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One last question on revalidation

Some 13 years after the GMC first mooted some form of regular checks on the performance and practice of doctors, it seems revalidation is finally here.

New health secretary Jeremy Hunt hasn't yet formally signed off on it – that's expected imminently. But some 13 years after the GMC first mooted some form of regular checks on the performance and practice of doctors, it seems revalidation is finally here.

While the GMC has been insisting for months the first wave of doctors would begin the process this December, that start date had seemed in doubt until the NHS Commissioning Board announced last week it would fund the remediation process for doctors – in England, at least. With that key sticking point addressed and the BMA giving a grudging green light, the last hurdle appears to have been cleared.

There remains a list of unanswered questions. What about remediation funding for doctors in Scotland, Wales and Northern Ireland? Will locums really be able to gather all the supporting information they require? Are there wider concerns over multi-sourced feedback, given a GMC-commissioned study of draft questionnaires last year found ‘potential for systematic bias'? Why will some GPs but not others have to pay for 360-degree feedback themselves? And above all, just how many doctors will be found wanting?

All this and more will need to be thrashed out – and given planning began in the previous millenium, it's astonishing so much remains unanswered with just two months to go. But there is a more fundamental question: just what is the problem to which revalidation is supposed to be the solution?

The official line is that ‘revalidation is to assure patients and the public, employers, healthcare providers and other healthcare professionals that licensed doctors are up to date and practising to the appropriate professional standards'.

But if revalidation is intended as some kind of public relations exercise, then it is an expensive and time-consuming one. And if it is genuinely intended to raise professional standards and weed out poor practice, it is a peculiarly woolly way of doing so.

As one GP put it this week: ‘Revalidation should test whether or not I am safe and
up to date. In fact, it does neither. An exam and observed surgery would have.'

Where is the evidence that asking GPs to jump through revalidation's hoops will prevent a new Shipman? The NHS Revalidation Support Team may claim it is not supposed to, but such a denial is disingenuous when the proposals in their current form were triggered directly by Dame Janet Smith's inquiry.

What must be acknowledged is that the undoubted benefits of revalidation inevitably come with a price tag attached. There is a financial cost – a not-insignificant one, given the ever-multiplying array of toolkits, working groups, appraisal systems and so on that has sprung up around the process.

But there is also a less tangible, professional cost. This week we publish the harrowing tale of a GP who faced an unfounded GMC complaint. It is an object lesson in the human cost of over-zealous regulation – increased stress, decreased morale and doctors practising defensive, inefficient medicine as a result. Will this also be the fate of GPs caught up in revalidation?

The great and good of the profession may now be on board, but many grassroots GPs are far from convinced. The who, what, where, when and how of revalidation are almost sorted. There's some work to do yet in explaining the why.

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