The Maintenance of Licensure (MoL) programme is being developed by the HPCSA in line with its regulatory mandate to uphold the social contract between the health professions and the public.
MoL seeks to assure patients, the public and employers that registered healthcare practitioners are engaging current knowledge, use evidence-based practice, adhere to the national guidelines, and are complying with the expected professional practice standards. MoL is a quality improvement and quality assurance process demonstrating the commitment of the healthcare practitioners to life-long learning and competence in their professional roles.
The MoL programme includes a focus on patient outcomes, peer review, and patient care. MoL can be considered as a continuous process rather than an event, and thus has both formative and summative assessments which takes into consideration work and a knowledge-based approach.
The goal of the MoL programme is to encourage, support and enable a culture of ongoing learning amongst the healthcare practitioners, based on assessments of knowledge and performance relevant to professional practice roles (i.e. clinical, teaching, research, leadership) and competencies.
Rationale for HPCSA model of MoL to practice
The focus of the HPCSA’s system of Continuing Professional Development (CPD) has primarily been on continuing education to update knowledge. A more comprehensive model that links CPD to the MoL is thus proposed. The rationale is to guide genuine learning, enable improved practice and facilitate demonstration of continued professional knowledge and performance. This model will replace the CPD system which has required healthcare practitioners to record the number of credits (Continuing Education Units i.e. CEUs) acquired for attending or engaging with CPD activities. Equating the number of CEUs accumulated with competence1 has been suggested to be erroneous2, as it does not necessarily indicate genuine learning nor does it equal a change in the quality of performance.
Currently, healthcare practitioners meet the requirements for mandatory CPD CEUs opportunistically or casually. The impact of many CPD activities is limited when undertaken in an ad-hoc manner outside of a defined structure of directed learning and contributes little to improve clinician performance or patient/client health outcomes. Learning activities that are planned and which are interactive, encourage reflection on practice, provide opportunities to acquire and practice skills, involve multiple exposures, help practitioners to identify between current performance and a standard to be achieved, and are focused on outcomes, are the most effective at improving practice and patient health outcomes3. There is a greater responsibility on practitioners to set out their learning requirements, engage in focused learning and demonstrate improvement in their professional performance. Such models more explicitly recognise that different professionals will have different development needs and require individual healthcare practitioners to take greater ownership of their professional development.
The new HPCSA model will shift control of learning to individual healthcare practitioners, enabling them to reflect on their learning needs and to design their own learning programmes. It is essential that such a programme effectively addresses the gap between optimal evidence-based practice and actual clinical practice. The critical requirement is for the practitioners to demonstrate that they have the essential knowledge and skills to in order to be issued a license to practise their profession.
Advantages of Maintenance of Licence for the Healthcare Practitioners
The autonomy of the healthcare practitioners is fostered as a personal responsibility given to individual healthcare practitioners to participate in the process, to identify their own learning needs, to engage with learning directed at improving their own professional practice. The relevance of learning (CPD) and assessment (MoL) is increased as these are aligned with a healthcare practitioner’s professional practice. Healthcare practitioners will confirm that they are indeed up to date, meet relevant practice guidelines and offering evidence based/ best possible service. MoL is advantageous in that it will guide reflection to include an outcomes-based orientation. Alignment with international professional standards will be fostered while context-specific developments will be a particular focus. For some professions, MoL activities may be pre-accredited, available on the HPCSA website and free of charge.
HPCSA Model for MoL
The MoL is integrated with CPD. It is a quality improvement and a quality assurance process designed to guide and demonstrate continuous improvement and performance in professional roles throughout a career. Healthcare practitioners will engage with the learning opportunities to enhance and refine knowledge and performance in accordance with identified learning needs. Each time a healthcare practitioner succeeds in demonstrating the requisite knowledge and performance, credits will be allocated and reflected in the healthcare practitioner’s personal MoL portal on the HPCSA website. The Professional Boards will specify the nature and number of knowledge and performance assessments to be undertaken by their healthcare practitioners in a five-year period.
The core components of the model for the MoL include: (1) Reflection, (2) Determination of learning needs, (3) Development and implementation of an individualised learning plan, (4) Application of learning to practice, and (5) Evaluations of Competence and Performance. The HPCSA ‘s MoL model has been demonstrated in Figure 1.
The requirements to obtain a licence to practice
Practitioners will be expected to engage annually with CPD which includes both assessments of knowledge and performance (Category 3 of CPD), as well as learning activities (Categories 1 and 2 of CPD). If the minimum annual requirements are met, then the practitioner will be adherent. If the requirements are not met, then the practitioner will be non-adherent, and both the practitioner and the Professional Board will be notified. Practitioner will be encouraged to be adherent.
At the end of a five-year period, practitioners will need to have met all requirements for CPD, inclusive of MoL assessments, as specified by the Professional Board annually and cumulatively (as illustrated in Figure 2). If all requirements are met, then the practitioner will be licensed for a further five years. If the requirements are not met, then non-compliance results in no licence to practice. Professional Boards will specify guidelines for practitioners to become compliant and regain a licence to practice.
| Requirements | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 |
|---|---|---|---|---|---|
| Group learning CPD activities | Category 1 | Category 1 | Category 1 | Category 1 | Category 1 |
| Individual CPD learning activities | Category 2 | Category 2 | Category 2 | Category 2 | Category 2 |
| Assessments | Category 3 | Category 3 | Category 3 | Category 3 | Category 3 |
- Weightings in each category to be determined by the Professional Boards.
- Every year practitioners should be adherent with the required minimum credits and within 5 years achieve the total number of HPCSA determined credits across categories to be licensed
Practitioners requiring additional information can email the HPCSA at Professionalpractice@hpcsa.co.za.
[1]IOM (Institute of Medicine). 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press.
[2] Ahmed, K., Wang, T. T., Ashrafian, H., Layer, G. T., Darzi, A., & Athanasiou, T. (2013). The effectiveness of continuing medical education for specialist recertification. Canadian Urological Association Journal, 7(7-8), 266.
[3] Wallace, S., & May, S. A. (2016). Assessing and enhancing quality through outcomes-based continuing professional development (CPD): a review of current practice. The Veterinary record, 179(20), 515.
Last Updated on 28 June 2021 by HPCSA Corporate Affairs