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‘Good enough’ must be the standard for revalidation



GPs understand how and why the process of revalidation has come into being. Now that it has it is worth taking a step back and checking that it is fit for purpose. What are we trying to achieve? The laudable aim is to identify GPs whose health, performance or conduct represents a risk to public safety or to the profession itself.

I lead performance assessment teams for the GMC. Those of us involved in the fitness to practice procedures are aware that doctors who give cause for concern tend to do so consistently and have little insight into the consequences of their actions. It is these colleagues who the revalidation process is trying to identify, ideally before harm has been done.

But the most salient fact is that, the numbers involved are very small, and I would reassure the rest of the profession that there should be nothing to fear from revalidation.

Basic stats

Those with a basic understanding of statistics but few politicians will appreciate that ‘average’ is in the middle of the distribution curve and 50% of observations will fall beneath it. We should not therefore be promulgating the idea that we are looking to weed out ‘below average’ doctors as 50% of the profession would lose their jobs. Neither those concerned nor the country can afford this. Less than 100 doctors undergo performance assessment each year and this is the group we should focus on identifying.

This leads to the standard to be set. The GMC standard is ‘acceptable’, not first class. While we should be encouraged to be good, ‘above average’ should remain an aspiration, and the revalidation standard should be good enough.

Asking too much

Five satisfactory annual appraisals with production of a portfolio of evidence are required before a revalidation recommendation is made by the responsible officer. We have great concerns arising from reports that some appraisers and responsible officers are applying their own aspirational standards rather than that of being acceptable. This is putting unnecessary pressure on General Practice which is already stretched to breaking point. Those who are conscientious will be driven harder to jump through ever higher hoops and amass unnecessarily gold standard evidence. It could become the proverbial straw that breaks the camel’s back and lead to good doctors leaving the profession before they had intended to. As well as this being a personal tragedy, it would in turn have profound workforce implications.

Having set a standard it is important that this is applied consistently across the country. The hoops should be the same diameter, height and distance apart whether you work in Dartford or Darlington, Carlisle or Canterbury.

The Cornwall and Isles of Scilly motion at LMC conference noted these inconsistencies. We called for the GPC to lobby for a nationally-agreed standard of evidence for GP appraisal in England and an overarching national appraisal board to ensure evidence for appraisal is consistent and proportionate. The motion was passed, but in order to take this forward it will be important to stand together, look at the bigger picture and understand the concepts involved. There is an important role for national oversight and the grassroots clinician should feel supported, rather than intimidated, by this.

Dr Sarah Gray is a GP in Truro and a member of Cornwall and the Isles of Scilly LMC.