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Revalidation can never prove its worth

The millions of pounds spent implementing this process would have been better used improving patients’ health, Dr Peter Tyerman argues.

In 2000 Harold Shipman was found responsible for a number of premature deaths.  His reasons for this have never been fully understood. He had been known, in the past, to have had drug problems and had been under investigation by the GMC.  He had also been reported to the Police by local doctors for suspicious behaviour.  However, none of the official bodies had taken action.  The result of this appears to be revalidation.  How revalidation is supposed to prevent what appears to be a ‘one-off psychological illness’ is not clear.

Following various enquiries and investigations into Shipman, several attempts at producing a system to prevent a further similar episodes have been developed, one of which is revalidation. As far as I can see no-one has suggested any reasons for going down this path except that Shipman did what he did and we must be seen to do something about it. But the idea that the solution should be relative to the problem was lost many years ago. Due to the intervention of political pressure groups and the press, this has morphed into a process which appears more designed to sound as though it is doing something rather than actually achieving anything. 

Revalidation is now like a runaway train – everybody is rushing around trying to keep it on the rails but nobody is willing to risk applying the brakes. The recent revelation that revalidation will cost £97m every year, mainly in terms of doctors’ time

If you use NICE-type calculations of cost per life year saved, over 100,000 people could suffer from the effects of introducing GP revalidation alone. Surely proper research needs to be done before we can justify this sort of expenditure and its consequences.  We may have created a situation where the response to Dr Shipman’s crimes may be responsible for the premature death or ill health of a thousand times as many people as Dr Shipman himself. 

When did this idea get out of hand? After the Shipman case multiple agencies thought they could come up with a method of preventing this happening again.  Instead of all these ideas being looked at and the best solution being chosen, they have all been proceeded with.  This has had the effect of becoming additional pressure accelerating the train.

The simplest method to stop this project would be to apply the brakes. If we could track, for instance, a computer model of doctors signing an unusually large number of death certificates then it would rapidly identify a Shipman-type situation with little or no additional cost.

But I do not believe we can stop revalidation now. There are too many individuals who have now created themselves a vested interest in the process, who would find it unacceptable to have their work derailed.

Dr Peter Tyerman is a GP in Barnsley, South Yorkshire.

Readers' comments (8)

  • "GMC chairman Professor Peter Rubin says many doctors think revalidation sprang from investigations into Manchester GP Dr Harold Shipman, convicted in 2000 of killing 15 patients.

    In fact, it was first discussed by the GMC in 1999, following the Bristol heart inquiry, which found that children had died because they received substandard heart surgery."

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  • Shipman-events are a daily occurrence in the UK as can be seen from statistics on unnecessary deaths, especially in the elderly. How many more Staffordshire Hospitals or Jane Bartletts are needed to show that the common denominator is the GMC, who acts as a buffer between the Doctors and the Criminal Justice system, protecting bad, mad and sad doctors at the expense of the public. No one seems to be willing or able to sacrifice this holy cow.
    To promote the enabler (who assists Shipmen) to re-validator, is to reward serial failure. The truth is that, was there no GMC, Shipman would not have been enabled to murder more than 2 patients before the Police would have stopped him. No logic can supports this. A simple yearly battery of on-line tests would be a simple, inexpensive and FAIR way of re-evaluation.

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  • What is the question revalidation is trying to answer? Until that is really decided I am not sure it will ever be fit for anything.

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  • Revalidation weeds out all the really really bad doctors who have been practising all these years, incognito !!

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  • Mark Struthers

    In these heady days of evidence-based medicine, it's evidence, evidence, evidence, where evidence is King. The public expects doctors to keep up to date and the public expects the government to produce the evidence. That's revalidation, stupid!

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  • Mark Struthers

    The GMC doesn't trust doctors to keep up to date. The GMC is bringing us revalidation to ensure that doctors do keep up to scratch ... or else. But remember that the GMC brought us the disastrous prosecution of the Royal Free Three ...

    .... and at enormous expense to doctors. Can the GMC be trusted? Revalidation is about trust, stupid!

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    All did not do their job to stop Shipman
    insanity ..These dinosaurs doing what they've always done and expecting a different result

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    The process has different implications for different specialities
    But at present it has a one approach fits all
    Obviously there is or should be a far greater emphasis on assessed quality and competence for say a surgeon
    or anaesthetist where care is life and death
    compared to say a GP in a practice with several doctors keeping an eye on each other

    Everyone always pulls the airoplane analogy ....
    but correct me if i am wrong i don't think proving it distracts the pilot from the job of flying
    and does not involve the pilot being constantly involved all year round gathering proofs

    The GMC basically can't be arsed to identify poor standards ..
    it would rather assume them if
    you have not beaurocratically spent all your time
    beavering away collating pseudoeducational logs

    The PCT Gives out contracts without any accountability
    for the standards at some places
    This puts patients at more risk in the first place rather than assuming that
    all is well on the basis of a yearly beaurocratic form fill chit chat appraisal

    Why is everyone surprised when everyone who can is retiring ????

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