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Revalidation: the unanswered questions

Rarely has such a momentous announcement been so unsurprising.

The decision by health secretary Jeremy Hunt to formally approve the launch of revalidation in December is without doubt a historic one. (The Department of Health press release trumpeted the fact that ‘regular checks were first recommended over 30 years ago’, while the GMC went one better and hailed it as ‘the biggest change in how doctors are regulated for more than 150 years’)

But it is also entirely expected, having been heavily trailed in recent weeks. The BMA’s decision to throw its weight behind the rollout, after a deal was reached on funding remediation, was a crucial turning point.

The announcement from the GMC at the end of last month that it was ready to go made a December rollout all but a foregone conclusion.

As we have written in recent weeks though, there remain big questions – questions which remain unanswered even after today’s announcement. We are somewhat closer to having an idea about how many GPs could require remediation – although DH surveys make the GMC estimate of less than 125 over the course of five years look a little low.

But will the appraisal process suddenly start performing as it should (given that in England 10% of GPs did not have an annual appraisal last year)? What about remediation funding in the devolved nations, which has yet to be resolved? Will GPs continue to face a postcode lottery in whether they have to pay for 360-degree feedback? And just how onerous will the process prove to the NHS as a whole once it is in full swing?

And the one glaring question, which somehow receives not a single mention in the GMC’s 658-word Q&A document, is the most obvious in these cash-strapped times – just how much is the whole process costing the NHS?

At the Department of Health’s press briefing yesterday, officials insisted revalidation would be ‘cost neutral’ or even provide an even better value system of regulation than currently. But the impact assessment which sets out the actual figures, which we were told would be published after the formal go-live announcement, still remains under wraps, and is now scheduled for release only on 5 November. (In the meantime, you can read a summary of what little we do know about the likely costs here).

The likely benefits, too, remain curiously nebulous – particularly if the whole convoluted process is unlikely to identify many or indeed any more GPs who require remediation. Our blogger Copperfield cannot have been alone in taking issue with Professor Mike Pringle’s explanation that ‘since it became obvious revalidation was serious, it has had a catalytic effect on standards’.

Whether these outstanding questions represent future elephant traps which could unravel the whole process, or mere details that will in due course be seen as minor footnotes to a historic announcement, remains to be seen.

There is a feeling that perhaps revalidation is too big to fail, and that doctors will surprisingly quickly overcome their objections to the new process. It is entirely possible that in five years’ time going through revalidation will seem a natural part of being qualified to practise medicine, and that to younger GPs it will be unthinkable that the profession ever operated without it.

Either way, we’re about to find out.

Readers' comments (7)

  • I am an orphan but the GMC team seem not to know what to do about people like me. IAm I expected to sort it out with other orphans??

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  • Letsstop for second, Roll back a few steps.Why do we need this, MORI poll after poll says we are the most trusted of professionals and a recent, BMJ published study also show we are, amongst 14 high income countries, top regarding public confidence in doctors!

    So why fix a problem which does not only NOT exist, but we are top of the game anyway. Now if you tell me its meant to root out the bad eggs, tell me which industry hasn't got bad eggs.The other ways to do this, not a blanket rule!

    Tell me i am wrong, please.

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  • Revalidation is just a way of keeping politicians out of the Shpman type frame. Just as CCGs (Doctors running the Health Service ) is going to pu the blame for problems on Gps not the Health Secretary or the politicians.

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  • I am delighted now that I have decided to retire on 31st December. You are all welcome to all your Appraisals and Revalidation. I've had enough of this nonsense. I agree with the earlier Anon that somebody is creating a problem that doesn't exist

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  • How much this process will cost the NHS is not the most important question.
    The crucial question is - What is the evidence for this revalidation? Has it been shown to work? Is it of benefit to Doctors and Patients? Does the process have any relationship to what it's supposed to be measuring?
    I have my doubts!

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  • Loke Colin Lees, I'm retiring on 31st December too, and this was part of the reason. Revalidation is like an untested, uncosted new drug. We know very little about the condition is it is supposed to treat, nothing about its efficacy, and the potential side effects are not even being discussed. These possible side effects include the risk of many experienced doctors retiring a few years earlier than they would have done. I'm going at 57. Is anyone measuring this?

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  • PS this is supposed to be about stopping another Bristol or Shipman. Another Bristol has been stopped by proper application of audit, there can't be another Shipman because of the forensics (morphine in victim muscle on exhumation, interrogation of falsified computer, modus operandi blown). Revalidation is about power and control.

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