Revalidation of Doctors - Health Committee Contents

2   A history of revalidation

9.   "Revalidation" is a broad term used to refer to the policy of proactively ensuring that practitioners who are registered to practise are still safe and competent to do so. This contrasts with the policy of investigating competence only when complaints are made or concerns are raised.

10.  The GMC first proposed a formal process of revalidation in 2000. However, these proposals were eventually diluted to a requirement that all doctors should participate in annual appraisals conducted by their employers, and that employers should issue a statement every five years to confirm the absence of significant concerns.

11.  A report in 2006[5] by the then Chief Medical Officer for England noted that, following qualification, a doctor could go on to have a 30-year career without any further formal assessment of their continued competency. Public opinion research conducted for that report found that almost half of those asked thought that doctors were already subject to regular assessments, with one in five believing that this happened annually.

12.  The then Government issued a White Paper in February 2007[6] which concluded that, because of changes in public and professional opinion, it was no longer sufficient to assume that a professional continued to be up-to-date in their knowledge and fitness to practise throughout their career; this trust now had to be "underpinned by objective assurance". In the White Paper, the Government proposed that all healthcare professionals should be required to complete a process of revalidation. There would be two main components to revalidation: "relicensing", under which all professionals would have to demonstrate that they remained fit to practise; and an additional process of "recertification" for specialist doctors and GPs, who would need to demonstrate that they remained competent in their specialism.

13.  The report of the Chief Medical Officer for England's Working Group was published in July 2008 which set out next steps for implementing revalidation agreed between the GMC, the Department of Health, and the Academy of Medical Royal Colleges—the three key bodies with responsibility for revalidation.

14.  These proposals for revalidation had three elements:

  • to confirm that licensed doctors practise in accordance with the GMC's generic standards (relicensing);
  • for doctors on the specialist register and GP register, to confirm that they meet the standards appropriate for their specialty (recertification); and
  • to identify for further investigation, and remediation, poor practice where local systems are not robust enough to do this or do not exist.

15.  In March 2010 the GMC proposed that rather than having two separate elements— relicensing and recertification—there should be a single system:

We have concluded that revalidation will be simpler, more effective and more efficient if it operates as a single set of processes, rather than ... two separate strands.[7]

16.  The consultation, from March to June 2010, was extensive:

During the course of the consultation we held or participated in around 130 events across the UK. We talked to more than 4,000 doctors, listened to their views and comments and discussed their concerns about revalidation. We also spoke to a range of employer organisations and representatives from patient groups across the four countries. By the time the consultation ended, on 4 June 2010, we had received nearly 1,000 responses.[8]

17.  Following that consultation the GMC's main proposals are as follows:

  • Revalidation should be based on a single set of processes for evaluating doctors' performance in practice.
  • It should be based on a continuing evaluation of doctors' performance in the workplace.
  • There will be a network of responsible officers—all of them senior licensed doctors—who will make recommendations on whether or not doctors will be revalidated.
  • The medical Royal Colleges and Faculties should not be directly involved in the responsible officers' recommendations, but should have a quality assurance and advisory role.
  • Trainees should secure revalidation as a result of successful progress through training.
  • Licensed doctors not currently engaged in medical practice should be able to gain revalidation through a formal examination or assessment.
  • The list of registered medical practitioners should indicate the field of practice on the basis of which a doctor has secured revalidation.[9]

18.  When the GMC's consultation was launched, it was intended that revalidation would be put in place in 2011. However, in June 2010 the new Secretary of State wrote to the Chair of the GMC to say that, having reviewed the current plans, "I do not yet have sufficient confidence that there will be time properly to gather and evaluate evidence on all aspects of revalidation and to amend plans in the light of the current pilots in the NHS. I therefore intend to extend the piloting period for a further year to enable us to develop a clearer understanding of the costs, benefits and practicalities of implementation ...". In its memorandum to us, the GMC says that "we are planning to launch revalidation in late 2012".[10]

19.  Against the background of this long and complex history, the Committee welcomed the description of the background and purpose of revalidation which was provided to it by the GMC in its memorandum to our inquiry:

All doctors who wish to practise medicine in the UK must be both registered and licensed with the GMC. This applies whether they practise full-time, part-time, as a locum, privately or in the NHS, or whether they are employed or self-employed.

Being registered and licensed with the GMC shows that a doctor has the necessary qualifications for medical practice and that he or she is in good standing. However, at present, it is essentially an historical record of qualification. It provides no information about the sort of practitioner a doctor has become or whether they remain competent and fit to practise.

Revalidation aims to change this by updating what it means to be a registered and licensed doctor. Its purpose is to assure patients and the public, employers and other healthcare professionals that licensed doctors remain up to date and practising to the appropriate professional standards. Doctors who are unable to demonstrate this will lose their licence to practise.[11]

20.  Responsibility for registering, licensing and revalidating doctors rests firmly on the shoulders of the GMC. Both the previous government and the Coalition have intervened in ways which have, for good reasons, extended the process. The result, however, has been, as we were told in evidence: "The pace of implementation of revalidation has been too slow. Under current proposals, regions that have not prepared for revalidation may be allowed further, unacceptable delays".[12] Now that "late 2012" has been set as the date of implementation, we look to the GMC to ensure that there are no further delays and that the current target date is achieved.

5   Good Doctors, Safer Patients, Department of Health, 14 July 2006 Back

6   Trust, Assurance and Safety: The regulation of health care professionals in the 21st century, Department of Health, Cm 7013, 21 July 2007 Back

7   Revalidation: the way ahead, Response to our revalidation consultation, GMC, 18 October 2010, para 45 Back

8   Ev 36 Back

9   Revalidation: the way ahead, Response to our revalidation consultation, GMC, 18 October 2010, pages 12-21 Back

10   ibid, page 6 Back

11   Ev 34 Back

12   Ev w20 [Picker Institute] Back

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