Will revalidation make a difference?

The GMC thinks revalidation will raise standards, but GPs remain concerned. Abi Rimmer reports.

Revalidation will begin in December, more than a decade after the concept was first aired at the GMC.

Although the BMA now officially backs the process, albeit with some caveats, many doctors remain convinced it will increase bureaucracy without improving care.

GMC chairman Professor Peter Rubin has been working on how to introduce revalidation since his appointment in 2009.

He is candid about its likely impact. ‘Will it catch a clever psychopathic murderer? No, that’s what the police do. But will it have a positive impact on the quality of patient care over time? Absolutely.’

Professor Rubin says many doctors think revalidation sprang from investigations into Manchester GP Dr Harold Shipman, convicted in 2000 of killing 15 patients.

In fact, it was first discussed by the GMC in 1999, following the Bristol heart inquiry, which found that children had died because they received substandard heart surgery.

Professor Rubin says the incident highlighted a culture in the medical profession that needed to change: ‘In the late 1990s, not only Bristol, but a number of individual medical scandals involving individual doctors, became very public. It was clear that in all cases other doctors knew there was a problem and did nothing about it. And so there was a sense of not being able to go on like this.’

Plans put on hold

After the Bristol inquiry, the GMC began to develop plans for revalidation. Criticism of the initial blueprint in 2004, from the Shipman inquiry, saw it put on hold. But in 2010 the GMC consulted on a revised model and piloted it.

A major turning point came in September this year when the BMA agreed to drop its longstanding opposition to the scheme after the NHS Commissioning Board offered to fund remediation for GPs in England. In the same month, the GMC announced it was ready for revalidation to go ahead.

According to the GMC, UK doctors will be the first in the world to face this kind of assessment. All doctors who hold a licence to practise will be revalidated once every five years. Revalidation will build on GPs’ existing annual appraisals.

Appraisal varies

The RCGP has drawn up proposed criteria and standards for the revalidation of GPs on behalf of the GMC.

However, both the RCGP and GPC remain concerned about aspects of the scheme. Both have warned that systems of appraisal vary in different parts of the UK.

RCGP revalidation lead Professor Nigel Sparrow says: ‘That’s not fair for GPs, nor is it fair for the public.’

The nature of annual appraisal could also change as it becomes part of revalidation, the RCGP fears.

‘We want to make sure appraisal remains supportive and developmental,’ Professor Sparrow says.

How locums will cope with the demands of revalidation has been a major cause for concern.
GPC negotiator and revalidation lead Dr Dean Marshall says: ‘You will need two significant event analyses in five years and for some locums, this will be extremely difficult.’

The GPC has repeatedly said it will be difficult for all GPs to gather multisource feedback from enough patients and colleagues who have an insight into their practice. GPC chairman Dr Laurence Buckman has described the process as ‘a massive paper-chasing exercise’.

Fears remain that older GPs may retire early rather than submit to the paperwork involved in revalidation.

Professor Rubin recognises that some doctors are unhappy. But he says: ‘What we think is that over time the introduction of revalidation will make good doctors even better.

‘We think it will do that by ensuring that every doctor has a chance to reflect on their practice, and that every doctor gets feedback on their strengths and weaknesses. Every doctor will be enabled through appraisal to identify for themselves and with their appraiser what they think they need to improve their skills and stay up to date.’

Feedback needed

In addition to an annual appraisal, GPs must provide information, ­including feedback from patients and colleagues.

Whether or not a GP is revalidated and retains their licence to practise is up to the GMC. Responsible officers (ROs), usually primary care organisations’ medical directors, will assess GPs at a local level and make recommendations to the GMC on whether GPs should be revalidated.

Professor Rubin says GPs should start preparing now. ‘If they’re not already, GPs should get themselves linked into an appraisal process. They should start recording the CPD they already do.

‘I strongly recommend using a CPD folder to keep up to date as they go along, and they should start thinking about how they do multisource feedback.’

So will revalidation improve and support GPs, or shackle them with pointless bureaucracy? The answer may lie somewhere in the middle, but the profession’s leaders will be watching closely.

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