The Department of Health has pledged to tighten up revalidation procedures to intervene earlier over poorly performing doctors, in the wake of Health Select Committee recommendations.

The all-party group of MPs claimed that revalidation processes were in danger of being too light touch, focusing on remediation rather than removing problem doctors from contact with patients.

The committee recommended that ‘the need to identify inadequate and potentially dangerous doctors must not be overlooked or diminished in the general move to use revalidation to eliminate unsatisfactory practice and improve overall performance’.

The government responded that ‘in essence, revalidation provides a positive affirmation of a doctor’s fitness to practise. Alongside this, enhanced systems of appraisal, clinical governance and responsible officers that underpin revalidation must be robust enough to identify and tackle poor performance at an early stage’.

Work is currently underway, the government said, to provide the necessary training for responsible officers to be able to identify and manage concerns. GMC guidance will detail which sanctions should be given when a doctor’s performance is poor under revalidation, and when fitness to practise procedures should be triggered.

Health secretary Andrew Lansley welcomed the report’s recommendations. He said: “Maintaining rigorous standards is critical to offering good care. Patients and the public have the right to expect that the doctors who care for them are up to date and fit to practise.

“All NHS organisations had to nominate or appoint a responsible officer from 1 January. Their role is key to ensuring robust, consistent and fair confirmation of doctors’ fitness to practise that will support revalidation. Patient safety is paramount. We will continue to work closely with the GMC and other bodies to test revalidation to ensure the system is effective, supports high quality care and provides confidence to patients and the public.”

Read the full response.

Medical directors fear they could be held accountable for failing to identify an incompetent doctor if they accept the new role of ‘responsible officer’ being introduced as part of revalidation reforms.

Responsible officers will make recommendations on the relicensing of doctors, handle complaints locally about the conduct and performance of individual doctors and refer those who fall short of fitness to practise standards to the GMC.

New details about the role have been published by the Department of Health. 

Medical directors of hospital trusts are most likely to take on the work as they already carry out many of the clinical governance tasks associated with the new role.

But the document leaves a number of issues unresolved, complains the Medical Directors Committee of the Association of UK University Hospitals (AUKUH).

It worries that if a responsible officer informs the GMC that a doctor is fit for revalidation who then goes on to cause a serious incident, he or she will be called to account. 

The guidance also fails to clarify what training will be available for responsible officers and how the new system will be paid for. 

 “It is evident that there will need to be organisational support for the responsible officer and the costs of this would be significant. Further clarity is required on how this will be funded,” said Dr Steve Powis, medical director of the Royal Free Hampstead Trust and chair of the AUKUH Medical Directors Committee.

He said there were also unanswered questions about whether locum agencies should have their own responsible officer and how revalidation will affect junior doctors who pass through several organisations.

Professor Jenny Simpson, chief executive of the British Association of Medical Managers, said: “Many NHS organisations already have careful and thoughtful systems in place to review and support the work of their doctors, and they will see how the new framework provides a solid legal foundation for their revalidation recommendations to the GMC.

“Medical managers are used to operating in complex, judgemental areas in patient’s interests and will, I am sure, embrace this opportunity for legal clarity and guidance.”

But medical defence organisations have criticised the proposals as unworkable. Dr Nick Clements, the Medical Protection Society’s head of medical services in Leeds, said the responsibilities of the responsible officer were “huge”.

He fears that trusts would have problems implementing the changes. “We work with a lot of medical directors who are good at their job and their organisations are good at providing resources which enable them to discharge their function but equally we deal with other organisations who seem extremely amateurish in comparison and how they are going to get to grips with this causes enormous concern.”

Dr Clements said they were also worried about a lack of safeguards in the proposals to deal with perceived conflicts of interest. ”In our experience doctors facing criticism often feel there is a degree of animosity between themselves and an individual or the entire organisation,” he warned.

Dr Hugh Stewart, head of case decisions at the Medical Defence Union, said: “We are not convinced that the case has been made for these changes which will be administratively burdensome.

“We very much hope that they will not lead to any extra layers of regulation in terms of additional unnecessary investigations over and above those that already take place.”

The guidance has been published as part of a consultation on the proposed legal framework for responsible officers and their duties and doctors are urged to contribute.