PERFORMANCE MANAGEMENT
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We’re now just months away from getting underway with revalidation, with around 230,000 doctors due to go through the process in the next few years. At the NHS Confederation conference 2012, revalidation was discussed by Confed chair Sir Keith Pearson, who chairs the UK Revalidation Programme Board, alongside Niall Dickson, chief executive of the General Medical Council; Ann Lloyd CBE, a trustee of the Patients Association and former chief executive of NHS Wales; Professor David Haslam, national clinical adviser at the Care Quality Commission; and Dr Penny Dash, principal at McKinsey and vice-chair of The King’s Fund.
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MC chief executive Niall Dickson (pictured above) explains the need for revalidation
with a biting analogy. If you were about to get on a plane, and heard that the captain is unable to fly, and a locum pilot is going to take control of the aircraft – the airline knows he got his pilot’s licence 20 years ago, but has never employed him before and doesn’t know his safety record or if he’s flown this type of plane before – would you fly?
He adds: “The interesting thing, of course, about this analogy is that there’s a crucial difference with doctors: the pilot is at least getting on the plane, so he’s taking some risk himself in this process!”
Dickson was one of five expert speakers on revalidation at an NHS Confederation conference session (pictured right), attended by NHE.
‘We’re ready enough’
Sir Keith Pearson, chair of both the NHS Confederation and the UK Revalidation Programme Board, spoke first. After outlining the need for revalidation, he said: “With many projects that many of us will have worked on over our careers, the danger is that you set yourself a landing place the size of a pinhead in order to achieve [a] state of readiness. That’s not the way it’s going to be: we’re going to have to reach a stage where we say ‘we’re ready enough’. And I think the UK Revalidation Programme Board has reached that position where we are ready to be recommending to the Secretary of State for Health that we think we’re ready enough to move forward.
“We’re ready enough to start a programme that will take about three years to implement, but it is important that we recognise that seeking perfection in the state of readiness is something that would elude any form of implementation.
“It is about three things: improving quality, achieving excellence and getting overall
24 | national health executive Jul/Aug 12
improvement. The programme is as much about reassurance for the patients and the public as it is about ensuring doctors are fit-to- practise and up-to-speed.”
Current competence
Niall Dickson joked that revalidation has been “about 18 months away for the last 12 years”, but said it is now finally happening for real.
He said: “There’s quite a lot of evidence that the healthcare industry – not just in this country, but across the developed world – has been really rather slow to embrace safety.”
“There isn’t another nation that I know of anywhere in the world that is building as robust or as comprehensive a system as this.”
He said reports into the issue have noted a focus on volume and throughput at the expense of quality; a disconnect between medical staff and management; and a lack of clinical governance.
He quoted the Bristol inquiry, referring to a consensus that had survived into the 1990s, that “if enough well-qualified professionals could be educated and trained, they could then be relied upon to provide services of high quality throughout their working lives”.
Patient safety He said: “You can’t ‘fail’ revalidation.
He praised the work of the Scottish Patient Safety Programme and the National Quality Board, and the increasing understanding among NHS chief executives and directors that patient safety is “core to their business”, highlighted by the fact that 400% more of them attended the 2012 National Patient Safety Congress compared to the 2011 event. “The capacity of doctors to do both good and
“Especially once the first cycle is over, the idea that for some coincidence at the point of the fifth year of that revalidation, something’s going to suddenly go wrong, is rather bizarre: if something’s identified, it should be identified during the ongoing process that is revalidation, not the point when the Responsible Officer (RO) is making a recommendation.”
harm is greater than it ever was,” he said, and quoted Sir Cyril Chantler’s famous maxim to that effect.
He went on: “The medical register has changed by leaps and bounds over the last 150 years, and yet in some ways it’s fundamentally the same: this person passed an exam at a certain point in time, and became a doctor. We either do or do not know that something terrible has happened in the intervening period; then we say goodbye to them when they retire.
“So it is really a historic record of qualifications and actions taken: it’s not an indicator of current or contemporary competence. Every other safety industry checks its people, it’s an absolute basic. The nuclear and aviation industries may have had their problems, but the idea that you wouldn’t check absolutely critical safety people? They’d think you’d come from the wrong planet.
“Every other major business throughout the world uses performance management: it uses appraisal. They don’t do this because it’s something fluffy and odd and different: they do it because it makes business sense to do it.”
Constant feedback
He said revalidation isn’t about identifying “bad doctors” or the next Harold Shipman and isn’t a pass-or-fail test, but is about identifying potential problems early and also about the “middle of the curve” – improving mainstream practice and helping good doctors get better.
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