Viewpoint: Revalidation publicity might undermine trust in GPs, Kings Fund and Ipsos MORI warn

If revalidation is to secure public confidence it will need to demonstrate that it is founded on a robust process of appraisal and feedback, write Anna Dixon and Dan Wellings.

Anna Dixon: 'The public were keen that the priority for revalidation should not be catching out bad doctors.'

After many years in development, revalidation of doctors finally looks set to begin in December.  But the public are surprised to find out that doctors are not already regularly checked to make sure they are up to date and fit to practise.

The King’s Fund and Ipsos MORI undertook research with the public, commissioned by the NHS Revalidation Support Team, to get their views on revalidation.  The report, Public and Patient involvement in Revalidation, was published last month.  We spoke to around 200 members of the public in a series of deliberative events held in four cities.

Public trust in GPs

The public have very high levels of trust and confidence in doctors.  Ipsos MORI’s veracity index has consistently shown that the public trust doctors to tell the truth more than any other profession.  Whilst some professions have seen their levels of trust decrease over the last 10 years, doctors have not.  In some ways, this overwhelming trust for doctors poses challenges.  If doctors are so highly regarded why is a system of compulsory oversight necessary?  Yet when members of the public found out that such a system was not in place, this in fact reduced their levels of confidence.  There is a risk that by highlighting the absence of an effective appraisal system, publicity about revalidation might actually undermine public trust and confidence rather than increase it.

Nevertheless, the public were keen to see revalidation introduced in a timely fashion and wanted to be assured that revalidation is in place for all doctors.  The public understood that the processes needed to apply equally to doctors in all settings, whether general practice, hospital specialists or in the private sector.  Broadly, people felt that it would most benefit non-hospital doctors working in environments that had less structure or support.

Members of the public grasped the concept and need for revalidation, recognising equivalents in other professions.  It is important that the parallels are made, when trying to explain revalidation to the public, between what is being put in place for doctors and the processes for keeping up to date that exist for other types of professions.  The public were keen that the priority for revalidation should not be catching out bad doctors, but rather saw it primarily as a positive process of good management and professional development underpinned by checks and balances.

Patient feedback approved

The inclusion of patient feedback within revalidation was met with particular approval.  The public felt that they were well placed to comment on the communication skills and other nontechnical aspects of care.  However, they were concerned that any comments they made should not get back to the doctor, out of fear that this would affect their relationship with the doctor.

Members of the public also sought reassurance that the people overseeing and assessing a doctor’s practice would be independent.  Although they recognised that medical expertise would be needed to judge the technical skills and knowledge needed, they were concerned that colleagues within the same organisation might not be sufficiently objective.

Despite the generally positive reaction some concerns were raised, mainly centred on ensuring that any processes that are put in place neither detract from patient care, nor prove costly. ‘Regulation’ had negative undertones for some and was associated with the extra burden it could place on frontline workers.  Revalidation should be more positively described, perhaps as supporting ‘quality improvement’ rather than as part of the system of regulation.

Time with patients

Most importantly, the public grasped the many complexities and contradictions inherent within revalidation with relative ease.  They appreciated that doctors need time for revalidation but did not want this to take away from time with patients, and they understood that revalidation focuses on the individual, despite the fact that doctors’ performance is influenced by their team and work environment.

The public did in the end agree that revalidation would improve public confidence by supporting doctors to improve the quality of their care.  As suggested above whilst the primary purpose of revalidation was not seen to be identifying poor performers this was seen as an important additional function of it.  They were clear that there should be consequences for doctors who failed to meet standards or keep up to date.  Interestingly, they also wanted revalidation to generate information that could assist them in making more informed choices about doctors.  If revalidation is to secure public confidence it will need to demonstrate that it is founded on a robust process of appraisal and feedback.  The surprise for most was that such as system did not already exist.  This poses an initial communications challenge but the response to the overall proposition from the public is certainly encouraging.

By Anna Dixon, director of policy at The King’s Fund, and Dan Wellings head of public health research at Ipsos MORI.

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