Revalidation in secondary care is unlikely to be as disruptive as some have predicted, claims a senior doctor who is piloting the process in his trust.
Dr Allan Cole, associate medical director at University Hospitals of Leicester, says they are well prepared to pioneer revalidation because they have a well structured clinical governance system and most of their doctors work in teams.
They have also already undertaken a number of exercises in appraisal and job planning, both of which are essential elements of revalidation.
“The chances of finding a bad doctor are fairly minimal. I know the ones I have got concerns about and I don’t think the appraisal and revalidation process are likely to turn up many more people who are not performing,” he said.
The Leicester hospitals trust is one of ten NHS organisations taking part in a revalidation pilot studies across England which will test an enhanced electronic process of medical appraisals; the role of the responsible officer (RO), the senior doctor with local responsibility for overseeing the revalidation process; and look at the part the medical royal colleges or faculties will play in supporting revalidation.
The pilots began in January 2010 and will run through to 31 March 2011. There will then be the first testing of the full process some time in late 2011 or early 2012.
In Leicester external trainers will be brought in to train appraisers who will be conducting a more rigorous and uniform process of appraisals. Doctors will be required to provide specific evidence of their professional development in the form of audit or measurement of services, knowledge, skills and teamwork.
“I think the concept that a professional has to supply information and actually think about how they can show that they are meeting the standards of general medical practice in the various domains that are part of revalidation are probably going to be beneficial and will help the profession.
“They won’t love it at the time but I think they will look back in a few years and think I can’t believe we didn’t used to do this,” said Cole.
For the pilot, Cole will be working as shadow RO. He says there is a real question of whether this role should be undertaken by the medical director or delegated to somebody else - this will be tested during the pilot.
He says they bid, along with 80 other NHS organisations, to take part in the pilot because it would not only put them ahead of the game but would also give them a chance to influence how revalidation will work.
“I don’t underestimate how difficult it could be - there are lots of traps that could turn revalidation into a ghastly bureaucratic process. My commitment is to make absolutely sure that it does not,” said Cole.
Dr Sonia Swart, medical director of Northampton General Hospital, which is also taking part in the pilot studies, said she too is keen that the process will add value to their trust and not turn into a tick box exercise.
She will be working to help doctors to understand that revalidation will improve the quality of their appraisal by linking it more specifically to quality and safety. The job planning process will be looking at capacity and productivity and making sure that time for research and teaching is properly acknowledged.
“I’m sure we will have a few glitches in making it all work smoothly. We will have to make sure we get the electronic platform for appraisals working and that everybody knows how to use it. It will also be important to maintain clarity the whole way through so that people don’t feel threatened by the process,” said Swart.
On the role of the RO she said: “There could be conflicts of interest with the RO having responsibility to the board for appraisal and clinical governance but also for reporting directly to the GMC and in deciding what information travels with a doctor from one job to another. To a certain extent we already have a process for these issues but it is informal.
“Revalidation will formalise this process and I think it will be very challenging - I plan to record all my concerns along the way as the pilot rolls out. I see that it will be an opportunity to actually flag up how these issues can be dealt with as they come up.”
Tags: Revalidation
All very nice but when will we hear from a grassroots clinician that revalidation is the best thing since sliced bread? Dr Cole is an associate medical director, ie a manager, and also a RO, ie GMC stooge. He’s taken ‘the Queen’s shilling’ and no doubt he’ll also be putting his role in this project on his CV for his next Clinical Excellence Award application. This business of rewarding doctors to execute govt or management initiatives is one of the greatest evils of contemporary medicine. It started with Tony Blair and ‘cash for honours’ and has percolated right down through many areas of life including the NHS. Dr Cole is at least candid enough to admit that “the chances of finding a bad doctor are fairly minimal. I know the one’s I’ve got concerns about”. So why is he prepared to engage in and promote this farce which will consume inordinate amounts of our time and of the NHS’s funds and was originally imposed upon us by Dame Janet Smith in the expectation that it would spot the next Dr Shipman? Money!
‘The proof of the pudding will be in the eating’ - but is the pudding already poisoned?! The idea was, originally, to stop another Shipman. Yet virtually everyone agrees that the present arrangements wil not do that! Dr Shipman, and Bodkin Adams before him, were both considered by their colleagues, and in their communities, to be ‘good doctors’! It was the Coroner’s Office that failed to investigate properly a suggestion that Shipman seemed to have more deaths than usual! The GMC then blithely accepted all the suggestions made by Govt., the NHS, and the courts - and came up with this overly bureaucratic system that almost everyone thinks will not work - because it is going to try to ‘measure’ things that are unmeasurable.
I am not against re-appraisal or re-validation in principle; I think it is right that all professional people should keep up to date - and should be able to ‘prove’ it. So, I think it should be restricted to a test of knowledge (by multiple choice questions - in both life-saving general medicine and in one’s specialty) and some proof of attendance at appropriate postgraduate courses. I do not see how one can measure such ’soft’ subjects as ‘communication skills’ and ‘team player’; nor are they necessarily ‘essential’ in medical practice - even though they may be ‘desirable’. Re-validation should only decide whether someone is ‘competent’, clinically, which means that the assessors must accept the ‘minimum’ standard required - not the ‘high’ standard to which (I hope) we all aspire.