, healthcare professionals, providers and patients to join hands to prevent unnecessary harm across Europe.

HFE is a non-profit organisation that aims to build policy aimed at ensuring better patient safety in the EU. The initiative, launched in December 2017, is open to all organisations and individuals and is intended to create a framework to stimulate policy development and actions in and between member states to guarantee patient safety.

In the Declaration for Patient Safety Working Document the HFE refer to the World Health Organisation (WHO) statistics demonstrating that patient harm is the 14th leading cause of the global disease burden, a figure akin to illnesses such as tuberculosis and malaria. In some European countries, the burden of patient harm is comparable to that of chronic diseases. New statistics show that strategies to reduce the rate of adverse events in the European Union alone would lead to the prevention of more than 750,000 harm-inflicting medical errors per year, leading in turn to over 3.2 million fewer days of

hospitalisation, 260,000 fewer incidents to permanent disability, and 95,000 fewer deaths per year.

The declaration recommends ten policy developments and actions to foster patient safety in the EU, including:

1 Foster citizen awareness and patient empowerment

2 Promote a blame-free safety culture

3 Risk prevention to minimise adverse events

4 Surveillance systems and data availability

5 Guarantee the right to personalised treatment

6 Respect the right to information

7 Uptake evidence-based medicines and technologies

8 Provide smarter and safer healthcare systems

9 Protect personal data

10 Increase resources for healthcare staffing.

Declaration for Patient Safety in Europe

The British Medical Association (BMA), 12 royal colleges and UK trade unions have written to UK Prime Minister Theresa May urging caution against the removal of working time regulations from UK law after Brexit. The regulations are enshrined in UK law and are derived from the Working Time Directive. A copy of the letter can be found here.

The letter highlights the importance of the regulations as they protect medical staff from the dangers of overwork

whilst protecting patients from overtired doctors and nurses. It also warns that it is not in the interests of either staff or patients to relax or move away from the safeguarding protections introduced by the Working Time Directive. Instead they urge the Prime Minister to properly invest in and resource the medical workforce.

The full list of signatories on the letter is as follows:

Letter to UK Prime Minister regarding the working time regulations and Brexit

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European Parliament questions

The European Commission has adopted its 2018 health work plan which sets out its priorities and actions for the next year. The overall budget for health in 2018 is just over €62 million, with 64% being allocated to grants, 24% to procurement and 12% to other actions.

The work programme feeds directly to the EU health programme 2014-2020 which is the main financial instrument for policy coordination in the area of health across the EU. It supports and complements member states’ efforts towards the achievement of major Commission priorities. This is done by pursuing the following four specific objectives:

Objective 1: Promote health, prevent diseases and foster supportive environments for healthy lifestyles

Objective 2: Protect citizens from serious cross-border health threats

Objective 3: Contribute to innovative, efficient and sustainable health systems

Objective 4: Facilitate access to better and safer healthcare for Union citizens.

Raising awareness of cross-border healthcareJana Žitňanská MEP has questioned the EC on how it intends to raise awareness of the available options for obtaining cross-border healthcare in a country other than their home country, particularly for people with disabilities. In response, the EC has stated that it is raising awareness through social media and the Europa website. The European Health Insurance Card smartphone app is also a useful tool related to necessary medical care. An event will be organised in 2018 to highlight good practices of cross-border health cooperation and explore ways in which it can be further developed.

Read more here

Recognition of Spanish nursing qualificationPascal Arimont MEP has questioned the EC on the case of a Spanish woman who has a degree in nursing from a Spanish university and who now wants to work in Belgium but whose documents are being questioned by the Belgian authorities despite the fact that she is a fully qualified nurse. In addition to her official diploma, she received a ‘diploma supplement’ from her university, which provides proof of the content and duration of her studies and which has been developed as part of the Europass initiative to improve transparency. However, the Belgian authorities are refusing to accept the ‘diploma supplement’ and are asking for a Spanish certificate of conformity which can only be acquired if the person in question takes out insurance for nursing professionals in Spain, which could cost them up to EUR 200 per month.

In response, the EC stated that it does not have sufficient details to assess the specific case referred to but that it advises the citizen to contact the Spanish or Belgian assistance centre or the SOLVIT network for assistance.

Read more here

MEPs vote on reforms in professional servicesMEPs have adopted a non-legislative report on the need for reform in professional services. The report focusses on the need to ensure transparent, non-discriminatory and proportionate rules on access to professions, to guarantee high-quality professional services, as well as on the impact of scientific progress, innovation and digitalisation in this area. The report was adopted in plenary with 490 votes in favour, 54 against and 38 abstentions.

