When will revalidation start?
The GMC’s latest implementation date for revalidation is late 2012, although it is clear that this will not be a big bang. Instead it is expected that it will take between two and three years to roll out the scheme gradually across the UK.
Revalidation will be introduced in areas that are most prepared, rather than filter from ‘south to the north’. While the GMC is reluctant to say which areas are likely to be the trailblazers for revalidation, it did say that compared with England, the Celtic countries have made ‘very good progress’.
RCGP revalidation lead Professor Mike Pringle says this could mean that in the initial year of implementation there will be a ‘much higher percentage uptake’ in Wales and Scotland, with some areas in England needing extra time to ‘get up to speed’ with revalidation.
What are the current plans for revalidation?
All licensed doctors will be required to link locally to a responsible officer (RO), who will make a recommendation to the GMC every five years about whether a doctor should be revalidated.
The RO will base their recommendation on the output of five annual appraisals undertaken by a doctor. These appraisals are likely to be more comprehensive than the current appraisals.
All doctors, regardless of their speciality, will have to provide the same supporting information for their appraisals and demonstrate that they meet the principles and values set out in the GMC’s Good Medical Practice. To do this, doctors must provide six types of supporting information: evidence of continuing professional development (CPD), quality improvement activity, 10 significant events, a review of complaints and compliments and one patient and colleague survey. Doctors will have to bring this information to each annual appraisal.
Doctors can demonstrate their CPD by collecting ‘learning credits’. Every GP will need to collect at least 50 credits per year, amounting to 250 over the five-year revalidation cycle. One learning credit is earned per hour of education, but if a GP demonstrates the impact from that learning then each hour will be worth two learning credits.
Are the plans likely to change?
Revalidation piloting is still ongoing, after health secretary Andrew Lansley extended testing until next year. While it is expected that the pilots will not fundamentally change revalidation, they could result in fine-tuning of the process.
GMC chairman Professor Peter Rubin says the pilots could see updates made to the toolkit that supports revalidation as well as changes to the amount of supporting evidence doctors are required to submit.
He adds that revalidation is also likely to continue to evolve even after implementation, although he said that there is no intention to make the plans more complex over time.
‘Revalidation has got to be doable for upwards of 200,000 doctors at the frontline. So that has to be a requirement that we keep in focus at all times,’ he explains.
How long will GPs take to complete revalidation?
A recent independent review of the revalidation support team’s pathfinder pilots found that GPs took an average of 18 hours to complete the strengthened appraisal process, compared with 12 hours for standard annual appraisal process. But the GMC says it is unlikely it will take this long in the future as the appraisal system used in the pilots has since been simplified and the toolkit updated. The GMC says once revalidation is up and running and becomes part of a doctor’s ‘working life’ the time taken to complete appraisal will be reduced.
Professor Rubin says that the time taken to complete appraisal will depend on the extent to which individual doctors record appraisal evidence as it happens.
What will happen if there are concerns around a doctor’s fitness-to-practise?
If a doctor is not revalidated they will have to go through a period of remediation. It is not yet known how many doctors will not be revalidated, although Professor Pringle believes that 5% of doctors would be ‘way beyond my expectations’. He says the ‘vast majority’ of GPs are ‘very good and fit to practise’, and where they are not up to standard this is usually known already.
Professor Pringle says he hopes there will be a firmer idea of how many doctors will require support before revalidation is implemented. He says ROs, which are largely in place already across the UK, must play a key role in scoping out doctors that might need extra support before revalidation begins.
The issue of who should pay for remediation has always been contentious and 17 months before implementation it still is yet to be resolved.
Professor Pringle believes this is a ‘major issue’ and the RCGP is working closely with the GPC to ‘get the debate going and solved’. The RCGP has previously demanded that the DoH should allocate ‘specific additional funds’ to pay for remediation, while the GPC has been clear that individual GPs should not foot the bill.
Will the NHS reforms in England impact on revalidation?
The GMC says it is very clear that the reforms in England will not impact on the implementation date for revalidation. But it admits that it does have concerns around how revalidation in primary care will be affected by the reorganisation.
The current RO legislation houses ROs within PCTs, which are set to be scrapped in 2013, so there remains uncertainty about where ROs will sit in the future.
The GMC will not specify where ROs should be placed but it did say that ROs must have the same levers ‘to make things happen’ as PCTs currently have.
Professor Pringle says the situation on the ground is that ROs are now sitting within PCT clusters. He believes this arrangement should continue, because housing ROs within outposts of NHS Commissioning Board would make them too remote from clinical commissioning groups.