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Professor Peter Rubin: in his own words

In an exclusive interview with Pulse, the new GMC chair, Professor Peter Rubin, talks to By Gareth Iacobucci about responsible officers, revalidation - and why it's not about stopping another Shipman.

By Gareth Iacobucci

In an exclusive interview with Pulse, the new GMC chair, Professor Peter Rubin, talks to By Gareth Iacobucci about responsible officers, revalidation - and why it's not about stopping another Shipman.

Revalidation has already faced numerous delays. Could it be delayed beyond 2011, and when will the first GPs be revalidated?

I'm absolutely certain that revalidation will not begin for everybody, in every specialty in every part of the UK on the same day. We're not going to start until we're ready, but I'm equally confident we'll be ready in some specialties and areas during 2011. We will then roll it out beyond that point. Who will be ready and who will not be ready is not yet clear. But I'm confident there will be enough to begin revalidation in 2011. It's going to be different in different parts of the UK.

Responsible officers will obviously have a large part to play in revalidation in making recommendations to the GMC. How can responsible officers avoid possible conflicts of interest with regards to their role?

We're taking one step at a time with revalidation pilots, to see how it goes on the frontline. Then, early next year, we will launch a pretty wide ranging consultation, to get opinions on things just like this so that we get the views of all those who will be involved. We want the process to run smoothly and to command the confidence of those who are being revalidated. We're still on the learning phase, and are very unapologetic about that. We want to get this right, that's why we want to take it slowly. We're assuming that issues such as this, which is a very important issue, will be clearer to us once the pilots have been completed, and once the consultation's happened early next year.

How can doctors overcome possible clashes of personality they may have had with their responsible officers? For example, what should GPs do if they are concerned that a previous dispute they may have had with either the Responsible Officer, or the PCT, may affect their revalidation?

We at the GMC will expect everyone involved in revalidation to behave professionally. Revalidation will be based on concrete evidence, and I think we have to step back and remind ourselves what the purpose of revalidation is. To ensure that doctors, like me, are up to date and fit to do what it is they do. There will be a number of sources of information to inform the process. It will be evidence based, and we would expect everyone to rely on the evidence and behave in a professional manner. I've no doubt that issues like this will form part of the consultation. As with any process of this kind, there will be an appeal option with respect of the GMC.

How will the appeals process work? Will the GMC handle this?

Revalidation is still two years off, and we don't have precise detail on how we are going to do this. The principle is most certainly there that there will be an appeal process. How the process will work will evolve over the next 18 months or so. And again, I know I keep going back to it, but the consultation will inform this. We really want to move in a way that commands the confidence of those being revalidated. And the GMC has found that consulting with those involved is a very effective way of commanding confidence.

Could GPs' path to revalidation be affected by the local policies of their PCT? For example, would it be appropriate to say a doctor should not be recommended for revalidation if they are not adhering to PCTs prescribing guidance?

The purpose of the GMC is to establish minimum standards for the protection of the public. Those standards are national standards. There will also be a national standard in respect of revalidation. In the case of GPs, that will be determined by the RCGP who will make a recommendation to us. The GMC will be the organisation that finally confirms the standard. So, as a consequence, it is by no means clear that a local decision would necessarily be relevant to revalidating someone against a national standard. It might be on occasions, depending on what the issue is, but doctors will be revalidated against uniform national standard, whether you're a GP in the north of Scotland or the west of Cornwall.

There is currently an investigation into the recent problems the RCGP has had with its nMRCGP exam, which The British International Doctors' Association complained was discriminating against ethnic minority doctors. Does the GMC acknowledge concerns that a disproportionate number of ethnic minority doctors may face problems with revalidation? What is the GMC doing to try and stop this from happening?

We certainly recognise the concerns. My colleagues in the revalidation team have already had a number of meetings with a number of organisations that represent doctors from ethnic minorities, and we have a very active equality and diversity committee. We have been very aware of ethnic minority issues for years now. We are determined that everyone will be treated fairly, and from a personal level, I spent 3 and a half years as chair of PMETB (Postgraduate Medical Education and Training Board), and during that time, I was proactive in ensuring that those doctors in the SAS grades who were applying to join the specialist register were treated absolutely fairly. As the next 18 months unfold, we will be increasingly giving more information as to how the revalidation process will work. All those who are involved in revalidation have to have confidence in the process, and I mean all.

How will revalidation be funded? Will GPs have to pay?

A huge part of the process that will inform revalidation will rely on local systems of appraisal. Where the systems already exist, it's a very small step from that to revalidation. Where they don't exist, any organisation that is committed to high quality really has to recognise that appraisal and revalidation are an integral part of the quality agenda. They are not an optional add-on, they are an integral part. So the cost should already be there, or should already be planned for, because appraisal is the key to revalidation. Where something is necessary, it needs to be done. The key for us, is, where possible, build on local systems, and where they don't exist, they need to be created.

How do you feel about taking over the role of GMC chair at this time?

I've taken over as chair of the GMC at a very interesting moment. Everyone knows the GMC has been through some very challenging times over the last ten years. We had a number of watershed moments, and we had choices as to whether to try and cling to the past; or recognise that the world around us and expectations of the public had changed. We chose to look to the future and we changed. I think the GMC has emerged from the last ten years as a much more confident and stronger organisation. I feel very privileged to be taking over at this time, revalidation is top of my personal list, but there are many other challenges. Bringing in PMETB is a huge one, and something I have a big personal interest in. The transfer of adjudication from ourselves to OHPA will also be an interesting challenge.

Can the GMC win the battle for the profession's hearts and minds over the need for revalidation?

I'm very heartened that the leaders of the profession are absolutely committed to revalidation. But in my view, we need to be doing more to convince the doctors at the frontline of the need for revalidation. That's why I am committed to going out once a month during my time as chair to meet doctors on the frontline, to listen to doctors' concerns, not to talk at them, and where appropriate, explain and clarify. One of the messages I'm keen to get across is that revalidation has been confused with all the events that surrounded Shipman. That is not why revalidation is being established. Nor was it a government idea, it was a GMC idea. It grew within the GMC in 1998 as a result of events that were unfolding in Bristol with cardiac surgery. It is a GMC idea, but is not to do with catching murderers. It is to do with assuring the public that all doctors practising in the UK are up-to-date and fit to practise.

New GMC chair Professor Peter Rubin New GMC chair Professor Peter Rubin

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