The Health Professions Regulation Act (in Spanish, LOPS)¹ continues to be a law that has still to be fully implemented. Fourteen years after it was enacted there are still several aspects that have not been developed, one of which we wish to go into in greater depth, namely, the diplomas of accreditation (DA) and advanced diplomas of accreditation (ADA) dealt with in Chapter IV of this law, specifically devoted to continuing education.

The third phase of the educational continuum, continuing education, which is the longest and plays a key role in good practice in health professionals' day-to-day activities, is addressed with mixed fortune in four of the 47 Articles included in the LOPS (Art. 33, 34, 35 and 36). Article 33 ('General principles') offers a good definition of continuing education which is not only still valid but also very topical. Article 34 ('Continuing Education Committee') is widely implemented in both the Central Administration and the Regional Administration. Article 35 ('Accreditation of centres, activities and professionals) has undergone a spectacular rate of development, especially in the section on the accreditation of continuing education activities, and work is already being carried out on the accreditation of continuing education centres. Finally, Article 36² ('Diplomas of accreditation and advanced diplomas of accreditation) has still to be developed, although the plenary session of the Continuing Education Committee of the Spanish National Health System is promoting the diploma of accreditation in palliative care and the diploma of specialised training tutors, in pursuance of the provisions of Royal Decree 639/2015, which regulates and determines the criteria, procedure and requirements for their implementation.

This unequal deployment leads us to pose a number of questions: Why has Article 36 of the LOPS been left languishing and neglected? Are DA complex, costly or difficult to implement? Do DA overlap or encroach upon the competences of some administration or body? Do they contribute something new to healthcare management? Are they yet another unnecessary credential in a world that is already overly dependent on the qualifications one holds? To put it in a nutshell: are DA useful or not? Are they of the slightest interest to anyone?

DA are a brilliant instrument because:

How is it possible that an instrument that is so useful to so many professionals, so versatile, so economical and practical, so interprofessional and intraprofessional has not aroused the interest of any sectors? Is anyone calling out for DA or for ADA?

No simple explanation can be given because, as in so many other things, there must be a number of causes. The pressing needs of day-to-day practice may be one of the reasons. The vicissitudes undergone by the mandatory core curriculum have certainly not helped. The interest of some sectors in accomplishing entities that are easier to understand, such as might be the case of a new specialty or a specific area of training, has also been a factor that has far from facilitated the implementation of DA and ADA. Our culture tends towards the highest and DA and ADA have undoubtedly been understood and rated as a 'lesser god'.

Do any of the following sentences sound familiar to you? 'My specialty is very important!' 'My professional activity deserves to be a specialty!' 'A specific area of training would be the complement to my specialty and the acknowledgement of my work!' And so on. Yet, have you ever heard anyone crying out for a DA or anyone who aims to reach the culmination of their work status with a DA?

Failure to develop an instrument that improves both management and the care delivered to patients has without a doubt been a mistake. The professionals themselves can surely be forgiven for these mistakes because nobody has explained to them what DA are and what they are for. But the clinical managers who deal with the management of human resources in healthcare institutions on a daily basis have less right to be excused. Wouldn't it be a good thing if those responsible for clinical management (when searching among their adjunct staff for the best to take on the role of 'residents' tutors') had at their disposal a credential that provided them with information about which professionals in their workforce are experts in teaching? Doesn't an extracorporeal surgery operating theatre need a professional who is an expert in perfusion, but there are no credentials that certify such a condition? What about outpatients oncohaematological care? And sleep pathologies? What credential do professionals who deliver palliative care have available to them? The same can be said of so many clinical activities that are practised on the basis of continuing education, but lack a credential that certifies competence in a specific functional area.

DA are of interest to both physicians and members of nursing staff, as well as, to a greater or lesser extent, any healthcare profession. DA do not encroach upon the competences of any administration or institution. If we take as an example a DA in tutorial practices, a hospital will designate the tutors that it deems suitable for the job, whether they have such a DA or not. The advantage of a DA is that it offers proof that its holder has completed training and the acquisition of a set of competencies during those training processes. Or, for instance, a nurse with a DA as a perfusionist will find it easier to move to another hospital or to another region if they can prove that, in addition to their nursing skills, they also have a credential accrediting them as a perfusionist.

We are not talking about being exhaustive in terms of the possible qualifications covered by DA and ADA. It is not even a question of those we have just mentioned, which are merely examples, being of greater or lesser interest or the most pressing. The idea is to think deeply about the benefits of DA and ADA. These credentials, which are based on continuing education, enhance the value of this kind of training. They do not require any kind of educational infrastructure (such as specific training areas), as they are based on continuing education and therefore have a very low cost. And they have an expiry date, which means that professionals interested in continuing to practise such activities will renew their DA and those who are no longer interested in doing so will not renew it. DA have only benefits to offer without any drawbacks, so why have they been left languishing and neglected?