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Taking off from the practice as a flight medical officer

The Government has scrapped the April start date for revalidation and is to carry out a root-and-branch review of the scheme.

GPs say they expect the review to demand a far more 'punitive' and heavy-handed system that will end the presumption they are fit to practise unless proved otherwise.

The GPC is warning the Government not to base revalidation on the assumption most GPs underperform.

The review, expected to last at least six months, is also likely to call for appraisal of GPs to be toughened. GP experts predicted it would either become a 'pass or fail' process or be separated entirely from revalidation.

Ministers have acted as a result of the Shipman Inquiry's damning fifth report. Inquiry chair Dame Jane Smith said existing plans to grant revalidation if a GP had participated in 'educational' appraisals were not sufficient to prove fitness to practise.

She called for knowledge tests, videos of consultations, clinical governance data and patient surveys to be included in a revalidation folder.

The RCGP has said it could take the lead in developing standards and evidence for the folders.

Dr Ruth Chambers, a GP in Tunstall and clinical dean of the University of Staffordshire, said GPs should expect to have to compile evidence of competency in up to 35 clinical fields. 'It's likely we will be asked to produce more objective evidence of our competencies that other people will recognise as evidence,' she said.

The Government decision deals a further blow to the GMC, which had believed it would only have to make minor changes to its plans.

The Department of Health said Chief Medical Officer Sir Liam Donaldson, who will lead the review, would audit the GMCs revalidation plans 'in depth' as the Shipman Inquiry's criticisms had raised 'such a level of uncertainty'. However, the GMC reiterated that it did not expect a wholesale rethink of its plans.

Stephen Brearley, chair of the GMC's registration committee, said its original proposals had not been 'a stab in the dark' and warned changes could cripple the NHS.

Mr Brearley also criticised the Government for 'kicking the whole thing into touch' until after an expected May general election. He said: 'The Government has buried this and made it look like the GMC's fault.'

The announcement of the review came as the GPC launched an attack on Dame Janet Smith for having a 'jaundiced' view of GPs.

GPC chair Dr Hamish Meldrum said her previous work had influenced her 'unfair' recommendations. He said: 'A lot of her last work was in medical litigation and that tends to give a jaundiced view.'

Dr Meldrum said the review should not be swayed by the 'false impression' given by the inquiry that most doctors underperform. He added: 'A punitive environment tends to make people hide problems.'

By Ian Cameron

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