Fit to practise? Doctors to receive competency tests

Doctors will be given annual assessments and full five-yearly checks to ensure they are still competent and fit to practise starting from December, the health secretary, Jeremy Hunt, will announce today in a surprise move that puts an end to more than a decade of negotiation. (From The Guardian…)

Revalidation of doctors had its origins in public concern over scandals such as the deaths of the Bristol babies and the botched surgery of gynaecologist Rodney Ledward. The former General Medical Council president Sir Donald Irvine said as early as 2000, when he launched the revalidation proposals, that the public assumed checks were made that doctors continued to be fit to practise – but that was not the case.

As the start date was finally announced, Niall Dickson, chief executive of the GMC, said it was a “historic moment … the biggest change in medical regulation for more than 150 years”.

The GMC will be responsible for revalidation, which will be on the basis of a dossier of evidence of a doctor’s competence compiled over five years. This will include annual assessments and patient questionnaires.

The negotiations with doctors’ leaders at the British Medical Association over how revalidation would be carried out has caused some of the long delays. The BMA has traditionally been wary, while saying that it supports the principle.

Plans were under way at the time of the Shipman inquiry in 2005, but Dame Janet Smith, who chaired it, was strongly critical, saying the proposals would not ensure that failing and bad doctors were picked up, so they had to be reworked.

Dickson said: “The decision to press ahead with revalidation after many years of preparation and planning means that we’ll be able to have a comprehensive system of regular checks for all doctors registered in the UK. Every NHS doctor is already supposed to have an annual appraisal but until revalidation appeared on the horizon many organisations were simply not achieving this. Now both the NHS and private healthcare organisations have begun to get their act together.

“Revalidation is not a panacea. It is not a magic bullet to guarantee that care is safe or that every doctor is perfect. It will take time to settle in. We will need to evaluate and improve the model.”

Hunt, in one of his first major announcements in the job, said: “We want to have the best survival rates in Europe for the major killer diseases.

“Doctors save lives every day and making sure they are up to speed with the latest treatments and technologies will help them save even more. This is why a proper system of revalidation is so important.”

The health secretary appears to have decided it is important to get the system up and running and sort out problems later. The NHS medical director, Sir Bruce Keogh, admitted that the system would not be immediately perfect, but said: “My personal view is that it is better to start than wait for perfection. I think that every doctor has a duty to be able to describe what they do and to define how well they do it — if you can’t do that you forfeit some of your professionalism. The process of assessing doctors in this new revalidation process is based on a beefed-up appraisal system within the NHS.”

First to be revalidated in December will be medical leaders. From next April, all doctors will be in the process.

The BMA gave the announcement a lukewarm welcome. “The BMA has always supported the principle of revalidation. We believe it is important that our patients have confidence that doctors have up-to-date skills and knowledge to be able to offer them the best possible care,” said Dr Mark Porter, chair of the BMA council.

“It is important to recognise, that while revalidation will undoubtedly enhance the rigorous testing that doctors undergo, clinicians are already offering patients a very high quality service and robust systems are currently in place to deal with any concerns.

“There is too much bureaucracy in the NHS and so we have to be careful that revalidation does not add to this unnecessarily. The system soon to be rolled out is much better to the one initially put forward. But we still need to ensure consistency across the UK so that all doctors are working to the same standards. And it is vital that sufficient support exists across the UK for those doctors who need it.” Revalidation would need to be monitored every step of the way to ensure it served the interests of both patients and doctors, he added.

The medical royal colleges, which have worked with the GMC on setting standards all doctors ought to meet for each specialism, were more enthusiastic.

Professor Mike Pringle of the Royal College of General Practitioners said: “We have worked hard to ensure that revalidation will be as effective for GPs and patients as possible. We have listened to the ideas and concerns of patients, GPs and colleagues and are confident that revalidation will not be an onerous task for GPs. It will help them in many ways to ensure they provide good care for patients.”

Sir Richard Thompson, president of the Royal College of Physicians, said: “Regular participation in the revalidation process will support physicians to develop and maintain the highest standards of care for their patients, and to achieve excellence in their professional lives.”

Dean Royles, director of the NHS Employers organisation, said revalidation was “a very positive step forward and should herald greater patient safety and build confidence. Patients need and expect this. Revalidation is a key part of ensuring safe, modern care for patients.

“Most importantly, it is crucial for assuring doctors that they are providing the highest levels of service. The introduction of regular tests and more appraisals will help engage doctors positively with the mandatory process of retaining their licence to practise. Many patients will be surprised this isn’t happening already.

“It would be great to see some of the country’s most senior doctors now putting themselves forward to be first in line for revalidation.”

The government was criticised by unions after it emerged that its health reforms will cost an estimated £1.5bn-£1.6bn, £300m more than had previously been thought.

“The money spent on the reorganisation of the NHS for the benefit of private healthcare companies, whose priority is profits for shareholders at the expense of patient care, would have been better spent on frontline services for the sick and the ill,” said Unite’s head of health, Rachael Maskell.

A Department of Health said: “These are one-off costs. By investing in these changes we will be able to reduce unnecessary bureaucracy and free up extra resources – £5.5bn during this parliament and £1.5 bn every year thereafter – for patient care.”

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