Written evidence from The Patients Association
The Patients Association welcomes the opportunity
to submit its views to this important inquiry.
1. The Patients Association strongly supports
revalidation as a vital mechanism for improving the safety of
patients and ensuring individual accountability for clinical care.
We are very disappointed that plans for the implementation of
revalidation for doctors have been delayed for a further year.
2. We are disappointed with the GMC consultation
response, particularly the lack of detail in responding to our
suggestions to collect patient experience in a systematic and
3. There is substantial evidence that patients
and the public support regular assessment of the competence of
their doctors. Notably the 2005 Department of Health public opinion
research that found:
(a) Almost half assume that regular assessments
already take place, with over one in five thinking they already
happen on an annual basis.
(b) Over 90% agree that it is important that
all doctors' competence is checked every few years.
(c) Nearly half the public think these assessments
should be done on an annual basis
4. A 2008 review of NHS safety and quality by
the Joint Commission International concluded "There is limited
oversight of individual practitioner performance" and "Information
on individual practitioner performance is virtually non-existent."
5. We welcome the emphasis of the current White
Paper to introduce much more measurement of outcomes and patient
experience across the NHS.
6. If individual clinicians were required to
collect evidence of the quality of care their patients receive
this would act as a powerful driver for the system to drive up
standards of care across the NHS and potentially prevent widespread
failings as developed at Stafford.
7. We consider the inclusion of patient evaluation
as part of the revalidation process to be vital to ensuring the
process genuinely ensures the suitability of a doctor to hold
a license is accurately reflected by the recommendations made
by the Responsible Officer.
8. A minimum threshold of patient evaluation
should be set taking into account average patient contact, likely
response rates and the available time for collection. We believe
a timescale of five years is un-ambitious. We would prefer a shorter
time scale for the entire process but recognise the need to balance
the burden on clinician time when developing this process. If
revalidation is to be conducted on a five yearly basis the collection
of patient experience data should be spread across this period
with a mechanism for bringing forward revalidation should concerns
9. Standardisation of at least parts of questionnaires
used to collect patient evaluation data should be introduced.
Whilst we accept that during the introduction of revalidation
understanding and comparing patient evaluation data may be of
limited value, we would expect that over time the standardisation
and benchmarking of patient evaluation results should become incorporated
into the revalidation process. This will only be feasible if there
are standardised elements to the questionnaire and so we would
recommend beginning with this approach to provide the best possible
foundation for developing the use of patient evaluation data.
There are a number of options to consider. Standardisation could
include questions/ratings common to all hospital doctors or GPs
or to doctors from the same speciality for example.
10. There should be standardisation of collection
methods to ensure particular aspects of this process are always
present (e.g. random selection of patients, selection from across
the doctors areas of practice, clear and credible assurances about
the anonymity of the participant).
11. We recognise that collection of patient evaluation
will not apply to all registrants. However, adjustments should
be made and barriers overcome to maintain a focus on patient feedback
as a centrepiece of evaluation, and ensuring that collection methods
are robust and the results comparable. In particular, ensuring
patient evaluation data is included in the revalidation process
for locum doctors is critical to ensuring the safety of patients.
12. We also feel that the development of a robust
framework for evidencing both the knowledge of and outcomes achieved
by healthcare professionals as part of the revalidation process
is also important for the same reasons as highlighted above. As
evidenced by the aforementioned research patients expect this
to be a part of the appraisal of doctors, ranking evidence that
a doctor is keeping up to date with medical developments as their
13. We recognise implementation of this
is more difficult, hence the need for a focus on patient experience
in the short term to prevent further delays to implementation
of the revalidation process.
24 Quality Oversight in England-Findings, Observations,
and Recommendations for a New Model, Joint Commission International,
2008, page 11. Back