Is revalidation delay good news?

With pilots being extended into 2012, Prisca Middlemiss looks at what the halt will mean for GP revalidation.

Professor Pringle: 'The year's delay in introducing revalidation will give the NHS a chance to prepare itself' (Photograph: JH Lancy)
Professor Pringle: 'The year's delay in introducing revalidation will give the NHS a chance to prepare itself' (Photograph: JH Lancy)

To judge by the comments on RCGP chairman Professor Steve Field's 'The Point of Kairos' blog, many GPs are hoping that health secretary Andrew Lansley's decision to apply the brakes on revalidation spells the beginning of the end.

GP Dr Janaka Pieris says the current proposals are 'unworkable, cumbersome, and time-consuming'.

A GP trainer and college member says it is clear that revalidation 'has lost its way, fundamentally because it was never clear what it was for in the first place '.

GPs wonder whether the delay could mean that revalidation will not now go ahead.

But Mr Lansley's letter to GMC chairman Professor Peter Rubin, in which he announced the delay, makes it clear that 'revalidation is something that the public expect their doctors to undertake'.

Delay welcomed
The BMA, GMC and RCGP are unanimous that revalidation will go ahead. All three organisations have 'welcomed' the delay of at least a year imposed by Mr Lansley, not as a shot into the long grass, but as a way of getting things right from the start.

The RCGP's revalidation lead, Professor Mike Pringle, says: 'The year's delay in introducing revalidation will give the NHS a chance to prepare itself properly. In particular, responsible officers need to be appointed and trained.'

Professor Pringle believes the extra year will also be useful to sort out the required resources, particularly for getting doctors who fail back up to scratch and are deemed to need remediation.

Professor Rubin called the delay a 'positive move'.

Even the BMA is at pains to explain that, when chairman Dr Hamish Meldrum says the organisation 'welcome(s) the decision to extend the period of piloting for a further year (...) before a final decision is taken as to the timing and nature of any roll-out of revalidation', it does not wish to imply that revalidation might not be rolled out.

Dr David Geddes, primary care medical director for NHS North Yorkshire and York, which is running one of the primary care pilots, agrees the delay is likely to strengthen revalidation plans.

With the earliest of the pilot's 123 appraisals not due until September, the extra year makes the pilot 'much more valid', he says.

This pilot, part of the Yorkshire and Humberside path-finder initiative, is looking particularly at the support that non-principal GPs will need.

The pilot got off to a late start as a result of 'national delays in co-ordination by the DoH', according to Dr Geddes.

However, the extra year will, he believes, allow GPs in the pilot to give better answers to questions on how well that support worked and whether it was too onerous for the PCT.

Dr Geedes says that there is a lot of local enthusiasm for the pilots. He says that, rather than feeling pressured into taking part, GPs in the pilots wanted to be able to influence the national programme.

Slippage has, however, dogged other parts of the revalidation project.

Responsible officer regulations, due to be laid in April, are still unlaid. But the DoH still expects the responsible officers to be in post from October.

Other colleges and costs
General practice seems to be further advanced in its readiness for revalidation than other parts of the profession and GPs risked going first into what Professor Pringle termed 'the firing line'.

The extra time will allow laggardly colleges to catch up with the RCGP in getting their specialist standards ready.

Behind this latest development, Dr Nigel Watson, Wessex LMCs chief executive, says there were two schools of thought on revalidation roll-out.

Until last week the 'evolutionary' approach, favoured by the RCGP held sway. Revalidation would 'evolve for ever', Professor Pringle said recently.

The approach backed by the BMA is closer to a 'big bang', with pilots finished and evaluated before roll-out starts.

'I suspect Mr Lansley's been persuaded (by the BMA argument),' Dr Watson says.And why? 'Revalidation is going to cost money and they want to make sure they have got it right before they spend money on it,' Dr Watson says. How much money remains anyone's guess.

It will be difficult to extrapolate overall costs from the cost of the pilot. Funding is for running the pilot, and does not pay for organisational change.

But the budgeted cost per appraisal in the Yorkshire and Humber pilot is anything from £1,393 to £1,858. With more than 140,000 doctors now working in the NHS, that would be an annual bill of more than £260 million.

Strip out the one-off costs of appraiser and appraisee training and the bill tumbles. But then the structural costs in the PCT of governance supporting appraisal need to be added in. Getting at costings is 'a bit of a nightmare', Dr Geddes admits.

Looking for answers
Whatever the costs, who pays the bill is another question for the pilots. Professor Field has said it is the BMA's job to secure the resources for revalidation, especially remediation.

Mr Lansley is looking to the pilots to answer more than this: he wants 'strong evidence on what works' and 'a clearer understanding of the costs, benefits and practicalities'.

Significantly, he also wants 'full engagement with the profession (...) before a decision to move to full implementation.'

The concern is that outside the pilots, no such engagement exists. For Exeter GP Dr Adrian Midgley, that disengagement is profound. He wonders how revalidation can go ahead when appraisal has not been properly assessed. 'How do you turn round distrust?' he asks.

Lansley's letter
Health secretary Andrew Lansley's letter calls for:
  • Strong evidence on what works.
  • Clearer understanding of the costs, benefits and practicalities.
  • Full engagement with the profession.
  • Robust and achievable benefits.
  • Affordable costs.

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