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Revalidation: A learning experience

December marks the first anniversary of revalidation and while it hasn’t been without its problems, 25,000 UK doctors have now been declared still fit to practise. The GMC chair Professor Sir Peter Rubin tells the BMA about the transition

Peter Rubin

It has been sparking controversy and anxiety since it was first proposed in the 1970s and there were long-running rows over what it should look like.

 

However, a year into the new process of ensuring doctors are up-to-date and fit to practise, GMC chair Professor Sir Peter Rubin (pictured) says the initial ‘noise’ has now diminished as the extensive lead-up to the process has allayed many fears.

Revalidation is not without its problems, he adds, and stresses that the process is constantly evolving. Research on its implementation and outcomes is already under way.

 

Arrow Listen to Sir Peter talk about his experience as the first doctor to be revalidated

 

Smooth process

Speaking on the first anniversary of the introduction of revalidation, Sir Peter says he feels the smooth implementation of the process is in part because the GMC listened to and acted on the concerns raised by doctors via organisations such as the BMA.

It was also the result of a realisation that revalidation was finally going to happen. The GMC says is the first time that such a system has been introduced across a national healthcare system.

‘The feedback has been that the process of revalidation was more straightforward than most of them thought it would be.

'But, again, I think that’s because it was new and no one knew quite what to expect and so overall the response has been hearteningly positive, the noise has largely gone away.

'If you think back a year or two, it’s very different now to what it was then,’ he says.

 

Part to play

 

‘I think it’s been helped by everyone who has been involved in this, playing their part in introducing what was a major change.

‘We put a huge amount of effort into publicity, into piloting, but we are also very grateful for the role played by the BMA and the medical royal colleges in understanding that revalidation was going to happen and playing their part in ensuring it was as straightforward as it could possibly be.’

Mark-Porter-QA-196x148The BMA lobbied on several principles it wanted to see in place before implementation.

These included:

  • Ensuring remediation was funded
  • Strengthening the role of responsible officers — who recommend a doctor is revalidated, to avoid conflicts of interest
  • Ensuring that the multi-source feedback to assess a doctors’ practice was properly validated.

BMA council chair Mark Porter (pictured) says: ‘The BMA has lobbied to make the process less onerous and also fairer to doctors ... We continue to liaise with the GMC over resolving issues such as ensuring doctors have the time to prepare for revalidation in a resource-pressured NHS.’

 

Trouble spots

 

The clamour for revalidation grew in response to a number of high-profile medical scandals including the high death rates among paediatric cardiac patients at the Bristol Royal Infirmary. Yet as a concept it was mooted some 40 years ago.

Last week, the GMC revealed that nearly 25,000 doctors have been revalidated in the first year of implementation. Countries including Australia and Canada are closely watching the UK’s lead.

Although Sir Peter says the process has been a lot smoother than expected — he says the GMC was ‘anticipating perhaps more teething problems than we actually had’ — it has not been without its challenges.

One of these difficulties was the timing of junior doctors’ revalidation dates, he says.

‘We thought we had a good idea for postgraduate trainees, having their revalidation date the same as their CCT [certificate of completion of training] date but, of course, the CCT can change so we’ve had to do a lot of deferrals purely because of a change in CCT date, which is not a big deal as far as the individual doctor is concerned but has been quite a bureaucratic issue for us,’ he says.

‘That was a useful learning experience.’

 

Locum challenge

 

GMC figures show 5,077 UK doctors deferred their revalidation date — many of these will be for reasons of parental or sick leave or career breaks, the regulator says.

Locum GPs have also experienced problems, largely due to the peripatetic nature of their work.

One locum GP wrote a blog on the BMA website, which provoked a huge response rate from doctors, describing how she felt forced to ‘jump through hoops’ to fulfil revalidation requirements and felt the process did not fit in with locum work where doctors often do not have audits to use or the chance to reflect on a particular case note.adrienne garner

Sir Peter says the GMC has been aware of this from the beginning and has been working with locum agencies to try to ensure the support is available to these doctors.

‘We have always known from the very beginning that locum doctors, particularly those who move around a lot, were going to find it more challenging than a doctor like me who just works in an organisation where everything is done for me in a way, which is why for several years now we have been working with locum agencies to ensure they are providing what they can.

'But it is very important that the NHS provides locum doctors, particularly locum GPs, with the information that they need.’

 

Stronger system

 

Revalidation has had an impact on the NHS appraisal system with 97.8 per cent of doctors, as of March this year, having a ‘designated body’ — an employer — with an appraisal policy in place.

Sir Peter says he hopes that the strengthened appraisal system will help identify problems early on, enabling them to be resolved locally.

Research into revalidation is being undertaken by Sir Keith Pearson who chaired the Revalidation Delivery Board which oversaw implementation.

It is the GMC’s intention to try to provide a snapshot of the medical profession before and after the introduction of revalidation using information from the GMC’s State of Medical Education and Practice as a baseline — this will take years.

 

Improved relationship

 

Sir Peter says: ‘It will identify the kind of issues that will bring a doctor to our attention and the kinds of interventions that have been effective.

'I think there’s an issue here about sharing the kind of good practice that has helped to identify problems locally and resolve them quickly. That is good practice that could be highlighted elsewhere.

‘We are very interested in the referrals to the GMC to see if the patterns change as a consequence of revalidation.’

Sir Peter hopes revalidation will help improve the GMC's reputation.

He says: ‘In the past I think the view was that a doctor needed to stay as clear of the GMC as they possibly could and we were seen — and to some extent still are seen — as the organisation that strikes doctors off the register, when in actual fact that’s quite a small part of what we do.

‘What revalidation will do is change that relationship to a much more positive one where we will be affirming and reaffirming a doctor’s quality.’

 

Sir Peter’s advice for revalidation

 

  • Gather all the information you need for appraisal
  • Read the GMC’s advice
  • Keep an e-portfolio for continuing professional development
  • Contact your responsible officer if you are having difficulties.