Revalidation verdict draws near
By Helen Crump
It's almost certain to happen in the next couple of years. It will undoubtedly place a huge burden on GPs. But no one knows exactly when it will kick in. Or how hard it will hit.
One thing is sure though. A new system of revalidation will will be almost as unwelcome among most GPs as an avian flu epidemic.
The issue of revalidation has lain dormant for almost 18 months since the Government announced a wholesale review of regulation of doctors.
That review was made necessary by the Shipman Inquiry's damning criticism of regulation of GPs.
Chief among its findings was that the GMC's proposed system of revalidation was 'an extensive rubber-stamping exercise that would have misled the public into thinking there was a genuine check into the competence of doctors'.
Inquiry chair, Dame Janet Smith, demanded a tougher system that would better weed out poor performers and potential Shipmans.
Sir Liam Donaldson, Chief Medical Officer, who has led the review, was meant to have completed his work by the end of last year but is believed to still be putting the finishing touches to it.
Unlike most Government delays, this one has caused little fuss. Partially because GPs are quite happy for the whole issue to disappear.
But last week, at the first conference on the aftermath of Shipman and the legacy of his crimes, Dame Janet and other proponents of a tough new regulatory regime took their opportunity to criticise Sir Liam and to restate their case.
Dame Janet told the conference at the Royal Society of Medicine: 'There are doctors who still think that everything is fine and that there is no need for change. There are still those who think Shipman was a one-off villain.'
She added that the raft of measures she proposed in her inquiry conclusions (see box below) were the only way to 'achieve public confidence in the medical profession'.
Dr Aneez Esmail, a Manchester GP and a medical adviser to the Shipman Inquiry, says he believes the delay is down to an 'unholy compromise' being worked out and predicted Sir Liam would 'fudge' the issue. 'We will end up in 50 or 60 years with further scandals,' he says.
Yet the CMO is well aware of the strength of opposition from GPs to a form of revalidation that involves lots of work and, potentially, knowledge tests one of Dame Janet's chief recommendations. It is not surprising that he has taken longer to reach his conclusions.
Dr Iona Heath, a GP in north London and chair of the RCGP's ethics committee, warns that over-zealous reforms could seriously damage morale.
While Shipman's murders were the first wrong to be committed, she says, the second is the 'increasing surveillance and coercion of doctors'.
Dr Heath adds: 'The crimes of Harold Shipman have been used to hasten the waning of professional power.'
Other GPs predict any attempt to bring in formal tests as part of revalidation will prompt an exodus of GPs and leave a gaping hole in patient care.
Dr Grant Ingrams, West Midlands LMC secretary, says: 'If you imposed a formal exam on a regular basis, 90 per cent of GPs within five years of retirement would just go. People would be worried about this and would want to take weeks off preparing.'
Dr Simon Bradley, chair of Avon LMC, says GPs 'who fall down on QOF or patient surveys' are the ones whom revalidation needs to target. Not the 'potential Shipmans'. He says: 'Revalidation would not detect another Shipman, that's quite clear.
'GPs should be assessed on the quality of the product rather than the qualities of the individual. We don't need to look at and dissect GPs' knowledge at an input level.'
Which side Sir Liam is taking remains an unknown quantity. Even Sir Graeme Catto, GMC president, says he hasn't seen 'a single word' of the final report and doesn't know anyone who has.
Received wisdom is that appraisal will not be a part of a new revalidation regime and that GPs will need to compile folders of evidence containing patient satisfaction and clinical governance data.
This would meet Dame Janet's demand for folders and for 'periodic evaluation of every doctor's fitness to practise'. But how onerous this is for GPs will depend on how much is required for the folder, how often revalidation takes place and, critically, whether GPs will need to take regular knowledge tests.
Whatever is decided, the delays mean revalidation is now unlikely to begin before 2008.
All GPs can hope is that the new system, and the avian flu epidemic that may hit around the same time, are not as bad as the worst predictions.
What Dame Janet wants:
· Revalidation to include an evaluation of fitness to practise
· Folders of evidence to be examined by a panel of at least three assessors
· Folders to include
Healthcare Commission, GMC or NCAA assessment reports
continuing professional development activities
appraisal Form 4
patient satisfaction questionnaire
clinical audit results
significant event audits
· Possible inclusion of a video recording of a consultation