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Interview: GMC chair stands firm over revalidation rollout

Professor Peter Rubin, GMC chair, is on a charm offensive, with his mission to convince GPs that introducing revalidation later this year is both workable and acceptable. He talks to our reporter Gareth Iacobucci

‘The two words that you'll be hearing a lot from the GMC are pragmatic and incremental'.

Professor Peter Rubin, GMC chair, is on a charm offensive, with his mission to convince GPs that introducing revalidation later this year is both workable and acceptable.

The policy, which will require doctors to undergo relicensing every five years, seems to have been in the pipeline forever. But finally, after more than a decade of false starts, it is finally set to be rolled from the end of this year, with 20% of doctors due to be processed in 2013.

But despite its imminent and long-awaited arrival, all is not rosy with revalidation. GPs at last month's LMC conference poured scorn on the GMC for its ‘shocking complacency', with demonstrable anger at the regulator for proceeding with the plans despite huge question marks over who will fund remediation for doctors that require it, how appraisals will work, how locums will be able to compile their portfolios of evidence, and how any doctor will have the time or wherewithwal to gather multi-sourced feedback from fifteen colleagues.  

So how would Professor Rubin respond to LMCs' criticism that the GMC has shown a ‘total lack of leadership on the issue'.

‘There will be a lot of leadership being shown by the GMC, a lot of clarification coming,' he explains, his relaxed demeanour belying the scale of the task he faces.

‘But we want to time it just right so that we are telling doctors things when they need to know it, not before then. Through the autumn particularly, we will be increasing the amount of information that we give. If anything, by next spring we might be being accused of something at the other end of the spectrum, that we are coming on too strong about this.'

But how much of that mountain of information will GPs be receptive too? On the key issue of how remediation will work, and who will pay for it, he is unable to provide answers, other than that the Government and the BMA are ‘still discussing the issue'.  The issue came to a head at the LMC conference, when GMC Council member Professor Malcolm Lewis angered GPs by claiming that thrashing out an agreement on remediation funding should not be allowed to delay revalidation, because the majority of GPs would not need such support.

Professor Rubin acknowledges GPs' concerns, but insists there would be ‘incredulity' among patients if the process was delayed any further.  

Of course we are very well aware of concerns about remediation,' he says.  ‘[But] the public would not understand if we as a profession delayed still further and said "sorry, we're really not ready yet to show that we're up-to-date and fit to practise".'

‘So revalidation will start, and we're very conscious at the concerns, and we will do all that we can to ensure revalidation is introduced in a pragmatic and manageable way.

He adds: ‘We all have a responsibility to make sure that we, as far as possible, don't get into a situation where remediation is needed. Having said that, we are very clear in our view that one of the advantages of the introduction of revalidation should be that those doctors who for whatever reason need remediation should be identified much earlier than perhaps has been the case in the past.'

He also defends the GMC's stance on multi-source feedback, and insists it will be feasible for doctors to collect 360 degree feedback from 15 colleagues, as the GMC has advised.

‘We know this a big change - the biggest change in medical regulation for over 150 years. We know lots of doctors have not done multi-source feedback before, and of course we know if you're in a small, rural practice, it is much less straight forward to get a wide range of people to feed in to multi-source feedback, ‘ he says.

‘On the other hand, in order to be as powerful as it can be, multi-source feedback should have as many people as possible responding, not least because it will become pretty well impossible to identify who said what.

‘So I think we need to be a bit creative but we also need to be very pragmatic -  15 is the ideal, that's the guideline we're giving, but each doctor will have to adapt to their local circumstances.'

Professor Rubin says the GMC is ‘very conscious' that peripatetic locums will find it more difficult to collect evidence for revalidation, but urges the doctors themselves, as well as their employers and agencies, to plan ahead as much as possible.

‘Everyone has a part to play here,' he says. ‘Top of the list are the peripatetic locum doctors themselves. They have a responsibility to ensure they do all they possibly can. But employers as well have to be far more ready than perhaps has been the case in the past to enable peripatetic locums to have access to the information they need in order to meet the requirements.'

‘We were [also] very clear that locum agencies have a very significant responsibility, to confirm that those doctors working for them are enabled to get the information necessary to be re-licensed. It is in everyone's interest to make sure that happens.'

With all this mind, does the resolutely cheerful Professor Rubin genuinely believe the GMC can reach a consensus with the BMA before revalidation is rolled out?

‘I'm very optimistic that we will,' he affirms.  ‘This is not going to be a big bang in April 2013. We're introducing revalidation in what we believe to be a manageable way, because we want to pick up any teething problems early on, we want to spot any glitches, and we'll be very much on the case in the early months.'

‘It's very much supplying more information and working with all involved, the BMA in particular, to ensure it all works very smoothly.'

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