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.
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 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.
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