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
- 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
- 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
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
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