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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