Taking revalidation forward

Sir Keith Pearson has carried out an independent review of revalidation. He gathered feedback from a range of individuals and organisations involved in the process and analysed recent research. Here, he talks about his key findings and where improvements are needed. 

I was asked to review revalidation. You might ask, why me? I’ve been involved in revalidation since 2009. I understand revalidation. But perhaps more importantly, I’m known as someone who constantly looks at healthcare through the lens of patients and the public. I have sought to answer the question:

Does medical revalidation provide assurance that doctors are up to date and fit to practise and do doctors reflect on the feedback they receive?

I think firstly we need to acknowledge the success of implementing revalidation – that was no small task. One of the great successes is that we launched a national revalidation process in December 2012 and, what I have discovered only 4 years on, is that it is very much owned at a local level. I don’t think we can dismiss the fact that doctors, no matter what medical field they work in, have an annual whole practice appraisal, which is something we didn’t have before.

Supporting information for revalidation, Taking forward revalidation, Fig. 2, p. 17

Supporting information for revalidation, Taking forward revalidation, Fig. 2, p. 17

I went to the four countries within the UK and met with responsible officers, appraisers, doctors’ representatives and system leaders, the Chief Medical Officers, employers and patient representatives, to name a few.

I think what I heard more than anything was that revalidation has settled – no one wanted to get rid of revalidation. Doctors agreed with the principle of revalidation and the fact it offers assurance to the public that they undergo a regular check to show they are safe to practise medicine.

I was surprised and heartened to hear some doctors tell me that they saw revalidation as a means of underpinning their own professional standing and I had not expected to hear that.

But there are doctors who do not fully support revalidation…

I interviewed many supporters of revalidation but I also sought out the views of doctors who were less than enthusiastic and yet to be fully convinced about the merits of revalidation. I heard that revalidation can be cumbersome; I heard that the burden in preparing for revalidation can be too much and I have advised within my review that this needs to be looked at.

Improving revalidation for all

I have identified a number of areas for improvement:

• I suggest that the burden for doctors can be reduced if organisations work towards providing better support and if they improve internal information systems. I heard across the UK that much of the information a doctor requires for revalidation sits on the systems of the provider they work for and that we need to make it easier for this information to be transferred to a doctor’s portfolio.

• Raising quality and consistency in appraisal is a priority. I do acknowledge that some appraisers and Responsible Officers are already undertaking work to assure the quality of appraisals and this is to be applauded.

Public awareness of revalidation needs to be increased if it is to fulfil its role in raising assurance. I hear consistently that the term revalidation has little meaning to the public – but the term re-licensing has considerable resonance and I recommend considering using this in the future.

I am troubled by the fact that we ask patients for their contribution to the revalidation process, their input into their doctor’s reflections, once in a five-year cycle. My view, and I express it through the report, is that any contact a patient has with a doctor should offer itself as an opportunity for that patient to be able to feedback on that doctor and for that to go into their portfolio.

Secondary care locums and doctors without a connection are weak points in the system and that need to be addressed. A doctor working in a non-standard setting should expect the same level of support from the body they work for as in any other setting. What I hope the review will do is not only shine a light on the needs of these doctors, but also on the importance of making sure the public can have confidence that all doctors working in the UK are up to date and fit to practise.

My concern is that doctors without a connection are sometimes falling outside the most exacting standards of revalidation. These doctors are required to have an annual appraisal in the same way as any other doctor, but there is limited assurance around the quality of those appraisals. And there is no obvious mechanism for identifying and dealing with low level concerns in respect of doctors without a Responsible Officer or Suitable Person. I believe the GMC and UK health departments should explore ways to bring doctors without a connection into the mainstream of revalidation.

So, does medical revalidation provide assurance that doctors are up to date and fit to practice?

I am assured that, since the introduction of medical revalidation, licensed doctors can now evidence that they continue to be up to date and fit to practise as a doctor in the UK.

I am further assured that all doctors holding a licence to practise in the UK are now in a managed system of governance that requires them to undertake an annual whole practice appraisal and to be revalidated once every five years – but I have identified areas where this governance can be made stronger.

Revalidation, alongside and underpinning other clinical governance and regulatory systems in the four countries of the UK, places the safety of patients as central to its purpose.

The report and my recommendations for improvement are now published. It’s available on the GMC’s website and I would encourage doctors to read it.

Click here to read Sir Keith Pearson’s full report, ‘Taking revalidation forward’ and the GMC’s response to the report,‘Our response to Sir Keith Pearson’s review of revalidation’, which includes the actions we will take forward and what we expect of others. 

Sir Keith Pearson

Sir Keith has worked in the healthcare sector for more than 30 years. He worked with BUPA for seventeen years and has held chair appointments in the NHS dating back to 1998. He is Chair of Health Education England and is also Chair of the GMC’s UK Revalidation Advisory Board. Apart from Sir Keith’s work in the NHS, Keith has been a Magistrate since 1999 and was appointed Deputy Lieutenant for the County of Cambridgeshire.

Related posts

Una Lane offers advice on how to handle revalidation if you don’t have a Responsible Officer

A group of doctors explain how they use the GMC’s My CPD app to log their learning on the move

GMC Chair, Prof Terence Stephenson, answers a common question: do I need a licence to practise if I no longer see patients? 

9 responses to “Taking revalidation forward

  1. The musical ‘La La Land’ is set to do well at the Oscars. It describes well the situation in my hospital and at the GMC concerning revalidation.

