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Wednesday 23 May 2012
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Practice governance procedures to be included in GP revalidation

By alisdair stirling | 23 Jan 2012

Exclusive: GPs will only be revalidated if they can demonstrate their practice has adequate governance procedures, in a move the GPC has warned confuses assessment of individual doctors with the organisation they work for, Pulse can reveal.

The RCGP told Pulse responsible officers would have to ensure adequate practice governance systems were in place as part of every GP's revalidation, and that an assessment of governance would be expected to ‘feed in' to every GP's appraisal.

The surprise revelation, which the GPC said went ‘beyond the purpose and remit of revalidation', came after it emerged a responsible officer in Cheshire had begun contacting practices to warn them their governance procedures would be taken into account in revalidation of GPs.

Professor Mike Pringle, RCGP medical director for revalidation, said: ‘The way it will work is the responsible officer will need to know a practice has adequate clinical governance and will expect that to feed into GPs' appraisals. I think we'll see this issue coming more to the fore as responsible officers begin to really bed in to their responsibilities.'

Professor Pringle insisted individual GPs shouldn't find their revalidation dependent on practice governance, because practices would be expected to have sorted out their governance systems in advance of the revalidation coming in.

But a letter to practice clinical governance leads from Dr Maureen Swanson, responsible officer for NHS Western Cheshire and NHS Warrington, suggests governance could become a key strand of revalidation.

She wrote: ‘The responsible officer's recommendation for revalidation of GPs will take account the clinical governance systems within each practice as well as the GP's participation in appraisal.'

But GP leaders expressed concern. Dr Andrew Mimnagh, chair of Sefton LMC, said: ‘It is news to me that governance arrangements within a practice may affect an individual's revalidation status. This would appear to draw an unfair distinction between principles and non principals in fulfilling revalidation.'

Professor Pringle denied salaried GPs would be adversely affected.

But GPC negotiator Dr Chaand Nagpaul said: ‘It appears the emphasis in this letter is making the practice's clinical governance a formal part of revalidation. That is not correct. By necessity an individual's performance might be contextualised in their working environment, but the way this is presented goes beyond the purpose and remit of revalidation which is about assessment of an individual doctor.'

Dr Rob Barnett, chair of Liverpool, said: ‘It's like saying everyone at Mid Staffs should have failed revalidation because of problems in the hospital.'

READERS' COMMENTS

Anonymous, PCT,
23 Jan 2012
"It's like saying everyone at Mid Staffs should have failed revalidation because of problems in the hospital"

No - it's like saying that the doctors who knew about the patient safety issues and did nothing about it should, and probably will be, reviewed by the GMC.
Clinical governance is a contractual requirement - this is nothing new. But revalidation is about the safety and quality of patient care. Surely if that's on your agenda there is nothing to be worried about?
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Anonymous, GP Partner,
23 Jan 2012
I'm sure they should check out if my bank account is in credit [as I'm a partner in a business] and how I get on with my partners [as working with colleagues is one of the areas, clearly if I am in dispute with them I should not be re-validated.??]

In fact, since I have to drive to visit patients a driving assessment is clearly indicated and any speeding fines should be taken into account - and as I have to walk on my feet I think how I cut my toe nails is probably relevent too!
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Anonymous, Salaried GP,
23 Jan 2012
I dont work for a specific practice so I will be banned because one of the partners in one of the practices I worked for a few years ago fell off his bike when DUI. Anyone know the password to get in to Australia?
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Anonymous, Manager,
23 Jan 2012
Understanding what Revalidation and embedded Clinical Governance is and what it is ultimately trying to ensure and achieve is key here . . . .

In my opinion, most if not all doctors, or indeed any healthcare professional, genuinely want to do everything possible to ensure their practice is safe and effective. Revalidation including related Clinical Governance processes need not be dreaded but seen as a chance to confirm that everything that should be done is being done - from an individual and team perspective.

All too often the waters have been muddied and this, in my experience, is when risk management tools and techniques, such as Revalidation and Clinical Governance, are introduced. Of paramount importance is getting these tools and techniques right i.e. efficient and effective for all concerned.

Aren’t doctors, practicing in line within ‘sound’ clinical governance processes, doing everything they can?
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Anonymous, GP Partner,
23 Jan 2012
conflict of interest from RCGP and the practice accreditation
how on earth the locum doctors and the hospital doctors will manage to get the governance issue with their employers?
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Anonymous, Practice Manager,
23 Jan 2012
"In fact, since I have to drive to visit patients a driving assessment is clearly indicated and any speeding fines should be taken into account - and as I have to walk on my feet I think how I cut my toe nails is probably relevent too!"

