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At the heart of general practice since 1960

GMC warned to act in patients' interests

The inquiry called for extra scrutiny to evaluate doctors' fitness to practise as well as knowledge tests for all GPs

Current plans for revalidation of doctors are not fit for purpose and do not offer adequate protection for patients, the Shipman Inquiry has concluded.

It recommends a radical overhaul of the GMC's proposals, including a new level of scrutiny to evaluate a doctor's fitness to practise as well as compulsory knowledge tests.

Inquiry chair Dame Janet Smith said her conclusions

only applied to GPs as the

situation for hospital doctors was beyond the scope of her inquiry.

She said existing plans to grant revalidation if a doctor had participated in 'educational' appraisal and had gained a certificate from their employer stating there were no unresolved concerns over clinical governance, were not sufficient.

The GMC's decision to

water down its initial ideas, notably not to subject appraisal evidence to scrutiny, was made 'not for reasons of principle but of expediency', she added.

Dame Janet was also concerned about the lack of transparency around procedures if a doctor 'failed' revalidation, as even a doctor practising under conditions could still be revalidated.

Instead, Dame Janet endorsed a proposal by the joint working group on revalidation that evidence folders be scrutinised by local clinical governance leads, another GP and a lay person ­ a level of scrutiny that had not been incorporated into the GMC's plans.

She recommended that folders' content should be compulsory and specifically laid down, and include clinical governance data, a record of continuing professional development activity, patient satisfaction surveys, a video of consultations and a successful completion of a knowledge test.

In addition, she said, the period in between revalidation could also be longer than five years for GPs under 50, to ease the burden.

RCGP chair Dr Mayur Lakhani said he welcomed the 'beefed-up' approach to clinical governance but warned knowledge tests were just a 'snapshot'.

Making revalidation tougher

Report conclusion on current proposals

'The arrangements will not provide an evaluation of fitness to practise. It is important the public appreciate this and realise revalidation will not provide the assurance that was hoped for.'

Folders should include

·Clinical governance data

·Record of continuing professional development activity

·Patient satisfaction surveys

·A video of consultations

·Successful completion of knowledge courses

·A new tier of scrutiny to evaluate fitness to practise.

Alternative routes to revalidation

·Automatic revalidation for GPs who gain membership of RCGP through on-the-job assessment and for GP trainers.

·Periods for revalidation longer than five years for doctors under 50.

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