Readers' letters – 3 May 2012

Revalidation: opportunity knocks

I read Jennifer Taylor’s excellent piece on revalidation and appraisal - and the fundamental place for clinical audit and other quality improvement cycles within those - with interest (Healthcare 100 Masterclass, 26 April).

She and the other commentators made many salient points in assessing the importance of revalidation, the barriers to achieving it (both perceived and actual) and how to get past those barriers.

The Medical Act does indeed describe revalidation as an evaluation of a doctor’s fitness to practise and that must remain front of mind at all times. But, as Ms Taylor rightly points out, the revalidation should be a simple one, building on existing and familiar processes.

Dr Nick Lyons of the NHS revalidation support team pointed out that “there was relief amongst doctors that medical appraisal would make the regulatory process of revalidation possible and it would inform their professional development”.

Yet, despite comprehensive support from organisations such as ours, for doctors, boards and trusts, many clinicians are not involved in clinical audit to the degree they need to be. As revalidation becomes a reality, it will in itself help address this, but there is still a great deal to be done. We have a wide variety of specific guidances, training packages and event-based support freely available and would urge individuals, trusts and boards to contact us to drive quality improvement in revalidation. 

We also work closely with the Royal College of GPs, and the latest output from that is the appointment of two clinical fellows, Dr Maeve Lawrence and Dr Rish Prasad, to help promote clinical audit among GPs as part of their training and their ongoing practice. Boards must also play their part fully - and that is currently rarely the case. They have a key role to play in recognising the importance of effective appraisal in supporting revalidation, developing services and staff, and assuring the public that services are of good quality.

As the GMC’s Una Lane highlights: “It’s not about slavishly going through any particular form, it’s about giving doctors an opportunity on an annual basis to reflect and demonstrate how they’re continuing to meet those values and principles through their practice and through their work and care for patients.” Solid clinical audit involvement is an enormously effective way of doing that as part of revalidation. And, integrated properly, should seamlessly become part of a doctor’s daily practice, not an onerous extra task.

Robin Burgess, Chief Executive Officer, the Healthcare Quality Improvement Partnership

NHS 111 - too hasty?

As the end of April deadline approaches, the NHS 111 debate continues to draw reaction, particularly the concerns about the system’s rollout. Having worked in emergency dispatch for many years, I welcome the concept NHS 111 is trying to achieve. However, experience also tells me the necessity of further testing and independent review prior to implementation. I offer two arguments in favour of slowing down the process for the good of the public.

Giving local authorities a mandate to respond within a short timeframe goes against good decision making. In the haste to submit plans, there has been no consultation with GP groups or emergency services to gain vital, on-the-ground input. Time, rather than good judgement, is dictating the process in the interests of getting proposals out of the door.

It has been reported that in areas already offering the service, ambulances are transporting people who would have been managed by out of hours services under the previous system. This concern is founded. The increased pressure on ambulance services to respond to patients inappropriately referred will compromise their ability to respond to patients in a genuine emergency. NHS 111 should not impede on an ambulance service’s job of dispatching emergency ambulances to patients requiring the service. It is the NHS 111 system’s ability to dispatch ambulances causing the anomaly.

Fundamentally, the public is entitled to receive the appropriate emergency response within an appropriate timeframe. Without further testing and independent review, NHS 111 cannot guarantee that this will happen. Haste should never prioritise steps critical to the public’s health and well-being.

Ron McDaniel, senior vice president, Priority Dispatch