Features: Revalidation: Your questions answered

The March special on Revalidation

29 March 2010

As part of the Revalidation Update publication, we answer some myths and questions about revalidation

It is unreasonable for me to have to prove every year that I am competent so that I can have my licence renewed.

Revalidation will not be an annual event. Doctors will need to take part in annual appraisal within the workplace, but most doctors already do this. Successful completion of annual appraisals over the course of five years will provide the basis for doctors’ revalidation. Revalidation will simply affirm what has already been demonstrated through the appraisal process. If the appraisal process does throw up any issues, they should be dealt with in the normal way. By the point of the fifth appraisal, revalidation should be a formality, based on what has happened over the previous five years.

Revalidation will be expensive, and all the costs will have to be borne by the profession.

Revalidation is based on strengthening local systems of clinical governance and appraisal in the NHS and independent sector organisations. These systems are not an optional extra; they are a prerequisite for safe and effective care and should form part of any good healthcare system. The requirements of revalidation should therefore already be in place as part of current appraisal processes. Where local systems require strengthening, the cost should not fall on individual doctors.

Revalidation is yet another example of bureaucracy overtaking doctors’ professional lives, rather than caring for patients.

It is important that revalidation does not create unnecessary burdens that will hamper doctors in fulfilling their main concern of caring for patients. For most doctors, revalidation should not mean having to do new things or change the way they work. The key is to enable greater assurance to be derived, as far as practicable, from existing professional activities that are worthwhile in themselves rather than new activities devised for revalidation. We will do everything we can to ensure that it does not involve wasted time, but we do believe that effective appraisal systems are important and can encourage more reflective practice and ultimately better care for patients.

Revalidation seems to be just about catching ‘bad apples’ not about supporting doctors.

Revalidation is not about tackling poor practice, although it does rely on robust clinical governance arrangements which should identify underperforming practitioners. Revalidation is about providing a positive assurance for the public, employers and the profession that doctors are practising to the appropriate professional standards. It should help doctors maintain and improve their practice and ensure that the organisations in which doctors work support them in keeping their practice up to date.
The vast majority of doctors do an excellent job, often in difficult circumstances. In the small number of cases where local clinical governance and appraisal identify problems, it is in everyone’s interests that these are identified early and appropriate support is given. This should minimise the chances of the problems becoming serious enough to affect the doctor’s subsequent revalidation or of having to involve the GMC.

Revalidation is being introduced without being comprehensively tested.

We are committed to piloting all aspects of revalidation thoroughly before the process is launched and we are working closely with the four departments of health who are funding pilots in each of the four countries of the UK. Piloting is already underway and will increase in scope and intensity over the next 18 months. For more information on the pilots that are running up and down the country, visit www.gmc-uk.org/doctors/licensing/revalidation_projects_and_pilots.asp.

Revalidation will only be introduced once we are satisfied that the local systems necessary to support doctors in meeting the requirements of revalidation have been properly tested and are sufficiently mature.

Isn’t revalidation really all about catching the next Harold Shipman?

This is a common misconception – whatever revalidation is about it is not about catching serial killers. Instead, it is one of several mechanisms intended to improve the quality of care by focusing on doctors’ efforts to keep up to date and improve their practice. It is true though that better appraisal and clinical governance should help to identify some doctors whose practice is not meeting the required standards – they will need support to improve their practice through local remediation in their own healthcare organisations, with the support of the deanery, college or faculty, or with advice or assessment from the National Clinical Assessment Service.