Professor Nigel Sparrow interview: the first year of revalidation

Professor Nigel Sparrow reflects on the revalidation experience and explains the changes to come. Marina Soteriou reports.

'I want to make sure that general practice is treated fairly and proportionately,' says Professor Nigel Sparrow, about his dual roles as the RCGP revalidation lead and the CQC's primary care adviser.

'We recognise the pressures that GPs are under,' he says, and is keen to emphasise that he is a practising GP who understands the day-to-day issues faced by the profession.

Professor Sparrow says he 'completely empathises' with GPs who are worried about the increasing bureaucracy of both revalidation and the impending GP ratings system.

Profession in turmoil

'General practice is in turmoil,' he says, citing the NHS reforms, the implementation of revalidation in December last year, rising workload and GP shortages, as part of a long list of challenges.

The good news is that revalidation is off to a strong start, he says, with the RCGP receiving relatively few queries from concerned GPs.

Only three or four GPs have 'failed to engage with revalidation', he says, adding that this is 'remarkably few'.

This could have meant a responsible officer has serious concerns about the GP, or they have simply refused to take part in revalidation.

The 15% deferral rate for GPs is the highest among any specialty, says Professor Sparrow, but he is confident this will fall.

Responsible officers are perhaps taking a more cautious approach with GPs, he says, because they have to navigate the regional variation in GP appraisal systems originally set up by PCTs.

'One responsible officer may now have to work on what was three or four different PCTs.

'The secondary care doctors haven't had that radical change.

They have remained within their trust and the systems in place have continued, whereas in general practice, PCTs have merged to form area teams.'

Standardisation

Professor Sparrow says the rationalisation of 152 PCTs into 27 local area teams now made it possible for a standard appraisal system to be developed across the country.

But he admits that the reforms, and NHS England's drive to standardise procedures, had led to problems in recent months.

NHS England ruled that locums would no longer be paid for undergoing appraisal, and that GP appraisers should receive a £500 fee per appraisal - a lower rate than some were already receiving.

This is BMA territory, says Professor Sparrow, but he backs the association in lobbying for a higher appraiser's fee: 'It's not a lot for the work that is being done. We are looking in total at about six hours of work.'

GP appraisals

Professor Sparrow is adamant that GPs should be appraised by GPs. It is 'completely inappropriate' for NHS managers to be appraising GPs, which is currently being piloted in some areas, he says.

There is also a threat that GPs could have to pay their own remediation bills, after NHS England said funding should be decided locally on a case-by-case basis. GPs should be treated the same as secondary care doctors, says Professor Sparrow.

As the first anniversary of revalidation approaches, he has been busy updating the RCGP guidance. 'We have given various options of quality improvement programmes that doctors can do instead of doing a standard two-cycle audit.

'Responsibility rests with the individual doctor to demonstrate they are fit to practise across the scope of their work,' he says.

The RCGP website includes example portfolios for a wide range of GPs, including those with a special interest or working in academia.

Professor Sparrow jokes that because revalidation 'has always been two years away for the past 10 to 12 years', GPs are well prepared.

'Those doctors who have been having good appraisals over the past few years will have noticed minimal difference when they have come to revalidation,' he says.

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