Why examine professional regulation and the healthcare workforce crisis?
Health systems are dependent on the availability and quality of the healthcare workforce, but the World Health Organization estimates a shortfall of 11 million workers by 2030. This has had a particular impact in low and middle-income countries, but the effects of the healthcare workforce crisis have been felt across Europe. In the four countries of the UK, and in Ireland, these issues were particularly visible during and after the COVID-19 pandemic, which required widespread recruitment campaigns including inviting retired healthcare professionals to return to practice and the redeployment of existing healthcare professionals. However, while the threat of this pandemic has receded, the challenge of delivering adequately staffed healthcare services remains, with on-going reports of struggles to meet patient demand and unsafe levels of healthcare staffing in Scotland and in Ireland.
Until recently, there was little academic focus on the role of professional regulation in addressing the healthcare workforce crisis. This is perhaps surprising in circumstances where the statutory regulators of healthcare professionals (e.g. for doctors, the Irish Medical Council (IMC) in Ireland or the General Medical Council (GMC) in the UK) have a direct role in matters such as who is entitled to provide healthcare services within their jurisdictions, and the standards to which these services must be delivered. In turn, this shapes the experiences of the healthcare professionals who deliver services, and the patients and publics who receive them.
In response to this gap, together with a team of researchers we initiated the RSE-RIA funded project Regulating for the Workforce of the Future , which convened research roundtable meetings in 2025 with stakeholders in Ireland and Scotland in order to examine the evolving role of professional regulation in this context. Although our focus was on the medical profession, it was clear that our findings also had resonance for other areas of the healthcare workforce. In our discussions, we took account of a ‘wellbeing economy’ model, where issues such as the quality and sustainability of healthcare roles to meet professional, patient and public needs, are considered alongside metrics such as the number of jobs available.
What did we find?
A key finding of our research is the multifaceted nature of the healthcare workforce crisis. In other words, this is not a single crisis that can be easily defined (e.g. ‘not enough doctors’) nor simplistically solved (e.g. ‘more undergraduate training places’). Rather we conceptualise this as a multitude of crises with different dimensions in accordance with factors such as: professional job roles (e.g. primary or secondary care); location (e.g. cosmopolitan or rural); and career stage and path.
Within this framing, key themes that emerged from roundtable discussions held in Ireland and Scotland included: (i) the recognition and registration of new healthcare professionals (such as Physician Associates); (ii) the challenges of remote and rural working; and (ii) the changing role of professional regulation. In this blog, we focus on the first of these themes, but full details of each theme can be found in our published Policy Brief.
Recognising and regulating new healthcare professionals: challenges and opportunities
One way in which the healthcare workforce is changing is in relation to the emergence of new professions. These healthcare professionals have the potential to play a part in addressing the workforce crisis as part of a diverse, multi-disciplinary team with complementary skill sets. However, careful consideration needs to be given to the safe and effective integration of these roles and the way in which they are recognised and, where appropriate, regulated.
An example of where a different approach has been taken in Scotland and Ireland is in relation to the statutory regulation of Anaesthesia Associates (AAs) and Physician Associates (PAs). In the UK, legislation has been passed by the UK and the Scottish Parliaments to enable regulation of AAs and PAs by the GMC, although this has not been without controversy. In contrast, a different approach has been taken in Ireland where the IMC has indicated that it is not the appropriate body to fulfil this role. The role of PAs is currently under review in Ireland with a report due by the end of 2025. The Health Service Executive (HSE), which is responsible for delivering a range of health and personal social services in Ireland, has paused recruitment of PAs pending completion of the review.
In the UK, the Leng Review (which reported in July 2025) was established by the Secretary of State for Health and Social Care to undertake an independent review of the PA and AA professions in England, with a focus on the safety of these roles and their contribution to multidisciplinary healthcare teams. Key recommendations that have emerged from this report relate both to matters such as the scope and positioning of the PA and AA roles, but also to the wider system in which all healthcare professionals work. It is of note that, in order to review these roles, it was necessary to engage with a wide range of stakeholders, including PAs and AAs, as well as patients and families and other members of the healthcare team.
In discussions that took place in the research roundtables, it was noted that many of the issues discussed and lessons identified in the Leng Review – for example around the scope of practice and team working – also have resonance for other healthcare professions where regulation may be introduced or expanded. For example, Nursing Associates are currently only regulated in England, and not in Scotland or Ireland. Taken together, this suggests the need for decisions about regulatory change to be made up front, alongside healthcare workforce planning, to ensure that risks are managed and all stakeholders are on board, as recommended by the Professional Standards Authority.
Some concluding thoughts
To return to the question posed at the start of this blog, our findings suggest that there is a significant role for professional regulation in addressing the healthcare workforce crisis. A caveat here is that professional regulation is but one factor within the healthcare ecosystem, and so communication and collaboration between stakeholders will be key.
Nonetheless, the role of professional regulation is evolving. While it retains a focus on protecting the public, there is potential for regulatory stakeholders to take an increasingly proactive approach in the context of the healthcare workforce crisis. It is an approach that, in collaboration with other stakeholders, contributes to shaping the cultural, educational, and organisational contexts in which healthcare professionals work.
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About the authors
Lewis Garippa is a Lecturer in Law and PhD candidate, University of Dundee, and a co-Investigator on ‘Regulating for the workforce of the future: addressing the healthcare workforce crisis in Scotland and Ireland’, a project jointly funded by the Royal Society of Edinburgh and the Royal Irish Academy as an Ireland-Scotland Bilateral Network Grant. Dr Annie Sorbie is a Senior Lecturer in Health, Medical Law and Ethics, University of Edinburgh. Dr Mary Tumelty is a Senior Lecturer in Law, University College Cork. They are both co-Principal Investigators on this project. The support of the RSE and RIA is gratefully acknowledged.
Photo by Ashkan Forouzani on Unsplash
