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3 When we talk of professional competence, we refer to patients' expectations that the professional they come into contact with will be up to the job. Professionals should be able to do that which they profess they can do. From the patient's point of view, it is shocking to think that this might not be the case. Indeed, the need for healthcare professionals to acquire and maintain appropriate levels of competence is so obvious that it would seem unnecessary to refer to it. The patient simply expects that the healthcare professional has up-to-date knowledge and skills. A healthcare professional's competence from the patient's point of view is not negotiable. Moreover, when we talk of professionals, we repeat that we mean all of the professionals who make the NHS work: doctors, nurses, the professions allied to medicine,  managers and other healthcare workers.
4 Levels of competence quite properly will vary. A consultant or a nurse ward manager will have a wider and deeper level of competence than the junior doctor or newly qualified nurse. Yet, even at the start of a professional life, competence should meet a critical minimum level. Competence will also vary at the level of specialist expertise. Consultants working in a highly specialised field, by declaring themselves to be specialists, profess that they have (and thus should have) a greater level of competence in the particular area than a consultant who is a generalist.
5 Professional competence requires a firm educational grounding, followed by a period of formal training to acquire the relevant knowledge and skills in the workplace. Thereafter, continued competence rests on a combination of education, continuous development, confidence and experience.  It depends on the motivation of individual professionals to learn and develop and the extent to which their employer supports them and enables them to do so. It also depends on the professional standards which they are required or expected to meet, and on the wider systems for ensuring that those standards are adhered to.
6 Thus, acquiring and maintaining professional competence involves collaboration between the individual, the educational institutions, the employer, and those who set and enforce standards of professional competence. Individual healthcare professionals, once qualified, need to be sufficiently motivated and have sufficient incentive to maintain and develop their competence. If the process of keeping knowledge and skills up to date is neglected, the professional's level of competence will diminish. It is crucial, therefore, that the working life of healthcare professionals be so structured as to allow them to meet these requirements. This means that the employer must provide professionals with sufficient time and opportunity to maintain existing skills, and to acquire and consolidate new skills. Thus, the work environment in the NHS must support and enable the process of continuous learning, through
7 Professionals' competence also depends upon professionals themselves having an honest understanding of their abilities. It is crucial that errors in practice, or gaps in skill or knowledge, are acknowledged as early as possible and used as an opportunity for learning, rather than being suppressed or hidden out of fear of blame or sanction. Learning through mistakes can often be a very effective way of improving competence and understanding. But to acknowledge errors and shortcomings, professionals must feel safe to do so. Employers, therefore, must create an environment which enables this to happen.
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 The term `professions allied to medicine' is usually taken to include professionals working in the fields of physiotherapy, occupational therapy, speech and language therapy, audiology, dietetics, podiatry, counselling and orthoptics
 The term `education' usually refers to the undergraduate period when prospective healthcare professionals are working towards an initial qualification; the term `training' usually refers to that period after qualification when the professional is acquiring further specialist skills; the term `continuing professional development' generally refers to activities undertaken by a qualified and trained professional to maintain their skills, during the course of a working life