Editorial: Revalidation needs to get the basics right first

It is 12 years since the GMC first proposed the idea of revalidation.

It was always going to be a tall order to implement such a system, but the fact that it has taken quite so long, and that we still seem so far from developing something that will actually work, suggests revalidation has become too complicated and, consequently, too costly.

The BMA certainly thinks so. In its response to the GMC's consultation on revalidation last week it said that, while it supported the principle of revalidation, it had serious concerns about the process and could therefore not back the current plans.

The BMA's comments will not stop revalidation in its tracks, but they will certainly force a rethink - not least among the new ministerial team at the DoH.

Even without the BMA response it was becoming increasingly clear that the timetable for revalidation was slipping yet further (as the RCGP admits in this week's GP) and that there are still too many unanswered questions, not least how much it will cost.

It is unlikely the new secretary of state will scrap a system that has protecting patients at its core, but he will not sign a blank cheque to pay for its introduction, particularly when doctors object vehemently to the plans.

Part of the problem is that the GMC has become bogged down with the complexities of revalidation before the basics are even in place. As RCGP chairman Professor Steve Field says in this week's GP, despite having had a decade to implement robust clinical governance procedures, the NHS has failed to do so in many parts of the country.

In practice this means appraisal for GPs and many other doctors is patchy at best. How can we think about introducing revalidation until NHS organisations take appraisal and clinical governance more seriously?

The GMC will surely now have to rethink some of its plans and, with cost such a priority for the new government, this will likely involve making the system simpler and more cost-effective. Working with ministers to ensure every doctor has access to a fair and supportive annual appraisal system might be a good place to start.

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