Recommendation 167

Inspection of approved practice settings

Accepted in principle
The Department of Health and General Medical Council should review the powers available to the General Medical Council  in support of assessment and monitoring of approved practice settings establishments with a view to ensuring that the General Medical Council (or if considered more appropriate , the healthcare systems regulator), has the power to inspect establishments , either itself or by an appointed entity on its behalf, and to require the production of relevant information.

The General Medical Council has undertaken a fundamental review of Approved Practice Settings (APS).  This review considered APS in the context of the General Medical Council’s functions and how they promote assurance and patient safety.  Since APS 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The General Medical Council review has found that these new powers have superseded APS as a source of regulatory assurance and has recommended that the legal provisions that deal with APS should be reviewed as part of the Law Commission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 APS 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 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.