Revalidation of Doctors - Health Committee Contents

3  Purpose of revalidation

21.  When it was initially proposed, revalidation appeared to be a tool for uncovering badly performing or potentially dangerous doctors. Revalidation, as now understood, however, is not merely a negative declaration that a doctor has not been found unfit to practise; it is a positive affirmation that a doctor is up to date and practising to appropriate professional standards.

22.  In some of our evidence it has seemed that the requirement to identify doctors who are unfit to practice has been seen as almost an insignificant part of the appraisal process. The Academy of Medical Royal Colleges argued that the summative function of appraisal (is this doctor fit to practise?) should be dealt with very expeditiously, so that the process could then focus on the formative function (how can this doctor's practice be improved?).[13] In its evidence to us on revalidation the Royal College of Psychiatrists said that it

emphasised the relative importance of quality improvement as the main benefit of revalidation. The public already has high confidence in the ability of their clinicians; a revalidation process that drives up standards and promotes excellence and quality throughout the profession will yield significant benefits which are much broader than just confidence in a regulatory process.[14]

23.  Conversely, the BMA, in its response to the GMC consultation, argued that the appraisal infrastructure that was being proposed was disproportionate if the principal aim was to deal with the issue of fitness to practise:

There is little value in spending large amounts of resource perfecting specialist frameworks for relatively little benefit, particularly when the GMC's own current [Fitness To Practise] statistics show that core generic skills (communication, probity, health, insight and keeping up-to-date) are usually what leads to action against the registration of doctors. It would be eminently more cost-effective to target revalidation against the core generic skills of a doctor.[15]

24.  Niall Dickson told us:

Is it possible that revalidation will identify problems earlier? I certainly hope that it will be able to do that. Will it encourage doctors in the middle of the bell curve, where most of us are even if we think we are at one end of it, to be more self-reflective? I think the evidence is, from already good appraisal processes, that that happens. So I think it will affect the doctor in the middle, not in the sense that they are going to face something terrible that has never happened before, but I think it will encourage them to organise their supporting evidence; to make sure that they are doing the right continuing professional development; to have a chance to chat to somebody who is saying, 'Do you think you ought to be able to do this?' or get a bit of patient feedback to which, 'Ah, I hadn't realised that I was doing that and I might be able to correct that.' These are all miles away from referral to the GMC. They are just things that should be happening anyway but they provide that level of assurance which we are not currently able to provide on our register.[16]

25.  Specifically on the issue of whether revalidation would stop "another Shipman", Una Lane of the GMC told us:

I think there is a general view that good local systems and good robust systems, if they produce the right information, and if that information is monitored appropriately, can identify outliers and at least enable a further investigation to take place. Once revalidation is introduced, will that mean that no doctor will ever deliberately or negligently damage a patient again? Absolutely not. We absolutely cannot say that. Do we think it can contribute to lowering the risk? Do we think that it can contribute to helping identify poorly performing doctors at an earlier point in the process? Yes, we think it can.[17]

26.  Although the Committee agrees that the focus of revalidation for most doctors should be a commitment to practice improvement, it believes that the need to identify inadequate and potentially dangerous doctors must not be overlooked or diminished in the general move to use revalidation to eliminate unsatisfactory practice and improve overall performance.

13   Q 67 Back

14   Ev w36 Back

15   Revalidation: The way ahead, BMA response to GMC consultation, 25 May 2010, page 11  Back

16   Q 46 Back

17   Q 27 Back

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Prepared 8 February 2011