This blog is a word to word account from Sir Keith Pearson’s report on the outline of the medical revalidation model for UK doctors.
The medical register and the licence to practise
- Registration with the GMC demonstrates a doctor has the necessary qualifications and is in good standing. However, holding a licence to practise is what allows doctors to undertake medical practice in the UK. Any doctor wishing to practise medicine in the UK must be both registered and licensed with the GMC – irrespective of whether they practise in the NHS or privately, part time or full time, or are self-employed.
- As of 30 September 2016, 273,146 doctors held full registration with the GMC. Of those, 229,992 held a licence to practise and were therefore subject to revalidation. The remaining 43,154 were unlicensed: they may be working overseas, retired or employed in a non-clinical role.
Outline of the revalidation model
- Revalidation is based on a doctor’s whole scope of practice across all the settings in which they work. For most doctors, the evaluation of that practice takes place in the environment in which the doctor works and is part of the wider clinical governance system within an organisation.
- Revalidation is not a point-in-time assessment or merely a demonstration of training and development activities undertaken.
- All doctors are required to have an annual appraisal that covers the whole of their practice. The GMC has described the supporting information that doctors are required to bring to their whole practice appraisals to demonstrate that they are meeting the standards in the GMC’s core guidance for doctors – Good medical practice. Most of the supporting information is generated in the doctor’s day-to-day practice or is available within their workplace. Doctors need to reflect on and identify learning from continuing professional development, feedback from colleagues and patients, any complaints or compliments made about them, any significant events they were involved in, and quality improvement activities.
- The vast majority of doctors have a prescribed connection to a designated body set out in the RO Regulations.* These regulations established arrangements for ROs to be appointed by each designated body (healthcare organisations and certain other bodies), with responsibilities relating to the evaluation of the fitness to practise of doctors who work in the body. When a doctor moves to work in a different body, their prescribed connection will change.
- Generally once every five years, a doctor’s RO will make a recommendation to the GMC to confirm that the doctor has been engaging in revalidation and there are no outstanding concerns about the doctor’s practice. Alternatively, the RO may recommend deferring the doctor’s revalidation date (for example, to give them more time to collect the necessary evidence) or inform the GMC that a doctor is not participating in revalidation by sending a non-engagement recommendation. In the latter case, if it is clear that the doctor is not sufficiently engaging with revalidation, the GMC can withdraw their licence to practise. This means that, although the doctor remains registered with the GMC, they can no longer practise in the UK.
- If an RO has concerns about a doctor’s fitness to practise (as distinct from concerns about their engagement with revalidation) which they cannot resolve locally, they may refer them into the GMC’s fitness to practise processes. This occurs separately from the revalidation process. Where the GMC decides to investigate, the doctor’s revalidation is placed on hold.
- Where a doctor does not have a prescribed connection under the RO Regulations, the GMC may approve a Suitable Person (SP) to make recommendations about that doctor’s revalidation. 1,002 doctors were connected to SPs approved by the GMC as at 30 September 2016.
- There are a small number of licensed doctors (4,366 on 30 September 2016) who do not have an RO or an SP. Doctors who do not have an RO or SP are still required to revalidate. These doctors are typically working on an occasional basis, outside clinical environments or are based overseas: the majority do not require their licence to practise. The process for them involves providing evidence directly to the GMC on an annual basis, showing that they have had an annual whole practice appraisal and providing statements from organisations to which they provide medical services confirming that there are no fitness to practise concerns. They must also take part in an assessment to demonstrate their medical knowledge once in every cycle.
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