1. Under current arrangements, the standard of competency to act under public health legislation derives primarily from a doctor filling a certain post in public health (usually a consultant in public health medicine) and / or meeting a competency standard as a Designated Medical Officer ( DMO). This title was created to carry out the functions requiring medical input in the Public Health (Scotland) Act 1897 and is used to refer to doctors, designated by the NHS Board and deemed suitably qualified to carry out legislative duties in health protection on behalf of the local authority.
2. The Public Health etc. (Scotland) Bill assigns functions to health boards and local authorities on a corporate basis. The Bill also defines the actions for which professional input is required (such as when powers are used to restrict personal liberty or impose obligations on individuals in relation to their premises), and provides that these functions must be carried out by 'competent persons'. Sections 3 and 5 of the Bill provides that health boards and local authorities must designate a sufficient number of competent persons for the purpose of exercising the public health functions assigned to them in the Bill, and that Scottish Ministers may prescribe the qualifications, experience and training of such competent persons in regulations. The Bill provides for a limited transfer of functions from local authorities to health boards.
3. The Faculty of Public Health of the Royal College of Physicians, the professional body responsible for standard setting in public health, has recognised that public health specialists need not be doctors if they are able to demonstrate a similar level of knowledge and competency and meet accreditation requirements that are equivalent to those set for doctors as specialists by the General Medical Council. In the longer term this means that consultant posts in the NHS that had previously been held by doctors who have a clinical background will be open to non-clinicians who are able to demonstrate skills and experience to a required standard. The Public Health Register was established in 2003 to provide regulation for senior level public health specialists who do not have a clinical background (such as epidemiologists and people who have trained in health improvement), but are able to demonstrate competence against a set of key criteria. Individuals on the Public Health Register are eligible to apply for consultant posts in the.
The UK Public Health Register
4. The UK Public Health Register (formerly the UK Voluntary Register for Public Health Specialists) was established in 2003 to promote public confidence in specialist public health practice in the UK through independent regulation. The Public Health Register provides professional regulation to specialists in public health who come from a variety of backgrounds, and registration is designed to ensure that multidisciplinary specialists in public health are appropriately qualified and competent.
5. Whatever their professional background, all such specialists on the Public Health Register have a common core of knowledge, skills and experience, and work at a senior or strategic level of management. Registration on the Public Health Register is comparable to registration with the General Medical Council ( GMC) Specialist Register for public health physicians or the General Dental Council ( GDC) Specialists list in dental health for dentists, by enabling individuals to be considered eligible for consultant posts within the NHS.
6. The Public Health Register is a legal entity and every new consultant in the UKNHS must be registered with either the Public Health Register or be on the GMC Specialist Register. Doctors on the GMC Specialist Register are required to undertake ongoing continual professional development. Once re-validation of the GMC Specialist Register has been established, the Registers will have a parallel process of demonstrating continual professional development.
7. There are currently 3 routes to membership of the Public Health Register. The first is by completion of an accredited 5 year training programme (identical to that undertaken by doctors to gain access to the GMC Specialist Register). The second route is by retrospective recognition through a portfolio of evidence that demonstrates a person's eligibility for the Public Health Register. The third route requires membership to the GMC or GDC's Specialist Registers in public health ( i.e. membership of the GMC or GDC register automatically enables membership to the Public Health Register).
8. Public health, as recognised by the Wanless report and by Better Health, Better Care (pages 20, 24) requires the knowledge and skills to act on areas other than direct biomedical subjects. With the continued development of training for public health specialists it is appropriate to consider individuals who do not have a clinical background as being potential health board competent persons for the functions set out in the Bill. The role of a competent person is not one of diagnosing or treating patients, but more one of risk assessment and risk management, a person having the knowledge and skills in health protection and the ability to take a leadership role and work with colleagues from other disciplines and specialities (including legal colleagues).