A very mature response to a serious problem
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David Mcbride, Manager,
23 Jan 2012
Unless the revalidation process is designed to evaluate commercial, risk management, change leadership, quality improvement and political skills in addition to clinical skills I really cannot see the point of this.

However, a practice proving it as effective clinical governance should include evidence of partner and employee revalidation as part of CQC processes. Each element of this (revalidation and CQC) is actually quite reasonable. It does not mean it needs doing twice.

To avoid creating 'new' bureaucracy the CQC and GP revalidation processes should set out clear and unambiguous aims. One to regulate practices and the other to regulate professionals. A little joined up thinking is required.

If implemented effectively, these changes could make a big difference to patient care. The worry, of course, is that both will be implemented badly. Ever the pessimist!
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Anonymous, GP Partner,
24 Jan 2012
This is all about enforcing control of appropriately independent medical professionals by NHS managers using revalidation as a smokescreen.

Management whim and the law of unintended consequence will characterise the 'governance' of the new system.

Individualism and with it freedom of academic thought and clinical practice is being stamped out .

We are at severe risk of becoming apparatchiks in a new NHS Soviet .

If we all think and behave the same and we are correct, fine.
If we all think the same and we are wrong there will be no-one to raise the alarm until it is far too late for the hapless patients we claim to 'care' for.

The NHS Soviet system will go the way of the old Soviet Union sooner rather than later but in the process will destroy not only the lives of GP s but their patients wholesale.

Despair and a planned move away from this insanity is the only rational reaction
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K M Hawking, GP Partner,
24 Jan 2012
Is it seriously being stated that if there are questions about "clinical governance" (however defined or measured) *all* the doctors working in that practice would fail revalidation - and be required to undergo remediation?
Will remediation in this - or all? - situation (failure of revalidation due to non-approval of practice clinical governance) be standard or targeted on the area of failure?
Group remediation anyone?
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Anonymous, PCT,
24 Jan 2012
"This is all about enforcing control of appropriately independent medical professionals by NHS managers using revalidation as a smokescreen.

Management whim and the law of unintended consequence will characterise the 'governance' of the new system. "

Who do you think is pulling all this together?? Managers?? Really?? Do you think managers are THAT influential! It's the GMC and Medical Directors (Doctors!!!) primarily. True, it initially came out of major incidents that resulted in patients dying - a useful reminder of how we got here - but it IS being driven now by the profession.

Regarding Dr Hawking's concerns - you would only "fail" revalidation if either you don't engage (GMC will then revoke your license to practise - see draft regulations) or the clinical governance systems within the practice were do dire that they were placing patients at risk AND the practice were doing nothing about it.
Revalidation is all about reflection and improvement in practice. There are a number of professions that this is expected of now - not just medical but legal, accountancy, actuaries, judicial - get with the programme!
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Anonymous, Sessional/Locum GP,
24 Jan 2012
A recent discussion with a member of the GMC was reassuring in that it seemed that all reasonable doctors would have little to fear from revalidation. Just those with irremediable personality disorders and the like.
As I was reading through the article above and responses to it the phrase "this is all about control" echoed though my mind thus the response above was a bit of an alarming deja vu.
What patients want from GP is acessibility, continuity, time and humanity which is largely provided by doctors who clearly want a good living but are not motivated by the huge financial rewards of some of the " unpriciples/unprincipals" and the leaders of the new consortiums many of who seem to avoid their patients and disdain their clinical colleagues who they seek to control along with the administrators at various levels.
I used to be able to refer my patients according to need to any specialist in the country who I had researched and found to be appropriate. Now even some of my referrels locally are rejected accordiing to some protocol by those who it is difficult to identify.
The new reforms seem to me to lead to two things at least: profits being deflected from patient care to the pockets of large internationals and tight punitive contol of most clinical doctors who will be protocolled into frustration. This will result in reduction of choice and care of patients.
Patient oriented doctors will be increasingly marginalised and unhappy due to these excessive controls .
And so on.
What a Brave New Whirled!
I continue medicine because I like to help patients.
I think that I shall soon be extinct.
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Andrew Mimnagh, GP Partner,
26 Jan 2012
I am really old fashioned.
I thought revalidation was about the performance of an individual and the CQC was about performance of a system such as a practice?

I agree the two are interlinked but whether you revalidate should be about your personal performance and not the quality of your place of work.
Of course a principle running a practice should be discussing its internal clinical governance as a part of the individuals management reponsibilities discussion during appraisal.
That does not mean that they are obliged to evidence it to any other 3rd party on request.

I too share concerns that this shift in tack is because the CQC have publically lambasted all individuals misleading GP's that an action "is required for CQC Accreditation".
I hope the GMC will issue a similar statement of position on revalidation and soon.
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