Who will win the tug-of-war over CPD and SPAs?

I got an email from the GMC this morning. It’s a press release about revalidation. The opening line says: ‘Revalidation, the regular assurance that all doctors with a licence are competent and fit to practise, is on its way.’

It calls on doctors and patients to take part in a major consultation to help shape the process. This will run from three months from 1 March.

Revalidation has been on its way for a long time, and it’s still got some distance to travel. While all doctors now have a licence to practise and pilot studies into the process of revalidation have started, they won’t be completed until 31 March 2011. The full process will not be rolled out until some time in late 2011 or early 2012. So, while ‘it’s on its way’ don’t hold your breath.

I suppose we should be grateful that the GMC is at least seeking to engage the profession in developing the model. And initial feedback from the pilots is positive.

Will revalidation catch potential serial killers? Of course it won’t. Will revalidation put more focus on professional development? Probably. A more rigorous and consistent approach to CPD and appraisal could contribute to raising the quality of practise, if it’s not matched with a rise in bureaucracy.

But there are still some big lumpy problems with revalidation. Others have highlighted ongoing confusion about overall purpose, problems with responsible officers and ‘agreed statements of concern’.

Cost is a big one and not much discussed. Appraisers, affiliates and responsible officers all need to be trained. The system needs to be coordinated and managed. The GMC affiliate pilots for example proved expensive.

Another cost issue emerged this week: the allocation of supporting professional activities (SPAs) to consultants by trusts. A recent leaked document from the Foundation Trust Network revealed that many employers will seek to reduce consultants’ SPAs to one per week within their job plans.

However, the Association of Medical Royal Colleges has just released a position statement on SPAs which supports the original recommendation of 2.5 per week. It also makes the important point that if revalidation is to be effective it will demand more SPA time not less.

It says the process of revalidation and the work that underlies it - such as CPD, audit, multi-source feedback, patient feedback and critical incident review - is all work that should be accommodated within SPA time.

So how many SPAs will consultants need post revalidation if the process is to be taken seriously? Three at least, when all the other ingredients such as - teaching, training, education, audit, appraisal, research, clinical management, clinical governance, service development - are taken into consideration.

Few trusts are going to pay for this. Balancing the books will clearly be a higher priority to them that supporting the principles of revalidation. These are the real world issues that people like Dame Janet Smith, sitting in their ivory towers, never appreciate.

Revalidation has the potential to be positive, to encourage a more systematic approach to career-long learning and development. But it has to be resourced, both in terms of money and management, across the piece; the employers’ role will be crucial and local finances clearly have the capacity to undermine the process.  

There’s a very real danger in these austere times that a model that looks good on paper becomes a pointless bureaucracy, a tick box exercise, a waste of time in reality. And, unfortunately, on 1 March, when the GMC starts consulting on revalidation, doctors and patients will not be in a position to address that most fundamental of questions.

Tags: Revalidation, SPAs