This blog is a word to word account from Sir Keith Pearson's report on the state of the medical revalidation exercise for UK doctors.
Revalidation – influences and objectives
Revalidation was under consideration and development for over a decade before its introduction in December 2012. I do not intend to provide a detailed history of its evolution – others have done this already. However I think there is merit in highlighting the key events that contributed to the journey and influenced the current shape of revalidation. A summary timeline of these events is included at Annex C.
No one single event triggered the start of discussions around revalidation. Changing expectations of patients emerged from several high-profile public inquiries into failings in the provision of care. There were calls for more transparency in the governance of the care provided by the NHS and greater accountability – both system and personal – for that care. And it was suggested that there should be some form of regular checks on doctors.
It is a common misconception that revalidation was devised in response to the Shipman inquiry. In fact, revalidation had been proposed by the GMC in 1998, before Shipman was even arrested. Its rationale was not to uncover criminality but to fill a gap in the regulatory framework whereby, barring serious concerns being raised, a doctor could practise from registration to retirement without any check on their performance or competency.
What revalidation set out to achieve
The GMC and the chief medical officers of the four UK countries set out their overall objective for revalidation in a joint Statement of Intent published in October 2010: “The purpose of revalidation is to assure patients and the public, employers and other healthcare professionals that licensed doctors are up to date and fit to practise.” Revalidation marks a departure from the traditional method of regulation for doctors. Most professional regulators, including the GMC, regulate by controlling access to a register. Doctors are admitted to the register once they have attained the correct qualifications, training and experience. However, the register only records past qualifications. It is not a contemporary account, and so it offers limited assurance that any particular doctor is as up to date now as they were when they entered the register, or that their practice across the range of their work is safe. Before revalidation, doctors would remain on the register without having to demonstrate their ongoing competence, unless a serious issue was identified about their fitness to practise and they were referred to the GMC.
Patients want to be assured that doctors are keeping up to date and are safe to practise. Revalidation was introduced to provide that assurance. All doctors who hold a licence are now subject to continuing evaluation of their practice in their everyday working environment. This means that holding a licence to practise has extra significance – it means that anyone holding a licence should now be engaged in revalidation and working within a governance framework that regularly checks to make sure they are up to date, fit to practise and that there are no outstanding concerns.
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