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
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 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 Collegesthe
three key bodies with responsibility for revalidation.
14. These proposals for revalidation had three
- 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 recertificationthere
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.
16. The consultation, from March to June 2010,
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.
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
- It should be based on a continuing evaluation
of doctors' performance in the workplace.
- There will be a network of responsible officersall
of them senior licensed doctorswho 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.
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".
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.
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".
"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
Trust, Assurance and Safety: The regulation of health care
professionals in the 21st century, Department of
Health, Cm 7013, 21 July 2007 Back
Revalidation: the way ahead, Response to our revalidation consultation,
GMC, 18 October 2010, para 45 Back
Ev 36 Back
Revalidation: the way ahead, Response to our revalidation
consultation, GMC, 18 October 2010, pages 12-21 Back
ibid, page 6 Back
Ev 34 Back
Ev w20 [Picker Institute] Back