A decade in the making, the revalidation procedure for the health profession is almost ready for implementation. General Medical Council chief executive Niall Dickson explains the next phase.
If good intentions were all that were needed, medical revalidation would be up and running. Instead we have spent more than 10 years deliberating the best way forward, without creating a system that will provide the assurance that every doctor working in this country is competent and fit to practise.
True, significant progress has been made. We have introduced good systems of appraisal in much of the NHS and the independent sector.
But the profession has moved on. There is much greater acceptance of the need to monitor medical performance and a greater understanding throughout the healthcare system that this is a safety-critical industry largely determined by doctors who have the skills to save lives, but also the capacity to do great harm.
Now at last we are moving to implementation. In October 2010, the GMC and the four UK health departments issued a joint statement of intent, which commits us to work towards implementation in late 2012.
The NHS (England) Operating Framework for 2011-12 makes it clear that all NHS organisations “will need to ensure that they have in place the key components to underpin medical revalidation”.
Throughout the UK, preparing for revalidation will be another item on a long “to-do” list this year, but it needs to be at the top.
Revalidation will be built on having in place good clinical governance arrangements, and these are a prerequisite for ensuring a high quality, safe service. This is not an optional extra, or a matter for doctors alone – it should ensure that every organisation employing or contracting with doctors, from NHS trusts to private practices to locum agencies, puts clinical governance at the heart of their work.
The first components of the new system are now being put in place. Responsible Officers are being appointed. They have a statutory responsibility to ensure that clinical governance systems, including medical appraisal, are working effectively in their organisations; that doctors are engaging in the appraisal process; that any concerns about doctors are investigated quickly; and that, where necessary, action is taken to protect patients.
Keeping it simple
Revalidation will begin in late 2012 with a final review of readiness by the secretary of state in the summer of that year. Organisations will need to have local systems in place to support revalidation and we will announce more detailed timelines and milestones in the next few months.
We know that there is a need for more information, particularly in some areas of practice, and that every doctor and every organisation needs to know how it will affect them.
The aim must be to establish systems that are robust but simple. We know there is support for the principle from managers and doctors but the consistent message has been that the process should be simple, proportionate and straightforward.
Revalidation should not and will not be a burden. It should not distract doctors, teams or organisations from delivering high quality care.
The GMC will be working with the health departments, the NHS Confederation, medical directors, the royal colleges and the BMA among others to make sure the detail is right and that we communicate clearly what is expected.
In many ways this is a top-down process, but if it is to succeed it needs to kindle flames of enthusiasm, ownership and drive at local level.
Giving doctors the space and the opportunity to reflect on their practice, to gather information about their performance, to benchmark their results – all this should build on what is happening already, and in the vast majority of cases, it should be positive and liberating for all concerned.
We know that some organisations have good systems of clinical governance and medical appraisal. We need to build on this and share examples of good practice.
As a start we believe every Responsible Officer should take a number of immediate steps:
- Review the organisation’s appraisal process – for example by asking whether every doctor is having an annual appraisal and checking that the process is robust
- Look at the team of appraisers – are there enough to deliver an annual appraisal effectively for every doctor? Are the appraisers adequately trained?
- Calculate the resources and the support that will be needed to deliver the Responsible Officer role
- Assess the information collected by the organisation about the care it provides. Does this give the doctors the supporting information they will need to assess their practice and to bring to their appraisal? Is that information robust? Is that information accessible?
- Responsible Officers (ROs) should make themselves known both within their organisations, with other ROs and to the GMC; these contacts will be vital for each RO and for the systems as a whole
- Establish revalidation as a priority within the organisation, with endorsement and support from the board and the entire senior management team.
These action points also apply to HR departments, the board, and those in senior management positions – in fact, anyone who will need to support and understand the work of the Responsible Officer.
In turn, the GMC and our partners who are working to deliver revalidation will do everything we can to give Responsible Officers the support they need while communicating directly with doctors about the progress being made and what they need to do to prepare for the system going live.
Making revalidation work well is the GMC’s number one priority but we are relying on good local systems to make it real and effective and that will require strong local leadership and commitment. We all stand to gain from making it happen and getting it right.