Revalidation of Doctors - Health Committee Contents

Written evidence from the Academy of Medical Sciences (REV 30)

The Academy of Medical Sciences welcomes the opportunity to respond to the Health Select Committee's inquiry on revalidation. In September 2009 we published a position paper on revalidation, and in addition to responding to specific consultations on revalidation, we have engaged closely with the Department of Health, General Medical Council (GMC) and the Academy of Medical Royal Colleges, as well as a range of medical constituencies across the university, industry and healthcare sectors.

The UK benefits from a first-class medical workforce, with clinicians undertaking diverse roles across a range of settings that contribute to the development and delivery of clinical service. It is important that any new reforms serve to protect and further promote the UK's ability to achieve excellence and do not bring unintended consequences.

The proposed revalidation proposals are a culmination of work undertaken by a number of organisations. The Academy views this an opportune time to carefully review the objectives of revalidation and ensure that the proposed processes and supporting documents are proportionate, workable for front line clinical service, and meet public expectation in a cost effective manner. We therefore welcome the GMC's response to their consultation "Revalidation: the way ahead" published on 18 October 2010.

It is essential that sufficient time is allocated to reviewing and refining the proposed revalidation processes prior to implementation and therefore we welcome the Secretary of State's decision to extend the current pilots. We support a careful, incremental approach; the pilots should not just focus on clinicians in mainstream NHS posts but include those working in other settings. The pilots must be robustly evaluated and the findings shared with the medical community, prior to full implementation of revalidation.

The Academy's position paper, sets out a number of principles of revalidation, however we would like to emphasise the following:


The Academy endorses the GMC's principle that revalidation should focus on instilling robust local governance across all areas of medical practice. There are numerous examples of localities with excellent governance; extending good practice will reap rewards in strengthening medical workforce management and providing world-class healthcare. A simple, flexible system that strengthens and empowers local governance with national support from the GMC is highly favourable.


The Academy strongly urges the GMC to adopt a simple, pragmatic and cost-effective approach to revalidation. A streamlined process is essential to avoid both unnecessary financial and opportunity costs.


As set out in our response to the Academy of Medical Royal Colleges' consultation on specialist standard frameworks, it is imperative that revalidation focuses on the competency of a clinician to deliver their defined and agreed job plan. We have reviewed the Specialty and General Practice Frameworks and whilst the proposed standards and attributes for each assessment domain are uncontroversial, we strongly question the effectiveness of introducing so many criteria, and the requirement for collecting vast amounts of detailed supporting information. Clarity is needed on how some of the information will help to assess whether an individual doctor is safe and qualified to undertake specialist practice. Care must be taken to ensure that perceived quality is not confused with competence.

The frameworks require evidence of participation in a wide range of clinical activities. This approach could disadvantage individuals who do not undertake full-time clinical service, including, but not limited to, those who undertake other roles, for example: clinical academics and individuals working in the pharmaceutical industry and public administration. Focusing upon a smaller number of core domains, each allowing a range of supporting evidence would help these individuals to demonstrate their commitment.

It would be timely to consider alternative models of how the current proposals might be incorporated into existing local assessment mechanisms in a manageable way that brings real value to both the doctor and their area of practice.


The Government's decision to protect investment in health and medical research in the recent spending review means that the UK can continue to translate extraordinary advances in medical science into benefits for patients and society. To support this translational science agenda, it is vital that the contribution of clinicians whose work involves a significant component, or a preponderance, of research, teaching and other academic work is greatly valued. University Medical Schools and their NHS partners have well-established mechanisms for jointly agreeing and appraising the clinical service and research contribution made by clinical academic staff, and it's important that these relationships are not compromised by the proposals for revalidation. Careful consideration must be given to clinicians who are currently working outside the NHS or established medical centres; individuals working in other settings must be revalidated equitably.

In developing appropriate mechanisms to revalidate clinical academics, it is imperative that appraisals adhere to the Follett principles. It is also essential to define the boundaries of revalidation; there must be recognition that many of the "non-clinical" activities undertaken by a clinician might not be relevant to their professional status. Revalidation should only consider those aspects of a clinician's activities for which it is a requirement to be a doctor. Other activities should only be relevant if they raise concerns about honesty and integrity, for example, research fraud.


The GMC must provide national oversight of the revalidation process in its entirety. The Royal Colleges and Faculties provide an essential national role in maintaining the standards for the knowledge base within specialties, by setting the training curriculum etc. The Colleges and Faculties have an important advisory role, but involving them directly in the evaluation and revalidation of individual doctors would be unwieldy and almost certainly inappropriate. However, we support the proposal for Colleges and Faculties providing appraisal and Responsible Officer facilities to specialists who work outside of managed healthcare environments.

November 2010

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