    Not one single senior or trainee doctor at my busy regional hospital had anything positive to say about it when I conducted a small survey last year.

    It is a massive distraction from delivering patient care in an increasingly chaotic environment. We are now producing Consultants who are vastly less experienced and capable than they used to be. THIS should be the major cause of concern …. not tick boxing those of us who have safely delivered a high standard of care for many, many years. I seriously wonder whether it weeds out problem doctors anyway. Harold Shipman would have flown through the process.

  2. I think you have created a bureaucratic leviathan of doubtful benefit to patient care and enormous cost to the NHS.

  3. It is unfortunate that the new recommendations are going to add nothing but more burden, more pressure and more distraction to a doctor’s already busy schedule.

    “Every patient should able offer feedback and that to be recorded in portfolio” – interesting. Then I suppose we should start video recording all patient to doctor interactions so that whatever the patient says can be REVALIDATED.

    What about huge cost burden with so many doctors not only being moved away from clinical services (so as to provide revalidation appraisal services) but also getting paid additional PAs and then their clinical work gets accumulated with long waiting lists etc and that work is being done by locums

    “Organisation data directly feeding to doctor’s portfolio.” Who is going to ensure confidentiality and editing the data and get a necessary technology etc. On top of that the doctor will have to input reflection for each of that data.

    One more important point to be taken in to account is honesty of the process of revalidation irrespective of the ethnic differences and conflicts of interests (or prejudices)

    Interestingly the Mr Pearson tries to convince he is sympathetic/empathetic with the doctors but due to his patient/public perspective ends up making it more difficult for doctors.

    Where are we heading

  4. This is appalling. This is clearly not an independent review if you have been involved in revalidation since it’s inception. Of all the things the GMC does, many of which I object to, my membership fees being spent on this ‘independent’ ‘review’ comes very near the top.

    Your suggestions appear to be to make revalidation even more labour intensive and to rename it re-licencing. Both of these suggestions are utter rubbish and will not address the issue revalidation was introduced in response to – Harold Shipman.

    I am appalled, but not in any way surprised.

  5. I was wondering whether we can expect some objective data on the impact (positive or negative) that revalidation implementation had or not. It would be useful to define some outcome measures and attempt to evaluate them. Revalidation needs its appraisal as well and although surveys are useful, the need for objectivity is compelling especially given the concerns raised.

  6. “I think what I heard more than anything was that revalidation has settled – no one wanted to get rid of revalidation. Doctors agreed with the principle of revalidation and the fact it offers assurance to the public that they undergo a regular check to show they are safe to practise medicine.”
    What utter nonsense, none of my 40+ colleagues think revalidation does anything but waste time and resources. No one wants it at ground level. Why is the UK the only country in the world to re-asses its medical practitioners post qualification outside of the examination system? Creates more bureaucratic jobs so you can all pat yourselves on the back for the great work you are doing?

  7. Revalidation should put to an end ,definitely a waste of time,money and energy . If NHS is that much concern ,practice oriented examination either oral or clinical can be introduced.

  8. Sir Keith is in the unfortunate position of having to support an apparatus which cannot be seen to be wrong. He is, in effect, a government stooge. The GMC can produce NO peer-reviewed scientific evidence whatever that revalidation has helped, and yet doctors themselves are constantly being asked to work on an evidence-based model. Why does the GMC insist on perpetuating this charade?
    If anyone had any doubt, then take a look at the recent Australian Medical Board discussion paper on how that country might revalidate its doctors. The one thing it does conclude is “we shall NOT be using the British system”. Take a look at that, Sir Keith!

  9. There is lot of debate about revalidation of doctors in NHS. Revalidation in theory is an excellent idea and reassures the public, the profession and also the nation. Fundamental purpose of revalidation is to make sure patients are safe and doctors provide safe and good care to their patients. No one can argue on these basic ethos. But current revalidation process doesn’t do that. Revalidating a doctor who is dangerous and doesn’t provide good care is much more dangerous than not having revalidation! This gives false reassurance to the public and patients!

    GMC has come a long way and I am very proud of GMC and respect current leadership. I have no doubt Prof Terrence Stephenson is keen to get professional regulation right and I wish him all the best. But as long as we have a system where clinical staff are well regulated but managers and leaders of NHS are not regulated, we are in danger of doctors and nurses getting blamed for systems failure. NHS culture of naming, shaming, blaming, bullying, discrimination, harassment and victimisation is causing lot of harm to patients and many hard working staff depending on their skill colour, race, gender, ethnicity and so on. Sad reality in our NHS is its club culture, old boys network way of working and some bullies, poor leaders, managers and poor clinicians get away with murder while other innocent staff suffer. BME staff and those who raise genuine concerns are severely punished while those who are close to the club or support management are rewarded by Clinical excellence awards or senior leadership positions irrespective of their abilities or capabilities!

    NHS has some very good leaders and I sincerely hope all these leaders come together and transform the NHS and make it one of the safest, the best and most vibrant health and social care in the World. It simply need good leaders with good governance and accountability from top to bottom and from Board to ward! Unless we focus on culture, values, leadership, governance I doubt if we will ever make NHS safer and better! I am very proud of NHS and social care and together we got to transform both of them and creating a bureaucratic, over regulated NHS is not the way to make it safer or better.

Leave a comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s