Revalidation has been discussed and debated for the over 10 years, and that debate is now over: revalidation will start in December this year. Our challenge now is to make revalidation work and be a positive process for doctors. Following the Bristol heart scandal in 2001, and the Ayling and Shipman inquiries, revalidation has become necessary to reassure the public that doctors are up to date and fit to practise.
Revalidation will not prevent another Shipman, as Shipman was a criminal; however it should prevent the mistrust which has already developed in our relationships with colleagues, politicians, managers and the public. In the interests of patients, we have recognised the need to move away from the notion that, once-licensed, doctors’ skills should remain unchecked until something goes wrong.
The majority of doctors have nothing to fear from revalidation. The process will simply validate that they are delivering safe and effective care to their patients. For those who experience difficulties, revalidation is not a test at the end of a five year cycle – it is a five year process during which, annual appraisals will provide an opportunity for difficulties to be discussed and appropriate support to be arranged.
There have been reports of record numbers of doctors requiring remedial support but this is not because doctors have got worse at their jobs – far from it. It’s because organisations have better governance and due to supportive appraisal processes, problems are being identified earlier, which is no bad thing.
There are frequent suggestions that revalidation is simply a tick-box exercise, shaped by medical managers and NHS bureaucrats, but in order to be effective, revalidation must have professional development at its heart. It must be combined with robust clinical governance processes and professional development to support patient safety and quality improvement.
Doctors should be doing most of the things that are required for revalidation already, but it may be that they have not recorded it in a systematic way before. The RCGP encourages GPs to think not just about the learning itself but the impact of learning – has it had a positive benefit on their patients, colleagues or practise? The appraisal process which underpins revalidation allows negatives to be turned into positives. A significant event audit, for example, provides an opportunity for learning and improving patient care.
Revalidation needs to be practical and straightforward. By working with the other medical royal colleges we are making sure that GPs are treated no better or worse than our specialist colleagues.
Patients are at the heart of revalidation. We have been surveying our patients for many years. Revalidation requires us to do one patient survey in five years. The difference now is that we will need to reflect on the results and that results inpatient input being meaningful.
Revalidation must be proportionate, cost effective and feasible for all doctors, regardless of their working circumstances.
Appraisal should continue to be a supportive educational process but the appraiser will now have an additional responsibility. The appraiser needs to check that the supporting information is sufficient for revalidation. The appraiser will not decide on whether the doctor should be revalidated. The responsible officer (RO) is the person who will be making the revalidation recommendation to the GMC.
The RCGP have recruited a network of revalidation specialty advisers who are all practicing GPs to be able to offer advice to ROs if they want to ask for specialty advice. We will not be advising on individual doctor’s revalidation portfolios ROs. Appraisers and individual doctors must also be able to access supporting information in a consistent way and we need to make sure that appraisal and revalidation are carried out consistently and fairly across the country.
It is unacceptable for organisations to deliver appraisal and revalidation differently. Doctors in difficulty must be supported and we need to make sure that standards of investigation, assessment and remediation of doctors is done to the same standard and all doctors are treated fairly. We do not want to see revalidation being more difficult for doctors who work in different situations
There are challenges ahead, and we need to balance the needs of doctors with the needs of the public and the NHS. We need to ensure consistency in the delivery of appraisal and revalidation. Revalidation has to be a positive process for GPs to help raise standards, protect patients and be straightforward for doctors with minimal disruption to their working lives. The RCGP will set standards and quality-assure the process so that revalidation is fair to GPs and patients.
Prof Nigel Sparrow is the RCGP Medical Director for Revalidation and a GP in Nottingham.