Revalidation of Doctors - Health Committee Contents

Written evidence from the British Society for Rheumatology (REV 24)


  • BSR is a medical specialty society promoting excellence in the treatment of people with arthritis and musculoskeletal conditions, and supports those delivering it. BSR has a 25 year history of promoting high quality standards of care, and providing education, training and support to those working in rheumatology. With more than 1,500 members including rheumatologists, scientists, trainees, allied health professionals and others from the UK and overseas, BSR also has close links with a number of patient groups, including Arthritis Care, National Rheumatoid Arthritis Society (NRAS) and Arthritis and Musculoskeletal Alliance (ARMA).
  • BSR generally support the suggested mechanisms and approaches of revalidation put forward by the General Medical Council (GMC).
  • A substantial formative element must be included at appraisal. Constructive the interaction between appraiser and appraisee is key to the success of the process.
  • High quality rheumatology practice includes working with a multi-disciplinary team to benefit patients. Therefore, gaining outcome measures to reflect only an individual rheumatologist is very difficult.
  • Team outcomes which are directly relevant to patient care are important to consider in relation to appraisal and revalidation for rheumatologists.
  • Quality assurance of the appraisal process is key to the success of revalidation.
  • Further detailed assessment is needed to identify appraisers.
  • More than one appraiser should be involved in the five year cycle of appraisals.


1.  BSR welcomes the opportunity to comment to the Health Select Committee on the current proposals for revalidation of doctors. The comments are relevant particularly in relation to consultant rheumatologists.

2.  In general BSR supports the increasing emphasis that the GMC is placing on developing practical, workable and relevant mechanisms for an individual doctor to demonstrate that they are practising to the appropriate standard.

3.  The workload involved in revalidation must be proportionate to the benefit of the revalidation process. In this context it is appropriate to focus on development of workplace based assessments.

4.  BSR also supports the approach now being proposed to combine the two previous processes of relicensure and recertification, as many of the aspects of supporting information overlap between them.

5.  BSR supports and has had input into the response to the GMC consultation provided by the Royal College of Physicians (RCP). In particular BSR would endorse the important potential role of revalidation in raising the standards of care provided by all physicians and its role in strengthening professionalism. In this context its value for the great majority of physicians who are already practising to a high standard must include a substantial formative element at appraisal and the success of the process depends to a large extent on constructive interaction between appraiser and appraisee.

6.  Rheumatology is a sub-specialty of medicine and BSR, as a Specialist Society, has worked closely with the RCP to develop the proposed framework of supporting information, as detailed in annex 2 of the consultation. BSR would like to emphasise that for our specialty, team working is of paramount importance and over recent years have promoted the value of working with other health professionals particularly specialist nurses, physiotherapists and occupational therapists for the benefit of our patients who have complex multi-system physical diseases and management plans. Indeed this multi-disciplinary approach to patient management in now endorsed in national guidelines such as those produced for Rheumatoid Arthritis by NICE. In this context, development of outcome measures which are a reflection of an individual rheumatologist's quality of practice are very difficult or impossible to identify.

7.  BSR has developed as a specialty a Peer Review scheme which assesses all aspects of care from the rheumatology team and multi-centre audits both regionally and nationally which also look at benchmarking aspects of the quality of team working. BSR feels that measures of team outcomes which are directly relevant to patient care are important to consider in relation to appraisal and revalidation for rheumatologists. At appraisal the individual rheumatologist can indicate how he/she has been involved personally in facilitating an area of excellence or if necessary what he/she is doing to address issues where overall practice needed to be improved. Clearly issues more related to an individual's practice might be identified by other mechanisms such as peer or patient multisource feedback and through other information available to the Medical Director/ Responsible Officer.

8.  BSR supports the development of strengthened appraisal as the cornerstone of revalidation. Quality assurance of the appraisal process is therefore key to the success of revalidation.

9.  BSR has concerns regarding potential conflicts of interest of appraisers and Responsible Officers. Doctors who are also local Trust Managers have a remit to ensure performance management of individual consultants and this may potentially conflict with the quality of care issues being addressed through appraisal. The recommendations on who the appraisers should be require further detailed assessment. For this reason it is important that more than one appraiser is employed in an individual doctor's five year cycle of annual appraisals for revalidation.

10.  BSR also has concerns regarding the relationship between the Specialist Societies, Royal Colleges and Responsible Officers. The role of BSR in conjunction with the RCP should be in the development of appropriate standards for assessment of rheumatologists, and not to become involved in discussion of individual cases.

November 2010

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