Revalidation to cost £1bn over a decade but benefits 'hard to predict'

Revalidation will cost almost £1bn over a decade and will prevent fewer than one in 133 cases in which poor practice results in death, or severe or moderate harm to a patient, a DH analysis suggests.

DH: analysis says benefits of revalidation hard to quantify

A cost and benefit analysis shows that, in England alone, introducing revalidation will cost the NHS £97m a year over a ten-year period starting from 2013.

However, it adds that once the system beds in, from 2017 it should deliver a 'net benefit of around £50m to £100m a year'.

The expected benefits are listed as:

  • increased public trust and confidence in doctors.
  • improved patient safety and quality of care.
  • reduced costs of support for underperforming doctors.
  • reduced malpractice and litigation costs.
  • better information about care quality.
  • positive cultural change in the medical profession.

The analysis admits that 'the expected benefits of revalidation are considerably more difficult to model' than the costs. 'Even where benefits can be quantified, these are outputs that are experienced over a longer period, which are difficult to predict,' it says.

But the report estimates that revalidation will prevent 0.75% of cases of death, severe harm and moderate harm per year. In 2011/12, the National Patient Safety Agency reported 44,274 cases in this category - suggesting revalidation would prevent just 332 cases.

The report says that 27% of doctors currently do not undergo annual appraisal. It estimates that 5% of this group 'will go into remediation' - meaning they will fall short of the standards required for revalidation and require additional support.

The report assumes that '10% of these doctors would have been suspended for one year without remediation', and that the NHS will save £100,000 for each of these people per year. Based on 185,000 doctors with full registrations in the UK, this would mean a saving of around £25m.

The report also estimates - in terms of quality adjusted life years (QALYs) - the benefits to patients of improved care that would result from revalidation.

It says: 'In light of the large number of patient contact episodes that doctors have, it is reasonable to assume that on average, doctors who make positive changes to their practice as a result of the appraisal and revalidation process will provide an improvement in the level of quality of care for at least 100 patients.'

Revalidation would mean that 20% of the 73% of doctors who already undergo annual appraisal, 40% of those who do not currently undergo annual appraisal, and 80% of doctors who undergo remediation will improve, it estimates.

Each of these doctors will 'provide a QALY gain of 0.001 to 100 patients' the report says. In addition, the report says that revalidation could save the NHS 3% on the cost of litigations.

Health minister Dr Dan Poulter said: 'Better care and increased patient safety - clear advantages of medical revalidation - outweigh the costs associated with it.'

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