Health work programme 2018: focus on the EU added value

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EPF roadmap to achieving universal health coverage for all by 2030

Recognition of Romanian dental qualifications in ItalyThe European Commission has responded to a petition submitted about the conduct of the Italian Ministry of Health which, it is alleged, refuses the recognition of professional qualifications of ‘medic dentist’ (dental practitioner) obtained in Romania. The petitioner claims that the Ministry of Health’s recognition of the qualification ‘medic dentist’ is subject to a compensatory measure consisting of the choice of an 18-month adaptation period or passing an aptitude test.

The EC stated that it organised and facilitated a dialogue

between the Romanian and Italian authorities in 2015 on the recognition of Romanian dental qualifications in Italy. It also asked for further information from the Italian authorities in order to establish whether they systematically applied the general system when assessing the requests for recognition of Romanian dental qualifications. In response, the Italian Ministry provided figures which demonstrated that the vast majority of Romanian dental qualifications were recognised automatically in Italy both in the year of 2016 and in the first semester of 2017. The Commission will continue monitoring the practice of the Italian authorities regarding the recognition of Romanian dental qualifications.

Read more here

Following its 2017 Campaign on Access to Healthcare, the European Patients Forum (EPF) has launched a roadmap entitled Taking action – A Roadmap to Achieving Universal Health Coverage for All by 2030.

The roadmap aims to provide EU and national decision makers with recommendations that need to be considered urgently to achieve universal health coverage (UHC) for all patients in the EU by 2030. It calls on member states and the EU to commit to a long-term vision where equity of access and UHC is a reality for all – a target of the UN sustainable development goal (SDG) on ensuring healthy lives.

While universal health coverage is a well-recognised goal for all healthcare system in the EU, the roadmap will be used as a tool to raise awareness of unmet needs and barriers patients face when accessing healthcare.

The roadmap is intended mainly for EU and member state decision and policy makers and urges them to:

recognise that patients everywhere in the EU, regardless of which country they live in or their country of origin, have the right to equitable access to high-quality care

commit to invest sustainably in healthcare based on outcomes and added value

ensure the delivery of healthcare products and services that are affordable for all, together with the healthcare industry

enhance cooperation and undertake measures to improve holistic health systems performance and access to health and related care for patients

end the discrimination and stigma that patients face and make sure that no population is excluded.

The roadmap was developed in dialogue with EPF’s membership and the wider EU health community based on an inclusive working process including extensive consultation. The EPF believe that health protection and improvement is a great success story of the European Union and closer cooperation and collaboration between member states will empower and equip countries with the necessary tools to tackle health inequalities. A factsheet on the roadmap can be downloaded here.

European networks update

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European medical competent authorities discuss professional qualificationsThe European Network of Medical Competent Authorities (ENMCA) met in November in The Hague, Netherlands. Hosted by the Dutch Ministry of Health, Welfare and Sport, representatives from 18 countries discussed practical experiences with using the IMI alert mechanism and issues encountered when implementing new provisions of the revised recognition of professional qualifications Directive.

Authorities also shared information on the processes for the recognition of third country medical qualifications in the various medical authorities.

PGEU appoints new Secretary General

The Pharmaceutical Group of the European Union (PGEU) has appointed Ms Ilaria Passarani as its new Secretary General. PGEU is the European association representing more than 400,000 community pharmacists, members of national associations and professional bodies of pharmacists in 32 European countries.

Ms Passarani was appointed by the PGEU General Assembly on 19 December and will be responsible for providing strategic direction and leadership. Ms Passarani is currently leading the food and health department at the European Consumer Organisation (BEUC) and is a member of the management board of the European Medicines Agency.

Commenting on her new appointment Ms Passarani said “I’m greatly honoured to have been appointed as PGEU Secretary General Pharmacists and to play a vital role in the healthcare system by ensuring access to high quality healthcare, protecting patients’ safety, improving health outcomes and contributing to public health. I look forward to working with PGEU members and staff to advance the pharmacy profession and community pharmacy practice to meet patients’ needs.”

Ms Passarani replaces Ms Jüratè Švarcaitè and is expected to take up her post on 19 March 2018.

Attendees of the November ENMCA meeting in

The Hague, Netherlands.

