Letters Burdensome regulation of the NHS

The Goldilocks problems in regulation

BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i3778 (Published 12 July 2016) Cite this as: BMJ 2016;354:i3778
  1. Terry Kemple, president
  1. Royal College of General Practitioners, London NW1 2FB, UK
  1. tk{at}elpmek.demon.co.uk

Edwards highlights the quantity of over-regulation in healthcare.1 Although everyone agrees that regulation is necessary, this is just the first “Goldilocks” problem—making sure that it’s not too little or too much. The second Goldilocks problem is getting the quality of the regulation just right.

Another aspect of regulation is that GPs are often required to have initial accreditation in many tasks that they want to or need to do, and, once accredited, they may be expected to get their knowledge and competence reaccredited regularly. Many of the requirements for accreditation are not fit for purpose because there’s too little or no linkage between a GP’s learning needs and the desired benefit for patients.

Typically, linkage is poor between learning needs and learning objectives; between the learning objectives and course content; between content and the desired change in GP performance or patient outcomes; and between the desired change in GP performance or patient outcomes and the stated learning objectives. The result is that the learning requirements for accreditations and reaccreditations are often of poor quality or are over-engineered and waste the learner’s time.

The hydra-like proliferation of poor quality accreditations and reaccreditations is an expensive misuse of scarce NHS resources (such as GPs’ time), and they contribute to the unnecessary, time consuming bureaucracy that can make GPs feel overwhelmed.

All doctors need to give robust feedback to accreditors that the quality of processes for accreditation and reaccreditation must be improved by following the best quality improvement and learning principles and processes. And we should stop most mandatory retraining unless we’re confident that it’s both necessary and effective.


  • Competing interests: None declared.


View Abstract