Written evidence from Care Quality Commission
1.1 The Care Quality Commission (CQC) welcomes
the opportunity to provide commentary to the Health Select Committee
on the revalidation of doctors. CQC responded to the General Medical
Council (GMC) consultation on revalidation earlier in the year
and would be happy to supply this to the Committee.
1.2 It should also be noted that revalidation
is being considered for other professions and similar issues identified
below will apply. There is currently a consultation on revalidation
of dentists and we are aware that the Nursing and Midwifery Council
is considering options for revalidation of nurses and midwives.
We believe the Health Select Committee should consider the impact
that their recommendations may have on other future revalidation
2.1 CQC is the statutory regulator of health
and adult social care providers in England. All providers must
be registered with us; it is the legal entity (whether this is
an individual, partnership or organisation, such as an acute trust)
that provides the regulated activity to patients that must register,
and once registered we will monitor their compliance on an ongoing
basis. To be registered providers must meet essential standards
of quality and safety. These have been developed by CQC as a result
of legislation set out in the Health and Social Care Act 2008
and CQC's (registration) Regulations 2009.
2.2 We have developed and use a risk-based approach
to monitor compliance and we are able to use a wide range of enforcement
powers to make sure that swift action is taken where services
are failing to meet these requirements. All NHS trusts, adult
social care, independent hospitals and clinics (which fall within
the rules) should now be registered with us. Primary dental care
providers will come into registration from 1 April 2011 and primary
medical care providers from 1 April 2012.
3.1 It is vital that the systems of regulation
for doctors and for healthcare providers must be aligned, while
their unique contribution to protecting public well-being are
recognised and maintained. There are several key issues that need
further development and consideration as revalidation is introduced
to ensure that alignment is as effective as possible.
3.2 CQC and the GMC have a good working relationship.
We recognise that we have a responsibility to work together, and
with other professional regulators, to share information appropriately
in order to safeguard the well-being of the public and minimise
the burden of regulation.
3.3 There will inevitably be some areas of overlap
and issues of mutual interest between the two types of regulation.
Where these overlaps occur the regulators must work together to
share relevant information and articulate the similarities and
differences in order that doctors and/or providers are clear about
both sets of requirements. We recognise that those doctors that
work on their own or in a very small provider and will need support
to understand how they can use information as evidence toward
revalidation as well as ongoing compliance with CQC registration
3.4 Clarity regarding these regulatory systems
is essential to ensure that poor practitioners do not fall through
the regulatory net, that patients are effectively safeguarded
from poor quality care. The public can have confidence in the
quality of care offered both by individual doctors and by organisations
providing care. This will also ensure that the profession is clear
about where regulatory responsibility lies; reducing confusion
and enabling doctors to focus on providing high quality patient
HOW CQC AND
THE GMC WORK
4.1 We have a close working relationship with
the GMC and in May 2010 signed a memorandum of understanding (MoU).
The MoU details how we will work together to share information
in order to safeguard the well-being of the public. In particular
we will share:
- Information about an individual's fitness to
- Concerns about GMC approved practice settings.
- Information that may call into question an organisation's
suitability as a learning environment, and
- Information about the robustness of appraisal
and clinical governance systems.
4.2 The MoU will be supported by a specific information
4.3 The MoU currently recognises the need for
cooperation between the GMC and CQC in developing the system of
revalidation of doctors. There are a number of key issues that
need to be taken into account as revalidation is implemented,
and the MoU will be amended accordingly.
5.1 When the Health Select Committee is considering
the implementation of revalidation we believe it is important
to recognise the different roles of registration and revalidation.
Registration provides assurance that an organisation delivering
services meets essential standards of quality and safety. However,
it does not provide assurance that every individual doctor delivering
those services is clinically and professionally competent to undertake
their specific role. This is the role of professional regulation,
and thus revalidation.
5.2 It is not CQC's role to assess the competence
of individual doctors. However, it may be more likely that concerns
about individual competence will not be addressed in an organisation
where governance arrangements are poor or where staff are not
adequately supported. These organisations may also be at risk
of not implementing appropriate appraisal and revalidation systems
and processes. Our compliance monitoring should identify organisations
where these risks exist. For this reason, information about an
organisation's registration will be of interest to the GMC. For
example, registered providers must meet essential standards about
- staff have the right qualifications, skills and
experience and are fit to do their job;
- staff receive appropriate support, supervision
and training, and
- the quality and safety of services is monitored,
learning is taken on board and improvements are made.
5.3 As revalidation is implemented we will look
at the systems and processes that organisations have in place
to support revalidation in relation to the essential standards
identified above. We will need to work with the GMC and responsible
officers to share information about concerns that may either:
impact on a provider's compliance with essential standards; or
vice verse, that may affect the quality of appraisal and revalidation
5.4 As well as systems to support doctors, and
other staff, there are others ways in which the registration essential
standards and the standards that must be met by individual doctors
for revalidation cover similar issues. For example, in order to
comply with essential standards a registered provider is required
to ensure that care delivered follows evidence based guidelines.
Similarly, appraisers and responsible officers, as part of the
revalidation process, will want to be assured that an individual
doctor's practice is evidence-based.
5.5 Given that there is some overlap between
the expectations of registration and the content of professional
standards it is important that both organisations are able to
clearly articulate the benefits of each system.
5.6 We recognise that doctors that work independently,
or within a very small provider, may feel that the process of
revalidation and registration together will be burdensome. We
are committed to supporting these doctors to use the evidence
they have for both purposes where overlap exists. We also hope
that effective partnership working between ourselves and the GMC
will, where concerns are identified, allow us jointly to take
decisions about the appropriate response.
5.7 We are aware that the Department of Health
is reviewing the scope of registration for some private doctor's
services. We expect that the role of revalidation will be considered
as part of this review. We will work with the Department and the
GMC to ensure that an appropriate and proportionate solution can
6.1 The complementary regulatory systems delivered
by CQC and the GMC will offer patients and the public greater
assurance about both the professional standards of the doctor
and the quality of care of the provider they visit. Patients will,
in future, be cared for by registered providers, where registration
means the organisation is meeting essential standards and safety;
and by revalidated doctors, where revalidation means that the
doctor is competent to undertake their role.
6.2 We hope that the Health Select Committee
is assured that the two regulatory bodies will continue to work
closely to share information appropriately, both to safeguard
patients and reduce burden on providers and doctors, as registration
develops and revalidation is implemented.