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The General Pharmaceutical Council (GPhC) has launched its new standards for the initial education and training (IET) of pharmacy technicians. Pharmacy technicians are a newly regulated profession and registration has been mandatory with the GPhC since 2011. Pharmacy technician training is delivered in two modes – face to face and distance learning - and the training takes place part-time while trainees are working in a pharmacy. The main sectors of practice for pharmacy technicians are community (public) pharmacies and hospital pharmacies but they do also work in the pharmaceutical industry, General Practice (GP; family medicine) practices, internet pharmacies, the military and academia.

The pharmacy team comprises pharmacists, pharmacy technicians (both regulated) and pharmacy support staff (non-regulated but working under the supervision of regulated pharmacy staff). As the team has evolved, pharmacy technicians have taken on increasing patient-facing, clinical roles and the new initial education and training standards reflect this. The new standards are aligned closely to the standards for pharmacy professionals, the standards for professional practice for both pharmacists and pharmacy technicians.

The key themes in the new standards are:

professionalis

patient-centred care

multi-disciplinary team working

leadership.

The standards were developed after extensive consultation with stakeholders interested in pharmacy technician education and reflect the feedback received through that consultation. The GPhC held a series of consultation events across the three countries of Great Britain (England, Scotland and Wales) and heard the views of patients, pharmacy technicians, pharmacists and education and training providers. This was followed by a public consultation which attracted 380 responses.

Courses incorporating the new standards are expected to be designed during 2018-2019; with all training providers expected to offer courses based on the new standards by 2019.

The GPhC has also developed an evidence framework to support the creation of courses that will meet the standards and to help course providers, trainee pharmacy technicians and employers understand key features of the new standards. This will be finalised and published by spring 2018.

The movement of pharmacy technicians within the EU is regulated through the general systems route in Directive 2005/36 EC (and later iterations) on the recognition of professional qualifications.

For further information please contact Damian Day at Damian.day@pharmacyregulation.org.

New standards for the initial education and training of pharmacy technicians Author Damian Day, Head of Education, General Pharmaceutical Council

Developments in European regulation

Legislative reform UK Government consultation On 31 October the UK Department of Health launched a consultation on Promoting professionalism, reforming regulation. A written ministerial statement from the Minister of State for Health Philip Dunne was also published to highlight the launch of the consultation.

The Minister stated that the governments of the UK have five objectives in taking forward reform: improved protection of the public, a more flexible workforce, a more proportionate and responsive approach to dealing with concerns, greater support for regulated professionals in the delivery of high-quality care, and increased efficiency in the system.

The consultation asks a series of questions about the need to reform healthcare regulation in the UK. One of the ideas put forward is to reduce the current number of UK regulators to one or two ‘super’ regulators. The consultation notes that a reduction in the number of regulators would deliver a more consistent approach to regulation, delivering savings in the cost of regulation as well as simplifying the landscape for employers, patients and the public when making a concern about a health professional.

The consultation closed on 23 January 2018.

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Consultation on the regulation of Medical Associate Professions (MAP) launched

On 12 October, the UK Department of Health launched a consultation on the regulation of Medical Associate Professions (MAP). The consultation seeks views on a proposal to introduce statutory regulation for Physician Associates, as well as seeking further views or evidence in relation to other professional groups. The consultation closed on 22 December 2017 and the Government’s response is expected in late March 2018.

The state of medical education and practice 2017 and data on EEA doctors practising in the UK

The UK General Medical Council (GMC) has released its seventh annual State of Medical Education and Practice (SoMEP) report. The report examines GMC data relating to the changing medical register and explores the patterns of complaints about different groups of doctors.

In this year’s report the GMC note that they have reached a crucial moment – a ‘crunch point’ – in the development of the UK’s medical workforce. In light of these warning signs, the SoMEP report highlights four priorities for workforce planning that include:

1 Maintain a healthy supply of good doctors into UK practice

2 Help the UK medical profession to evolve to meet the needs of patients and healthcare

3 Reduce the pressure and burden on doctors wherever possible

4 Improve the culture of the workplace, making employment and training more supportive and flexible.

As part of their workforce planning priorities, the GMC has also produced four working papers to provide a current snapshot of GMC data on doctors with a license to practise and gives a summary of the doctors who gained their primary medical qualifications (PMQ) in the European Economic Area (EEA).

The latest working papers’ produced in November and December can be found here our data about doctors with a European primary medical qualification in 2017 and the relationship between primary medical qualification and nationality, 2016 and 2017.

The latest snapshot states that in 2017, there were 21,609 EEA graduates who had a license to practise in the UK – nearly a tenth of the UK workforce. However, since 2013 the number of licensed EEA graduates has reduced (table 1), both in absolute numbers and as a percentage of the workforce.

