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The General Medical Council (GMC) first started to talk about the idea of revalidation for doctors in the mid- 1990’s. It was thought that the traditional way of doctors being put on a register and then practising for the next 30 years of their professional life without checks on their fitness to practise was no longer tenable.
The Bristol scandal was beginning to unfold and there was pressure for the profession to change. The public were surprised to know that doctors did not already have regular checks on their practice.
Appraisal for doctors had already been introduced, and it was thought that if appraisal were made more robust, that would suffice. The profession, the GMC and departments of health began work on introducing a system of revalidation based on appraisal. There were some philosophical disputes as to whether appraisal was summative and developmental or could be formative and judgemental about a doctor’s practice, or should be a mixture of both.
This debate was overtaken by the case of Harold Shipman, the doctor who was convicted of killing his patients with drug overdoses. Dame Janet Smith’s Inquiry into the Shipman case looked at the ways the profession was regulated, in order to prevent a further “Shipman”-like incident. She was highly critical of the proposals for revalidation, opining that they were not robust enough.
The Government’s response to the Shipman Inquiry resulted in the 2007 White Paper: Trust, Assurance and Safety - the Regulation of Health Professionals in the 21st Century and the GMC was obliged to respond by introducing more robust proposals for revalidation of all doctors.
Revalidation
Revalidation is the process by which doctors will, in future, demonstrate to the GMC on a regular basis that they remain up to date and fit to practise.
Stop Press - Update!!
As a member of the Academy of Medical Royal Colleges Steering Group on Revalidation, representing the Royal College of Physicians and Surgeons of Glasgow, I have had a hand in developing the standards that have been submitted to the GMC. All the work on standards has been co-ordinated by Ian Starke on behalf of the Federation and I believe he has done a spectacularly good job.
The standards have been signed off by the GMC in the last few weeks and will now go out for consultation in the near future. It is my understanding that the systems for appraisal and the collection of relevant information (e.g. audit and quality data) may be different in each of the UK countries but the result and standards will be the same. BGS members should not be put off by what now looks like a revalidation industry covering many issues. The process is likely to be incremental and won’t start before 2011. The key data required will be proof that the doctor has kept themselves up to date involves participation in clinical governance; multi source feedback from colleagues and patient feedback. Thus apart from MSF the requirements are not greatly different from now. With regard to CPD it is likely that with the fullness of time you will be required to have more CPD involving some form of on line self assessment, but no exam is are envisaged at the present time.
In Scotland the Health Department have embarked on a training programme to produce some 600 secondary care appraisers modeled on the Scottish On-line Appraisal Resource (SAOR http://www.scottishappraisal.scot.nhs.uk/ ), a GP appraisal system developed by NHS Education Scotland who also developed the e-portfolio now being used for core medical training. To this will need to be added the information detailing specialty requirements as outlined by Colleges.
Prof Paul Knight
Director of Medical Education (Associate Medical Director)
Royal Infirmary, Glasgow
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Revalidation will have three elements designed to:
- Confirm that licensed doctors practise in accordance with the GMC's generic standards.
- Confirm that doctors on the GMC's specialist register or GP register continue to meet the standards appropriate for their specialty.
- Identify for further investigation, and remediation, poor practice where local systems are not robust enough to do this or do not exist.
All licensed doctors will need to demonstrate to the GMC that they are practising in accordance with the generic standards of practice set by the GMC as described in Good Medical Practice. For most doctors, they will need to do this every five years. This is the process known as relicensing.
Relicensing
In order to relicense, doctors will need to collect a folder of information about their practice. This will include, for example, information about appraisal, CPD, audit, and patient and colleague feedback.
Relicensing will have three main elements:
- Participation in annual appraisal within the workplace (based on the doctor's folder of information).
- Participation in an independent process for obtaining feedback from colleagues and, where applicable, patients.
- Confirmation from the 'Responsible Officer' (usually the Medical Director, but that is not yet finalised in England) in their local healthcare organisation that any concerns about their practice have been resolved. The Responsible Officer will provide a recommendation to the GMC, on the basis of which the GMC will make a decision whether the doctor's licence should be renewed.
Most doctors already participate in annual appraisal and obtain feedback from patients and colleagues. Relicensing will build on what they are already doing.
Licences were issued by the GMC in November 2009. All BGS members should have received a letter about their licence. Their information is held electronically on the GMC register
Recertification
The second element of revalidation is recertification. This will apply only to those doctors who are on the GMC's specialist register or GP register. These doctors will need to demonstrate, through re-certification, that they continue to meet the particular standards that apply to their specialty or area of practice.
Work is being undertaken through close co-operation between the GMC, the medical Royal Colleges and the Academy of Medical Royal Colleges.
Doctors on the specialist register or GP register will not go through two separate processes, once to relicense and once to recertify, there will be one process.
The GMC have designed a framework covering the generic standards in Good Medical Practice, Research and Management. This covers 4 domains, namely, domain 1 – knowledge, skills and performance;
domain 2 – safety and quality; domain 3 – communication, partnership and teamwork; and
domain 4 – maintaining trust
The Federation of Physicians (including RCP London, RCPSG and RCP Edinburgh) has been meeting with the Specialist Societies in Medicine to devise a generic list of the evidence, which will need to be collected by ALL physicians to demonstrate that they are competent in their specialty. This will map against the GMC framework. The BGS has decided NOT to add more requirements to this generic list but will be issuing guidance to the membership of the sort of evidence they might collect - for instance, participation in CPD is required. A geriatrician who is doing the unselected acute medical intake will need to show CPD in general emergency medicine but also CPD in topics specific to the care of older people.
It is envisaged that there will eventually be an electronic system to generate the portfolio. In addition, the requirements will develop over time.
What does this mean for BGS members?
The important thing to note is that revalidation covers what you actually do. If you are a stroke physician, then you will have to demonstrate competency in stroke, if you do specialist continence clinics, then you need to demonstrate competency in that, if you don’t do the general medical intake then you may not need to show you are up to date in dealing with unselected medical emergencies.
Multi source feedback and feedback from patients is mandatory - there are examples of questionnaires on the Royal College of Physicians website.
Doctors outside the system
For doctors who are working outside of a managed organisation special arrangements will have to be made. This particularly applies to locum doctors who will need to be clear about the arrangements for their revalidation.
You need to be collecting evidence for your appraisals, as in the past and also be sure to do MSF and patient feedback questionnaires - the BGS is recommending these be done twice in a 5 year cycle.
Conclusion
As the work with the Federation continues, we will keep you apprised of any developments.
The question remains whether revalidation is going to make a substantive difference without making people feel vulnerable, but if it makes people more reflective about their behaviours and more receptive to patient feedback, it can only be a good thing.
Do contact us at the BGS if you have any queries and look at the GMC website
Linda Patterson
BGS Topic Lead
Recertification and Revalidation
BGS Newsletter, February 2010
Issue 25 ISSN 1748-634000 25 |