Revalidation Doctor General practitioner

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Why is revalidation necessary?

The vast majority of doctors are good doctors - they have the skills and experience to deliver first-class care and, with support, most are able to do this. But just as the capacity of doctors to do good has never been greater, the risks associated with medical care are also greater than ever.

Making sure that we use and support this incredible skills base, and recognise the importance of quality and safety in doing so is what revalidation is all about.

Most patients think that there is a system in place already. They believe that, as in most jobs, and certainly all those where there is a safety-critical component, doctors are appraised and given feedback on their professional performance.

Revalidation will help strengthen the trust patients have in their doctors by making sure that all doctors are part of a governed system in which employers and contractors have to provide support, have a system of regular appraisals and be satisfied that the doctors who work for them are up to date and fit to practise.

Revalidation is not a panacea but it will provide a strong link between the core guidance for doctors, Good Medical Practice, and their regular appraisal. This will mean that doctors are regularly checked against the professional standards patients expect them to meet.

Over time, we believe revalidation will identify problems in some doctors' practice earlier and, more widely, that it will encourage self-reflection. That must be good for both patients and doctors because it will help to improve the care patients receive.

Revalidation is not something strange or peripheral that the medical profession is engaged with - it is one small but vital component in building a safer higher quality healthcare system.

 

Why has revalidation taken so long to implement?

It has taken much too long. The profession began to discuss this back in the 1990s and, to be fair, there were relatively advanced plans by 2004-2005, but the then government decided to undertake a major review following the Shipman Inquiry. The result is probably a more robust system but it has meant further delay.

However, we should not understate the scale of what is involved. This is a UK-wide programme affecting 230,000 licensed doctors and hundreds of organisations. It was bound to take time to deliver change on this scale and it has taken time to refine and test the plans.

On the other hand, we have to acknowledge that revalidation, in large part, is only requiring the health system to do what it should have been doing for about 10 years. Annual appraisal has been part of most doctors' contracts since the early 2000s, yet until now the record of the NHS has been patchy.

The immediate upside of revalidation, even before it starts, is that employers have had to strengthen their appraisal and clinical governance systems. Just about every inquiry into poor standards of care has shown institutions where clinical governance is weak.

The good news is that considerable progress continues to be made across the UK and we are confident we will be in a position to begin revalidation at the end of this year as planned.

 

There have been a few false starts on implementing revalidation before - why is this time different?

We are in a totally different place now. The medical profession is more engaged; the approach has been agreed; employers and the four governments of the UK are all fully on board.

The regulations which underpin revalidation and which have brought in responsible officers have been approved by Parliament. The effect is to give responsible officers the statutory duty to provide appraisals, make sure doctors have access to the supporting information they need, as well as dealing with any concerns about doctors on their lists.

There is also strong and broad political support and among patient groups a determination to make sure this time it will go ahead.

 

What are the GMC's key messages to doctors on revalidation?

This is about underpinning the trust your patients have in you and your colleagues. Doctors who have a licence to practise will have demonstrated on an ongoing basis that they are competent and fit to practise in the area of medicine in which they operate. That has to be good for patients but it is also good for the profession as a whole.

Revalidation, and the systems that underpin it, should also mean that doctors have access to the support they need to maintain and improve their practice as well as the opportunity to reflect regularly on their practice and how it could be changed and improved.

Over time, revalidation should help to improve the quality of care that patients receive and if doctors embrace this process and drive forward new and better ways of assessing clinical performance, and of benchmarking, the gains could be considerable.

The other important point is that while we want to make sure every doctor has a well-constructed and conducted annual appraisal, and is given the support needed to collect information about their practice, we do not intend to revalidate all doctors immediately.

The idea is to roll out the process over the next few years. In short, while not every doctor needs to be 100 per cent ready to revalidate by the end of this year, all doctors do need to be getting ready.

For most licensed doctors, this means they need to have an annual appraisal, with Good Medical Practice as its focus, and that they are collecting the required supporting information, as set out in our guidance.

We will keep doctors updated and tell them exactly what they need to do and by when, in order that they will be ready to revalidate. There is growing evidence that we are making good progress towards being ready to begin revalidation.