Features: Making revalidation work for doctors
29 March 2010
Supporting doctors’ practice and encouraging professional development
As well as promoting public confidence in the profession, writes Malcolm Lewis, a Wales-based GP and Chair of the GMC’s Continued Practice Board, revalidation will support doctors’ practice and encourage professional development. Here he looks at how the new process will work.
Revalidation will neither be a ‘box-ticking’ exercise nor a punitive process. What it will be is relevant to our day-to-day medical practice and built upon systems that should already exist in the workplace to support high-quality care. The GMC and other organisations are determined to make sure that it will be neither burdensome nor hamper us in any way in fulfilling our main duty: caring for our patients.
Appraisals
Revalidation will not be a single point-in-time assessment of a doctor’s knowledge and skills. Instead, it will be based on a continuing evaluation of doctors’ actual performance in the workplace.
It will be based on local systems of appraisal which will need to include an evaluation of the doctor’s performance against the generic standards set by the GMC and the specialist or general practice standards set by the Medical Royal Colleges and Faculties and agreed by the GMC. This means surgeons will be evaluated in their work as surgeons, GPs will be evaluated in their work as GPs and so on.
For most doctors, taking part in an annual appraisal will be nothing new. However, for the purposes of revalidation, it will be essential that these appraisals include an evaluation of performance against the relevant national standards.
Doctors will need to maintain a folder or portfolio of information drawn from their practice to show how they are meeting the required standards. This will provide the basis for discussion at their annual appraisal. (For more information on the standards, see our article Working together: doctors and employers.)
Because each doctor’s practice is different, the information collected will vary. After a period of usually five years, these appraisals will be used to inform the doctor’s revalidation. By linking performance to national standards and identifying areas for action, any concerns should be addressed long before a doctor is required to revalidate. To that extent revalidation will be automatic; it should simply affirm periodically what has already been demonstrated through the appraisal process.
Responsible Officers
To revalidate a doctor, the GMC will require assurance that he or she is meeting the required standards and that there are no known concerns about their practice.
In most cases, this revalidation recommendation will come to the GMC via the local Responsible Officer. This is a new role created under the provisions of the Health and Social Care Act 2008. Although there will be some differences between England, Scotland, Wales and Northern Ireland, the Responsible Officer will generally be a senior doctor in a healthcare organisation, such as the medical director.
To make a revalidation recommendation to the GMC, the Responsible Officer will rely on the outcome of a doctor’s annual appraisals over the course of five years, combined with information drawn from the clinical governance systems of the organisation in which the doctor works.
In a large organisation, the Responsible Officer may cover several thousand doctors spread across a range of different specialties. It is not realistic to expect one Responsible Officer to be familiar with the practice of every doctor in that organisation, so the person conducting the appraisal (who will usually be from the doctor’s own specialty) will therefore have a crucial role in informing the Responsible Officer’s recommendation.
The Responsible Officer will also be able to draw on advice from others and particularly have regard to the specialty standards developed by the Medical Royal Colleges and Faculties and approved by the GMC.
Once the Responsible Officer makes a recommendation to the GMC about a doctor’s revalidation (normally every five years), it will then be for the GMC to decide whether the doctor concerned should be revalidated. The GMC will itself need to be confident that the recommendations are robust, fair and consistently applied.
Both the process leading to the recommendations, and the recommendations themselves, will therefore be subject to quality assurance and audit.
I am confident that the vast majority of doctors will have no difficulty meeting the standards for revalidation. These doctors will retain their licence to practise until their next revalidation is due. This will generally be after a further five years.
Outside standard practice
Some doctors will be in wholly independent practice, or working in organisations that do not provide an appropriate appraisal system or a Responsible Officer.
These doctors are strongly advised to make alternative arrangements to ensure they undergo an appropriate and regular appraisal and that they link up with a Responsible Officer once they are in place. This will make their revalidation more straightforward. In particular, it will help to ensure that they are meeting the requirements before the time comes for them to revalidate.
There are a number of organisations that may be able to help with this. The Independent Doctors Federation, the Royal Society of Medicine, and some Medical Royal Colleges or Faculties are considering providing appraisal or Responsible Officer facilities for their members.
Affirming good practice
The proposals for revalidating doctors should not exist in isolation from other systems designed to assure the quality of care. Revalidation will focus on affirming good practice for the vast majority of doctors but will complement other systems for detecting concerns about practice.
The key is to enable this assurance to be achieved, as far as practicable, from existing professional activities that are worthwhile in themselves rather than new activities additional costs on the healthcare service and the time we have to spend away from our patients.