The GMC has been accused in the past of placing an unrealistically positive spin on doctors' views of revalidation. It would need Alastair Campbell on his very best form to put much of a sheen on the feedback from the revalidation pilots.
Take this choice quote from an LMC chair who describes himself as an enthusiast for appraisal and revalidation: ‘I spent weekend after weekend trying to fathom it out. My wife and I joke that it almost cost our marriage.'
Other GPs involved in the revalidation pilots warned the workload was ‘huge' and that GPs received the scheme ‘far less well than hospitals', which is some claim, given the deep lack of enthusiasm for revalidation uncovered by early reports from the secondary care pilots.
The Revalidation Support Team, which includes the GMC, argues it is not revalidation itself that has caused difficulties, but the IT system used in the pilots, which even leads for the scheme admit was ‘clunky' and unreliable. It claims the software, which we reveal is now being scrapped, was only ever intended for the pilots, and that its labyrinthine complexity was put in place not because revalidation requires it, but to allow the scheme to be monitored in detail during its evaluation. In other words, revalidation has so far failed in pilots not because it is a failed scheme, but because failure was built into the piloting process. It's a bit like those existential arguments about fly-on-the-wall documentaries, and whether the very fact that real life is being recorded means it ceases to be real.
For GPs involved in the pilots, such distinctions are of course irrelevant – their experience of revalidation was defined by and indivisible from the purgatory they went through to make the software work. A second set of pilots will now take the level of technical sophistication down a notch or two, asking GPs to record their learning needs, evidence of CPD hours and 360-degree feedback not online, but on printed PDFs. If these pilots fail, will that be blamed on pilot-specific factors too? Dodgy paper stock perhaps, or print jams?
So far, the GMC has traded heavily on the goodwill of GPs, many of whom have taken part in pilots of revalidation to no personal benefit, but because they supported the principle of good-quality appraisal and wanted to get the scheme right for the profession. But the GMC's leaders must realise there is a limit to that goodwill. Revalidation is now being pushed through in an environment very different from the one in which it was conceived – one in which the public's Shipman-related fears have faded, and in which GPs are already faced by the bureaucratic complexity of commissioning and the Care Quality Commission.
If the GMC hopes to retain the support of the profession, it needs to pilot revalidation in conditions as close as possible to those it expects the final scheme to take, and to demonstrate unequivocally that under those conditions the scheme is workable and practicable, alongside the numerous other demands GPs have on their efforts and time. If it can't manage that, revalidation is destined for the dustbin and no amount of spin will save it.
Responsibility without power
The Government insists it still intends to push ahead in April 2013 with plans for a quality premium, which will be focused largely on the outcomes GPs achieve through their commissioning decisions, but won't be awarded if the budget busts. That then heaps a considerable responsibility on GPs' shoulders, for not only ensuring their commissioning improves patient care and reduces inequalities, but does so while sticking to a painfully tight financial settlement. So it's alarming that GPs will carry that responsibility alone while being asked to cede much of the power over commissioning to a myriad of other health professionals and managers. Clinical senates, the NHS Commissioning Board, local authorities and Monitor will all have their say over the key decisions taken by the new clinical commissioning groups. But only GPs face being held to account for their decisions via their pay packets.