GPs want revalidation compromise

As they await publication of the CMO's report, GPs tell Joe Lepper what they would like it to say about revalidation.

With the release this month of CMO Sir Liam Donaldson's report into medical regulation GPs will be a step closer to finding out what system of revalidation will be placed on them.

The report, which follows Dame Janet Smith's inquiry into the case of Harold Shipman, has a wide remit, looking at the future role of the GMC and its constitution, as well as clinical governance, whistle blowing and revalidation of GPs.

GPs, such as GMC member Dr Krishna Korlipara, are optimistic that the CMO will not force a 'draconian checks-and-balances system on GPs', as many had feared.

'I have a feeling that he will not adopt a hard-line approach,' said Dr Korlipara. 'He knows he needs to strike a balance between ensuring the public have confidence in their doctors and the needs of the profession.

'If draconian measures are in place, such as tests or examinations every year, then many doctors will leave and it will put off many others from joining, at a time when we can't afford that to happen. He knows that.'

Dr Korlipara would like to see the system proposed by the GMC whereby GPs are assessed through an appraisal scheme that would be validated every five years. This, however, was rejected by Dame Janet Smith.

NHS Alliance chairman Dr Michael Dixon suggested that while Sir Liam Donaldson was unlikely to simply ratify the GMC proposals, he was equally unlikely to follow Dame Janet Smith's tougher stance.

'I would hope that he comes up with something that the public will feel confident about and that is not just over-bureaucratic or about ticking boxes,' he said.

'The emphasis should be on learning, helping GPs to progress and offering support, rather than something that makes people think they might as well retire early.'

GPC member Dr Chaand Nagpaul also recognised the need to ensure a more robust system is in place.

'The important point is that the CMO needs to keep things in proportion and not present some knee-jerk measures,' he said.

'It needs to be sensibly built between not being onerous and being robust enough.'

Dr Brian Balmer, secretary of Essex LMCs and a part-time GP said that the issue of GPs retiring early or leaving the professions if a hard-line stance was taken could have 'serious consequences'.

'If they present something that is intrusive, then a lot of part-time GPs will just wonder why they bother,' he said.

He also hoped that what is presented by the CMO will be a system of revalidation that is in line with the appraisal system: 'It is important to have the appraisal and whatever is decided needs to fit into that,' he said.

National Association of Primary Care chairman Dr James Kingsland was also in favour of linking revalidation to appraisals every three to

five years.

But in addition he wanted to see the appointment of external 'but non-threatening' examiners, and for GPs to be assessed on how they worked within a team.

There are some elements to the GMC proposals that many GPs, particularly those in single-handed, rural and sessional sectors, hope Sir Liam ignores.

These include a two-tier system, where those working within an approved environment would face lesser regulation than those who are less easy to monitor.

Dr Michael Taylor, chairman of the Small Practices Association, said: 'That would worry me greatly because it implies that certain GPs are a much greater risk to patient safety. There is absolutely no evidence to suggest that.'

He was concerned about the method of revalidation, which could include video evidence of a GP's consultation skills.

'There are a number of GPs who would feel extremely uncomfortable about being videoed,' he said.

Despite these concerns, Dr Taylor believed that ministers were right to task Sir Liam to ensure the balance was right between creating a system that helps further public confidence in GPs while at the same time not being too intrusive.

'Revalidation's time has come and we welcome it even though I'm sure it will cause a few sweaty palms and sleepless nights. It is for the benefit of the patients and that's what we are in the business for,' he said.

GPletters@haynet.com

- What form do you want revalidation to take? Write to GPletters@haynet.com

REVALIDATION DEBATE
GMC: Proposals linked to annual appraisals.
Dame Janet Smith: Has called for GPs to undergo 'knowledge tests'.
NAPC: Appraisals plus assessment of GP team work.
SPA: Discrimination against single-handers.
NHS Alliance: Emphasis should be support.

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