Chris Lancelot: Standards must be worth setting and keeping

As I wrote a couple of weeks ago, the DoH is considering abandoning its requirement to achieve information management and technology directed enhanced service accreditation before uploading patient summaries to the spine. Not only is this potentially dangerous but it is a slap in the face for those GPs who spent time and effort completing the training.

Indeed, it calls into question the whole matter of standards in the NHS. Obviously, we must have standards - but standards need to be appropriate, consistently applied, maintained and predictable.

Standards must be appropriate: it is not appropriate to ask highly qualified doctors to produce further certificates attesting to their abilities in subjects already covered in their training (minor surgery, immunisations, child development, etc.) Vocational training and/or MRCGP should be sufficient.

We are professionals, and should be trusted to keep ourselves fully up to date.

What about revalidation? As currently planned, this is heavy-handed, mostly unnecessary, time-consuming and intrusive. It would be much better if revalidation were automatic, with formal investigation confined to that small percentage whose behaviour was already causing concern.

Standards must be consistently applied: if doctors and nurses have to keep to standards, so must managers. Half the NHS workforce cannot continually be under scrutiny while the other half is largely unregulated.

Standards must be maintained: they should not be set, only to be abandoned for political convenience. Arbitrary introduction or removal of standards implies they are only of use to manipulate staff.

Finally, standards need to be predictable, not changed surreptitiously. There was a time when vocational training was more than sufficient qualification for a lifetime as a GP. Then, without formal announcement, MRCGP started to creep in as an additional requirement, not just for registrars, but for employment in the Darzi clinics.

'Diploma creep' is bad news for doctors, especially when introduced without formal discussion or considerable prior warning. At all stages of their careers, doctors should be fully aware of exactly what qualifications will or will not be required in 10 years' time.

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