Revalidation of Doctors - Health Committee Contents

Written evidence from The Patients Association (REV 25)

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 comparable way.

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."[24]

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 arise.

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 key priority.

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.

November 2010

24   Quality Oversight in England-Findings, Observations, and Recommendations for a New Model, Joint Commission International, 2008, page 11. Back

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