Revalidation of Doctors - Health Committee Contents

Written evidence from Lifeblood: The Thrombosis Charity (REV 28)


  • Lifeblood recognises and fully supports the General Medical Council's (GMC) prioritisation of revalidation.
  • Doctors should be able to demonstrate at revalidation adherence to best practice standards of safe and effective care and that their patients are receiving a positive patient experience.
  • Lifeblood recommends that any core revalidation criteria match national priorities for the NHS as well as knowledge on conditions which are recognised as having a significant health and economic impact on the NHS.
  • VTE Prevention, as a national priority has the capacity to save thousands of lives and hundreds of millions of pounds of NHS spending each year, but has low awareness among health professionals.
  • As such, knowledge of and adherence to nationally accepted minimum standards of VTE prevention should form a core criteria of professional revalidation.
  • Lifeblood supports the recommendation of the Academy of Medical Royal Colleges in calling for this inclusion.


1.  Lifeblood: The Thrombosis Charity (Lifeblood) is delighted to submit evidence for the Health Select Committee's Inquiry into the revalidation of doctors.

2.  Lifeblood will respond to the most relevant issues. This submission will focus on the Statement of Intent published in October 2010, as agreed by the General Medical Council, the Chief Medical Officers for England, Northern Ireland and Wales, the Deputy Chief Medical Officer for Scotland and the Medical Director of the NHS in England. This submission will also draw on the GMC response to the revalidation consultation, also published in October 2010.

3.  Lifeblood recognises and fully supports the GMC's prioritisation of revalidation. We fully agree that the revalidation system must support high quality and safe care in the organisations and practice settings where care is delivered.

4.  In confirming the timetables and milestones for NHS employers and other healthcare providers to have the local systems in place to support the revalidation of their doctors, Lifeblood recognises that there is core information that will be required by doctors who will be leading the appraisal. Lifeblood recommends that there are clear criteria to determining this core information.

5.  Lifeblood recommends that any core criteria match national priorities for the NHS as well as knowledge on conditions which are recognised as having a significant health and economic impact on the NHS. An effective appraisal process must include awareness and up-to-date understanding of the medical protocols around such health and prevention priorities.

6.  In developing a streamlined process which reflects these national priorities, Lifeblood supports the role of the Academy of Medical Royal Colleges' Faculties and Members to review their speciality and general practice frameworks. Any separation of information which is "expected" and which is "optional" must mirror national healthcare priorities if it is to be significant, relevant and useful.

7.  It is essential that in developing what "expected" standards look like, the Faculties draw on the expertise of organisations dedicated to the relevant area.

8.  The prevention of venous thromboembolism (VTE) - manifested as deep vein thrombosis (DVT) or pulmonary embolism (PE) - is a condition which the Health Select Committee in 2005 recognised as the greatest avoidable cause of hospital mortality. Although PE are known to be under-diagnosed and often missed, in 2008-09 alone, there were 62,066 recorded cases of DVT and 56,029 recorded PEs (Hansard, 1 November 2010: Column 658W) and in 2008 over 19,000 recorded deaths in England due to PE.

9.  It is recognised by leading clinicians, the Department of Health, and the Academy of Medical Royal Colleges, that significant progress can be made in reducing avoidable deaths and long term morbidity from VTE, through simple and effective risk assessment and prophylaxis in hospital, as two thirds of all cases of VTE occur following hospital admission ("hospital acquired VTE"). The rate of death due to hospital acquired VTE result in it being the number one patient safety issue in hospital care. It is therefore essential that the principles underlying the revalidation of doctors recognise the importance of bestowing professional responsibility on clinicians to ensure their clinical knowledge is intrinsically linked to delivering patient safety, by demonstrating the understanding of these core components to a competent authority.

10.  VTE has historically been classified by the Chief Medical Officer as a Cinderella issue, due in part to low levels of professional awareness about the causes and preventative steps that should be taken to prevent avoidable incidence of VTE in hospital patients.

11.  Lifeblood supports the Academy of Medical Royal Colleges' five point plan to cutting the numbers of deaths from VTE, specifically the commitment by Colleges and Faculties to ensure Fellows and Members participate in regular audit of the percentage of patients risk-assessed for VTE, which in some specialties, "is suitable for becoming a mandatory standard for revalidation".

12.  VTE prevention needs to become an embedded standard of care in the NHS, so that the scale of this preventable condition can be tackled, and clinicians can be adequately protected from the risks of medico legal challenge, which are now prevalent in confirmed diagnoses of hospital acquired VTE, due to the requirement for root cause analysis, to identify where national guidance was not followed.

13.  Education has a part to play by ensuring the next generation of doctors are properly educated at the undergraduate level, by ensuring a consistent level of inclusion in medical school curricula. However, part of the solution for protecting the patients of today rest with qualified doctors.

14.  VTE prevention knowledge is therefore central to enabling doctors to undertake their daily duties in a safe and effective manner. Therefore, adherence to nationally agreed prevention protocols should be demonstrated during professional revalidation.

November 2010

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