The working papers also focused on EEA graduates in each country, where EEA doctors qualified and the areas of practice. For more information please follow this link.

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HCPC publishes Fitness to Practise Annual Report 2017The UK Health and Care Professions Council (HCPC) which regulates 16 healthcare professions recently published the Fitness to Practise Annual Report 2017 covering the work of the HCPC considering allegations about the fitness to practise of our registrants between 1 April 2016 and 31 March 2017.

The report highlights that whilst the Register has increased by 2.5% and new fitness to practise concerns

have increased by 6.2%, the proportion of the Register affected still remains low, with only 0.64% of registrants being subject to a new concern.

The report, alongside a key information document is available for download from our website.

Revised guidance on confidentiality from the HCPCThe HCPC recently relaunched guidance on confidentiality following a review and a public consultation. The guidance provides advice for registrants on how they should handle and share information about service users.

One of the main changes is a clarified definition of ‘consent’ by a service user to the use or disclosure of confidential information – in that it must be voluntary, informed

and given by an individual with the capacity to make the decision. Other changes include further guidance on electronic records, handling information about children and young people, data protection legislation, and sign posting to other sources of guidance.

The guidance can be downloaded here.

Around the world

IAMRA Symposium on Continued Competence 2017

On 5-6 October 2017, the General Medical Council (GMC) hosted the IAMRA Symposium on Continued Competence 2017 in London, UK. Over 100 delegates from 19 countries met to discuss and explore the theme “Continued competence systems – measuring their impact and value”.

This was the fourth event of its kind, with previous symposia held in London in 2010, Washington D.C. in 2013 and in Montreal, Canada in 2015. These meetings have contributed greatly to the medical regulatory community’s understanding of the ‘what’, ‘why’, and ‘how’ of continued competence interventions in a number of very different jurisdictions.

IAMRA Chair, Dr Humayun (Hank) Chaudhry, welcoming

delegates to the symposium. Continued on next page >

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What happened at the 2017 Symposium?

Experts shared their views on various topics such as revalidation, the role of reflective practice, health and wellbeing, the medical workforce, multisource feedback, appraisal, risk-based regulation, and the future shape of Continuing Medical Education (CME) and Continuing Professional Development (CPD).

Professor Kevin Fong, Consultant Anaesthetist at University College London, delivered the opening keynote looking at the role of the individual in systems of continued competence. Sir Keith Pearson, Chair of Health Education England, delivered a keynote session on the future of revalidation, exploring some of the key findings from his review of revalidation in the UK - Taking Revalidation Forward. Delegates also heard from Dr Susi Caesar, Medical Director of Revalidation at the Royal College of General Practitioners, UK, who spoke about the central role of

appraisal in ensuring the continued competence of health professionals.

The full programme for the event can be viewed here.

Take a look at the Twitter hashtag #IAMRA2017 to see what conversations have been happening around the event.

About IAMRA

The International Association of Medical Regulatory Authorities (IAMRA) exists to bring together and support medical regulatory authorities around the world to protect, promote, and maintain the health and safety of the public by ensuring proper standards for the profession of medicine. Through scientific, educational, and collaborative activities, IAMRA’s aim is to share experiences, learn from each other and encourage best practice. IAMRA currently has 112 members from 49 different countries. For more information about IAMRA membership please follow this link.

Delegates attending one of the breakout sessions on risk-

based regulation.

Professor Kevin Fong delivering his keynote address on the role of the

individual in systems of continued competence.

Modern physicians pledge approved by World Medical Association The World Medical Association (WMA) has approved a modern update to the Hippocratic Oath for physicians. Physician leaders meeting at the WMA’s Annual General Assembly in October 2017 in Chicago approved the revisions to the Declaration of Geneva, which was first adopted in 1948.

The revised Declaration, to be called a pledge, refocuses the text to reflect changes over the decades in the relationship between physicians and their patients and between physicians themselves. As a result, the new pledge makes specific reference for the first time to respecting the autonomy of the patient, which is not included in the current text. It also includes a new obligation for respect between teachers, colleagues and students. The present Declaration says students must

respect their teachers, but there is no reciprocity.

There is a new obligation on physicians to share medical knowledge for the benefit of their patients and the advancement of healthcare. Also added is a requirement for physicians to attend to their own health, well-being and abilities in order to provide care of the highest standard.

The current Declaration of Geneva is used across the world by physicians. In many countries it is actually part of the medical professional code and in some it is legally binding. However, in other countries it is either not used at all or is adapted in some way.

