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Revalidation double-think



You will, I am sure, be looking forward to revalidation. Doubtless you’ve always felt that what general practice needed was an invigorating dash of paperwork, and you’re probably pleased that NHS resources are being redirected in this valuable way, rather than frittered away on your patients.

So I offer my sincere apologies for blunting your enthusiasm by having a whinge. Some of this whinge is long overdue, but it’s only now that I have a forum for forcing you to share in it. Sorry – I will try to make it relevant, and at least this is only a short article. I don’t intend to address the issue of the revalidation project’s cost, or questionable projected benefits, as these have already been pulled apart by people far more qualified to do so.

What interests me is the stark doublethink that the whole process exposes. Back in 2008, I worked in the oncology department of a tertiary referral centre. I was a first year SHO, or to give the then freshly-minted newspeak, an FY2.  This dual identity provided a bizarre insight into the changing way doctors were starting to be perceived.

By night, I was an SHO. I was the sole provider of medical care for three oncology wards, including a haematology ward where people did their level best to rapidly die of things I’d never even read about. I’m forever grateful to one of the wonderful nurses for an on-the-hoof tutorial on ATRA syndrome, and more importantly how to stop gibbering and do something about it. There were constant tough calls to make, and fairly soon I felt I could look older, less cosseted doctors in the eye. At night, when it suited the hospital’s needs, I was a fully qualified doctor who needed no supervision.

By day however, there were plenty of registrars and consultants around, and a remarkable transformation took place. Like Clark Kent having kryptonite snuck into his cornflakes, I instantly lost my super-powers and became a new-style FY2. This meant that I was, by any measure that mattered, quite suddenly an irredeemable moron. In order to show that we could do anything at all, my cohort of doctors had to have a piece of paper to prove it.

A friend once had to put in bilateral chest drains and a central line during a night shift. Because it was portfolio season, she then spent the next morning chasing her consultant around, trying to get a signature confirming that she was competent to take a blood sample.

The whole of general practice today is in a similar position to those exhaustedly chimeric SHOs/FY2s of a few years ago. When it suits the politicians to say so, we are the solid bedrock of the NHS, the new beating heart of its decision-making process. But when their priorities change, and sometimes even simultaneously, we are all potential Shipmans: dodgy mavericks who need to be watched at every turn.

This isn’t a productive way for us and our political leaders to work together. They need to be honest and consistent in their dealings with us; we need them to trust us, and to treat us like grown-ups. Revalidation is going to be a time-consuming and demoralising white elephant, just when we can least afford it.

Dr Nick Ramscar is a GP in Bracknell, Berkshire