May 2017

How does professional regulation affect the identity of health and care professionals?


This report presents the findings from a study conducted for the Professional Standards Authority to explore and compare the views of health and care practitioners in the UK on the relationship between regulation and professional identity. (You can download the report at the foot of the page.)

What is professional identity?

Professional identity – an individual’s conception of her/himself as a professional – is a complex construct, and existing accounts highlight multiple, interconnected components, with changing degrees of importance. In this report, we focus on two components in the accounts of our participants which are central to understanding the relationship between regulation and professional identity:

a fundamental commitment to help – along with its corollary, a fundamental commitment to do no harm

a coherent way of understanding and intervening in the world, or professional stance – which is more than the mere aggregation of the knowledge and skills a professional brings to their practice

Regulation and individual practice

What role does regulation play in individual practice? Accounts from a regulatory perspective typically conceptualise regulatory activity as identifying and addressing any gaps between actual practice and register requirements. We can think of this as a ‘piano-tuner’ model of regulation. Pianos, like professionals, have their own internal standards: the keys reliably produce notes, and there is no need for a piano-tuner to stand next to the piano during the concert. However, those internal standards may fail to align with the objective requirements of the harmonic scale: the notes produced by some keys may be out of tune. The job of a piano-tuner is not to fix this when it happens during a concert: it is to prevent it ruining the concert in the first place.

By contrast, participants offered for the most part what we might call a ‘piano-teacher’ model of regulation. This model assigns a critical role to register requirements in the development of a strong professional identity:

practice requirements play a central role as objects of discussion, reflection and learning, and in the formation of the individual standards associated with one’s professional identity

access requirements play a key role in ensuring that individuals engage in this kind of focused consideration of practice requirements

Communities of practice

What the above account misses, however, are the social dimensions of professional identity. As an individual, one should also be able to trust that the professional identities of others on a register – along with the standards for individual practice which follow from those identities – are, in certain key respects, the same as one’s own. This sense of alignment with a wider community, via a common body or register, can provide a reciprocal validation of one’s own professional identity and standards by that community.

Underpinning this sense of alignment is a third model of the relationship between regulation and practice, focused on ‘holding to account’. This model highlights the role register requirements play not in making but in justifying decisions about how to act as a professional. Alignment is established not because everyone on a register is checking the same codes and standards – they are not – but because, if the worst occurs, everyone on a register will be held to account by the same register-holder, acting on behalf of the aligned community as a whole.

Not all of the professionals in our sample attached the same level of importance to communal validation of one’s professional identity. Instead, our evidence suggests a spectrum of views from the more ‘communitarian’ to the more ‘individualist’. For those who have a more communitarian perspective, regulation has a much more substantial role to play than it does for those who have a more individualist perspective. Specifically, it has a role to play not just in the development, but also in the maintenance of a strong professional identity – not because it directly influences individual practice, but because it provides communal validation for an individual’s professional identity and standards, and communal standards against which individual practice needs to be justified.