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Revalidation: the unanswered questions



Rarely has such a momentous announcement been so unsurprising.

The decision by health secretary Jeremy Hunt to formally approve the launch of revalidation in December is without doubt a historic one. (The Department of Health press release trumpeted the fact that ‘regular checks were first recommended over 30 years ago’, while the GMC went one better and hailed it as ‘the biggest change in how doctors are regulated for more than 150 years’)

But it is also entirely expected, having been heavily trailed in recent weeks. The BMA’s decision to throw its weight behind the rollout, after a deal was reached on funding remediation, was a crucial turning point.

The announcement from the GMC at the end of last month that it was ready to go made a December rollout all but a foregone conclusion.

As we have written in recent weeks though, there remain big questions – questions which remain unanswered even after today’s announcement. We are somewhat closer to having an idea about how many GPs could require remediation – although DH surveys make the GMC estimate of less than 125 over the course of five years look a little low.

But will the appraisal process suddenly start performing as it should (given that in England 10% of GPs did not have an annual appraisal last year)? What about remediation funding in the devolved nations, which has yet to be resolved? Will GPs continue to face a postcode lottery in whether they have to pay for 360-degree feedback? And just how onerous will the process prove to the NHS as a whole once it is in full swing?

And the one glaring question, which somehow receives not a single mention in the GMC’s 658-word Q&A document, is the most obvious in these cash-strapped times – just how much is the whole process costing the NHS?

At the Department of Health’s press briefing yesterday, officials insisted revalidation would be ‘cost neutral’ or even provide an even better value system of regulation than currently. But the impact assessment which sets out the actual figures, which we were told would be published after the formal go-live announcement, still remains under wraps, and is now scheduled for release only on 5 November. (In the meantime, you can read a summary of what little we do know about the likely costs here).

The likely benefits, too, remain curiously nebulous – particularly if the whole convoluted process is unlikely to identify many or indeed any more GPs who require remediation. Our blogger Copperfield cannot have been alone in taking issue with Professor Mike Pringle’s explanation that ‘since it became obvious revalidation was serious, it has had a catalytic effect on standards’.

Whether these outstanding questions represent future elephant traps which could unravel the whole process, or mere details that will in due course be seen as minor footnotes to a historic announcement, remains to be seen.

There is a feeling that perhaps revalidation is too big to fail, and that doctors will surprisingly quickly overcome their objections to the new process. It is entirely possible that in five years’ time going through revalidation will seem a natural part of being qualified to practise medicine, and that to younger GPs it will be unthinkable that the profession ever operated without it.

Either way, we’re about to find out.