Liam Farrell: Beware the evil goblin of revalidation

'You disgust me,' he said, 'you and your fancy shirts and your fast women and your big shiny car. Well, let me tell you, joy-boy, it cuts no ice with me.'

Some of this was quite flattering, so I didn't protest. 'I'd like to leap over this desk,' he went on, 'rip out your guts and wrap them round your neck.'

The appraisal was not going well. We got off to a bad start - he hadn't been impressed by the old The Dog Ate My Portfolio excuse.

There is a possibly apocryphal, yet potentially enlightening story from Ceausescu's Romania. An associate producer at Romanian TV suggested it would be a good idea to show a nightly 10-minute review of the dictator's activities.

The next toady up the pecking order suggested 10 minutes wasn't enough, it had to be 30 minutes, and so on and on, until the people had to endure three hours on the leader's activities every night.

Ideas have momentum and stopping them is like jumping in front of a train. Assessing doctors' performance is obviously a Good Idea, isn't it? Who could reasonably object? But this idea midwifed the sulky child of appraisal, which has in turn matured into the evil goblin of revalidation.

There are vested interests thriving here and the goblin has become like a living being; the original remit, to ensure doctors practise to an acceptable standard, has been lost, and its real mission now is to grow, extend its influence, employ more lackeys, and bump up the salaries and pensions of its senior management. This labyrinthine bureaucracy will cost, apparently, more than £1bn.

But, I hear you say, without revalidation or appraisal, how would we track down the massive problem of underperforming doctors? Actually it's not massive, it's less than 1% of doctors, and I have a solution, which is cheaper and more fun.

We employ counterinsurgency techniques and simply grass them up. I'd have no problem informing on any of my colleagues, in the interests of the greater good; provided, of course, that the phoneline was completely confidential. I wouldn't want any unpleasantness.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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