The Health Select Committee (HSC), appointed by the House of Commons to examine the policy of the Department of Health, has published a report into the revalidation of doctors entitled Health Committee - Fourth Report - Revalidation of Doctors – the policy of proactively ensuring that practitioners registered to practise remain safe and competent to do so.
The General Medical Council (GMC), which first proposed a formal process of revalidation in 2000, undertook a consultation on its latest proposals early last year. This being just the latest round in a debate that has now been going on for over a decade, the HSC was keen to establish the reasons for the lack of progress, even though the GMC itself is accountable to the Privy Council and not directly to the Secretary of State.
The initial proposal was that there be two components to revalidation: relicensing, under which all professionals were to demonstrate that they remained fit to practise in accordance with the GMC’s generic standards, and recertification, by which specialist doctors and GPs would need to demonstrate that they remained competent in their specialism. However, it was later decided that the system would be more effective if it operated as a single set of processes, rather than two, based on a continuing evaluation of doctors’ performance in the workplace by a network of responsible officers.
When the GMC’s consultation was launched, it was intended that revalidation would be put in place in 2011. However, when Andrew Lansley came into post, he felt it was necessary to extend the pilot period by a further twelve months, in order to develop a clearer understanding of the costs, benefits and practicalities of implementation. This put the launch of revalidation back to late 2012. The HSC has tasked the GMC with ensuring that there are no further delays in implementation, so that the current target date can be achieved. By that date, the GMC also needs to be clear about where responsible officers currently based in PCTs will be situated in the post-PCT world.
The HSC felt that the consultation had given too little attention to the issue of how to deal with doctors whose practice gives cause for concern. While it was important to ensure the rights and legitimate interests of individual doctors were safeguarded, the primary purpose of revalidation was the protection of patients. The committee therefore recommended that the GMC publish guidance to responsible officers on how they should deal with doctors whose performance gives rise to concern and how to deal with any conflicts of interests arising out of their dual role as medical directors - members of the employers’ senior management team - and responsible officers making recommendations about revalidation.
The HSC also expressed concern about the variation in the quality of appraisals across the country and enjoined the GMC to ensure that all organisations which employ doctors have satisfactory, robust and consistent systems of appraisal in place on a timescale consistent with the introduction of revalidation in late 2012. The HSC confirmed that patients’ and colleagues’ views must be an integral part of the process and welcomed the GMC’s commitment to strengthening its proposals on both of these fronts.
As to the incorporation of doctors from elsewhere in the European Union into the revalidation system, the HSC accepted that the current legislation was an impediment to ascertaining the existence of performance concerns amongst EU doctors. However, it left the GMC in no doubt that if it lacks the powers to assess such a doctor’s ability to communicate effectively with his or her patients; it is for the GMC to say so publicly and to report to Parliament what changes are necessary to enable it to fulfil its functions effectively.
Henceforth, as a mechanism to improve the scrutiny of the GMC, the HSC announced that it intends to exercise the accountability function nominally held by the Privy Council on behalf of Parliament. The GMC will, accordingly, give oral evidence to the committee each year on its annual report.