Letter: Revalidation is the sensible way to ensure competence

Dear Editor,

I read with a mixture of interest and incredulity the article by Joe Lepper on revalidation (GP, 2 June). 

It is unfortunate that some in the profession still seem to link revalidation with appraisal.

Notwithstanding that this was rejected by Dame Janet Smith, it is an attempt to link two processes that are designed to serve different needs.

Appraisal was conceived and is applied as a formative process which, while acknowledging good performance, helps to focus on professional development. It could, however, change to include performance assessment and assume the character of a summative process. In this latter form it is possible for appraisal to inform revalidation to a more robust degree than is possible a present.

Revalidation, on the other hand, seeks the answer to the question as to whether a doctor is fit to practise. Appraisal, in its current form, cannot provide that answer, nor was it designed to do so.

It is imperative that those who are on the GMC register are deemed to be fit to practise to a degree that is uniform and reproducible in each speciality. Whether a written examination is a satisfactory assessment tool is questionable. Practice-based assessment has much to offer in this respect and is a better means of estimating performance as opposed to verifying competence via a written test. The level at which any such assessment is set is a matter for discussion, but the standard should obviously be that at which a doctor would, on the balance of probability, be deemed to be fit to practise.

While any assessment is likely to be a burden on doctors it remains a necessity which will eventually engender public confidence in the profession.

The fact that assessment is likely to precipitate resignations of some colleagues and thereby appear to destabilise the provision of healthcare is no reason for its dilution or delay.

However, the increasing numbers of nurse practitioners, specialist nurses and so on who provide independent care and advice to patients should also be included in fitness-to-practice procedures. In some cases these would be similar to those applied to doctors.

Unfortunately there appears to be a widening 'competency and fitness-to-practice deficit' in this respect associated with conspicuous silence on the subject. Equally, the unquestioning acceptance by the public of these practitioners is a cause for concern.

Dr Ken Menon, Ongar, Essex

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