CONTINUING PROFESSIONAL DEVELOPMENT
Professor Mike Pringle, clinical lead for revalidation at the Royal College of General Practitioners, explains the work being done to prepare for the revalidation process.
R
evalidation requires the involvement of almost every healthcare organisa-
tion in Britain. The overall orchestrator is the General Medical Council; the Depart- ment of Health has to get the legal frame- work in place and set the direction of poli- cy; the Treasury has to sign off the business case; the NHS has to deliver effective clini- cal governance, including annual apprais- als and the appointment of ‘responsible offi cers’; and the deaneries have to oversee the revalidation of doctors in training and support for those about whom concerns have been raised.
In such a complex project, the Royal Col- leges have been given the role of defi ning the standards expected of the doctors in their disciplines and the supporting infor- mation that will demonstrate that those standards have been met. The Colleges will not be involved in making revalidation de- cisions but in advising responsible offi cers and the GMC on the thresholds to be used.
Getting the politics right
So, what has the Royal College of General Practitioners (RCGP) been doing? The fi rst role we fulfi lled was a political one. As the leading organisation representing 42,000 general practitioners we supported the idea of revalidation but fought to ensure it was equitable, feasible and proportionate.
While we want to encourage all doctors to maintain and improve their standards,
48 | national health executive May/Jun 11
The RCGP is not alone in publishing a spe- ciality specifi c version of the GMC’s core document, ‘Good Medical Practice’. Almost every other Royal College has done so and the expectations are very similar.
Supporting information
The next task was to defi ne the ways in which general practitioners could demon- strate that they meet the agreed threshold.
thus protecting patients from unacceptable clinicians, we also want to ensure revalida- tion doesn’t become an ‘industry’ that bur- dens doctors and the NHS. The RCGP has been intimately involved therefore in the decade-long debate on how revalidation should be conducted.
Setting the threshold
Our second task was to set the general level for the revalidation threshold for GPs. In essence the standard should be that ex- pected from a new entrant into general practice in terms of knowledge and skills, with the added expectation of experience and performance in the job. We did this by writing, with the British Medical Asso- ciation, ‘Good Medical Practice for General Practitioners’, which is now in its second edition. While pointing out the attributes of an exceptional doctor, for the fi rst time this document defi ned the unacceptable GP and it is the latter that sets the general standard for revalidation.
Over the past three years we have evolved a set of supporting information that should be within the scope of every GP to collect. When we compared these to the proposals from other colleges, we found that we were right in the central ground and all colleges have now agreed a core set.
Putting fl esh on the bones
Some of these items need a bit of unpack- ing. For GPs, extended practice has been identifi ed as a high-risk area. If a GP works in the NHS in a quality assured contract, as a proper ‘GP with a Special Interest’ for ex- ample, then the risks are minimal. If a GP sets up a private drugs and alcohol service, the risks may be far higher. For those GPs operating outside NHS clinical governance systems we will expect extra information to reassure us that appropriate standards are being achieved.
The ‘exceptional circumstances’ informa- tion area allows a GP to explain any idi- osyncrasies in their portfolio. They might have changed practice, worked abroad, taken on a new clinical role, been on sab-
We considered a whole range of options from a periodic examination to an exter- nal assessor looking at each doctor’s prac- tice. Most of these were rejected on either grounds of feasibility or appropriateness. We have consulted widely with other or- ganisations and with GPs collectively and individually.
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