The WMA is now expecting that the revised pledge, agreed following a two-year revision process, including a period for public consultation, will become a global ethical code for all physicians.

More information on the revised pledge can be found on the WMA’s website.

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Nurses in advanced roles in primary care: Policy levers for implementation Claudia B Maier, Linda H. Aiken and Reinhard Busse from the OECD have produced a working paper on primary care nurses from 37 OECD and EU countries. Many OECD countries have undergone reforms over the past decade to introduce advanced roles for nurses in primary care to improve access to care quality of care and/or to reduce costs.

The working paper provides analysis of these nurse roles and developments. Four main trends have emerged, including:

1 The development in several countries of specific advanced practice nursing roles at the interface between traditional nursing and medical professions

2 The introduction of various new, supplementary nursing roles often focuses on the management of chronic conditions

3 The rise in educational programmes to train nurses to the required skills and competencies

4 The adoption of new laws and regulations in a number of countries since 2010 to allow certain categories of nurses to prescribe pharmaceuticals (including in Estonia, Finland, France, Netherlands, Poland and Spain.

To read the full working paper follow this link.

Professional Performance Framework designed

The Medical Board of Australia has designed a Professional Performance Framework to ensure that all registered medical practitioners practise competently throughout their working life. The framework was recommended following a report by an expert advisory group on revalidation in August 2017.

The Professional Performance Framework will support doctors to take responsibility for their own performance and encourage the profession collectively to raise professional standards and build a positive, respectful culture in medicine that benefits patients and doctors.

There are five pillars to the Professional Performance Framework, including:

1 Strengthened Continuing Professional Development

2 Active assurance of safe practice

3 Strengthened assessment and management of medical practitioners with multiple substantiated complaints

4 Guidance to support practitioners

5 Collaboration to foster a positive culture of medicine.

Unsplash ken-treloar-411651

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Nursing now! campaign update

Nursing Now! is a campaign to improve health globally by raising the status and profile of nursing, demonstrating what more it can achieve, and enabling nurses to maximise their contribution to achieving universal health coverage. The campaign is being run in association with the World Health Organisation and the International Council of Nurses and is a programme of the Burdett Trust for Nursing. Nursing Now! will be launched on 27 February 2018 and run to the end of 2020.

To ensure a smooth campaign launch in February, organisers undertook 30 phone interviews about the campaign with key stakeholders and sent out a survey form, where almost 600 responses were received. All parts of the world were represented in the feedback. The responses provide a

valuable source of views and ideas which will shape the campaign as it develops. A summary of responses are available at the All-Party Parliamentary Group (APPG) on Global Health website.

The Nursing Now! website will go live in February 2018 and social media will start to be used extensively in the build up to the launch on 27 February 2018. Launch events are being planned in Uganda, Singapore, the USA and the UK – and more are welcome. The Nursing Now! website will contain details about how to be involved as soon as possible.

More information and the report Triple Impact led to the development of the campaign can be found on the APPG on Global Health website.

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Upcoming events

06 February 2018 HiAP 2018 a strategy for improving population health London, UK

21-23 March EAHP congressTallinn, Estonia

13-14 April 2018 CPME Board and General Assembly meetingBrussels, Belgium

02-04 May 2018 The International Forum on Quality and Safety in Healthcare MaltaAmsterdam, The Netherlands

19-20 May 2018 World Health Professions Regulation Conference 2018Melbourne, Australia

15 June 2018 CEOM meeting Romania

22 June 2018European Network for Medical Competent Authorities meeting Paris, France

10-12 September 2018 The International Forum on Quality and Safety in Healthcare Melbourne, Australia

09-10 November 2018CPME Board and General Assembly meetingGeneva, Switzerland

26 November 2018 European Network for Medical Competent Authorities meeting Vienna, Austria

Newsletter and Updates

If you would like to contribute a piece to the next Crossing Borders Update please contact the HPCB secretariat.

Health and Care Professions Council (UK)

Nursing and Midwifery Council (UK)

European Federation of Nurses

European Federation of Dental Regulators eNews

General Dental Council (UK)

General Chiropractic Council

European Commission DG GROW

Health-EU e-newsletter

IAMRA newsletter

European Parliament internal market committee newsletter

Professional Standards Authority (UK) newsletter

General Pharmaceutical Council (UK)

European Social Network

Association for Dental Education in Europe (ADEE)

French Order of Doctors

General Medical Council (UK)

CORU (Ireland)

PSI newsletter

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