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Revalidation can never prove its worth



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.