Revalidation of Doctors - Health Committee Contents


Written evidence from the British Cardiovascular Society (REV 10)

SUMMARY

  • The British Cardiovascular Society supports the concept of revalidation as a "streamlined, straightforward and proportionate process".
  • We believe that there is a danger that the process as currently outlined could result in expenditure of considerable unnecessary effort by individual doctors.
  • The BCS has developed a simple template for revalidation of cardiologists.
  • National clinical audits provide a potential mechanism for the development of risk stratified and benchmarked clinical outcome data that could be used to support revalidation and more generally to drive quality improvement.
  • Funding of some important national clinical audits is at risk.
  • The BCS believes that key national clinical audits should be centrally funded.
  • Professional societies have a key role to play in the development of risk stratified outcome models from national audit data and need academic and financial support to do so.
  • The cost of supporting national audits and development of outcome models will be a small fraction of commissioning expenditure for any specialty.
  • For specialties where national audit data is not readily available, accreditation of services against nationally agreed standards could provide an alternative means of providing supporting information on objective assessment of performance for individual doctors.
  • Professional societies should have a role in assisting Responsible Officers in evaluating doctors who are at risk of failing to achieve revalidation.

1.0  BACKGROUND

The British Cardiovascular Society (BCS) is the Professional Society representing all those working within cardiovascular health, science and disease management. Its members who are cardiologists and cardiovascular physicians support the concept of revalidation as a "streamlined, straightforward and proportionate" process. A key aim of the Society is to improve the quality of cardiac services within the UK and we see revalidation as an important component of this process. The Society and its affiliated subspecialty groups have a strong track record of national data collection through the Central Cardiac Audit Database (CCAD) and we believe that so far as is possible supporting evidence for revalidation should be derived from validated national audit data. 

2.0  EVIDENCE

2.1  There is a widespread perception that current proposals for revalidation are too complicated and could result in expenditure of considerable extra time and effort by individual practitioners. This has been highlighted in the responses to the GMC consultation. We agree with this concern and view it as a strong argument for the use of routinely collected national audit datasets where these are available.

2.2  The BCS has developed a template for revalidation of cardiologists based on the three domains of knowledge, skills and professionalism:
http://www.bcs.com/pages/page_box_contents.asp?navcatID=34&PageID=523

These proposals were widely supported by the membership. It is likely that our proposals will require some modification as the process of revalidation matures but we believe that the underlying principles are sound.

2.3  Central to the skills based domain is a hierarchy of supporting evidence such that provision of appropriate risk stratified outcomes benchmarked against national audit data and demonstrating continuing competence removes the requirement for any additional locally collected data.

2.4  There are currently seven national clinical audits (NCA) of cardiac topics with varying degrees of data completeness. Some such as the database on cardiovascular interventions of the British Cardiovascular Intervention Society and the MINAP database have extremely high rates of data submission. These were not initially set up to provide supporting evidence for revalidation but provide a rich resource of data that can be routinely collected at low cost.

2.5  The White Paper "Liberating the NHS" states that existing NCAs should be expanded to a wider range of conditions and to increase their validity, collection and use. It also indicates that NCAs should produce clinical outcome data as well as process data. Many existing NCAs could in principle be adapted to serve the purposes of revalidation by providing risk stratified outcome data. Since in many cases the mechanisms to collect such data already exist little additional local infrastructure would be required to make these audits universal. This would be a highly cost efficient way to provide high quality supporting professional information.

2.6.  Funding of NCAs is currently haphazard. Identification of a number of mandatory core NCAs with secured central funding is essential for the agenda outlined in "Liberating the NHS" and would greatly assist the development of revalidation.

2.7  The active engagement of Professional Societies such as the BCS is key to the success of both revalidation and more generally the provision of meaningful outcome data. Professional Societies have a role in defining datasets and appropriate outcome measures. Societies will need academic and statistical input to build and apply risk models against which individual performance can be benchmarked and will need to be supported financially to do this. However the cost of such analysis will be only a small fraction of the overall commissioning expenditure for a specialty and cheaper than the alternative of multiple duplicative processes at local level. There is an expanding evidence base that high quality care is cost effective care.

2.8  There is a public expectation that doctors demonstrate their continuing competence. The BCS supports the publication of appropriately risk stratified benchmarked individual outcome data where this is applicable. This is only possible with full data collection, sophisticated modelling and agreement on what constitutes an outlier.

2.9  Some medical specialities do not lend themselves so easily to provision of robust outcome data and other measures need to be used. In cardiology this includes cardiac imaging. The imaging groups affiliated to the BCS have developed departmental quality assessment and improvement processes, otherwise referred to as accreditation. It is our view that a cardiologist practicing in an imaging department that has met nationally agreed standards including systematic quality control should meet the requirements under the skills domain (or objective assessment of performance) without the need to provide additional supporting evidence in this domain. Since these processes are standardised they remove the requirement for duplicative local efforts and will be cost effective. There are many other areas where appropriate use of standardised accreditation or peer review processes could be used to provide supporting information in this way.

2.10  The BCS believes that the structures of revalidation should be as simple as possible. Some general information, such as description of practice and statements on health and probity are mandatory for all doctors. In our view confirmation of ongoing competence in the skills domain as described above accompanied by evidence of completion of CPD against the full range of clinical activity (knowledge domain) and satisfactory completion of peer and patient feedback (Professionalism) will in the great majority of instances provide all the additional information required for revalidation.

2.11  The GMC has not yet fully defined the process for handling the situation where a Responsible Officer has concerns about an individual doctor's fitness for revalidation. The BCS believes that Professional Societies should have a role in supporting the Responsible Officer by providing expert advice and evaluation where required.

November 2010


 
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