Revalidation 'must benefit all doctors' to justify £1bn cost

The £1bn cost of revalidation over its first decade will be unjustifiable unless it is treated as a tool to help good doctors improve rather than one to detect poor practice, GP leaders say.

Dr Jane Lothian: estimating economic value of revalidation is 'nebulous' (photo: Pete Hill)

DH analysis of the costs and benefits of revalidation has revealed that it will cost £97m a year for 10 years, starting in 2013, but says it will prevent fewer than one in 133 cases in which poor practice results in death, or severe or moderate harm to a patient. It says the benefits of revalidation are 'difficult to predict'.

The DH report attempts to build the cost-effectiveness case for revalidation by estimating the overall gain it will generate for NHS patients in terms of quality added-life years (QALYs).

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

Each of these doctors will 'provide a QALY gain of 0.001 to 100 patients', the report says. It adds that revalidation could generate a net benefit to the NHS of £50m to £100m a year from 2017.

RCGP revalidation lead Professor Nigel Sparrow said that if revalidation was considered as a screening programme to pick up poor performance, its costs might not be justifiable. 'It has to mean something for doctors going through it who have no problems about performance. That is dependent on effective appraisal that encourages reflection and development,' he said.

The impact of revalidation on GP performance may be limited, he suggested. 'In 2012, fewer than 10% of GPs did not have an annual appraisal. Those doctors who have had a good appraisal will find very little difference when we come to revalidation.' There was little evidence that doctors who had not undergone appraisal were better or worse, he added.

Northumberland LMC secretary Dr Jane Lothian said estimating the economic value of revalidation was 'very nebulous'. She added: 'I am a huge fan of appraisal, but I can't see what revalidation adds to it.'

Dr Richard Fieldhouse, chairman of the National Association of Sessional GPs, said: 'The benefits of revalidation are far too tenuous for it to be an objective test like an MOT. But, overall, it's just the right thing to do.'

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