PERFORMANCE MANAGEMENT
Dickson said the feedback and evidence doctors must bring to their annual appraisal are not onerous: evidence they are engaging in CPD and quality improvement activity; a discussion about significant events in the past year; and colleague and patient feedback.
He said the feedback element will “develop over time”, acknowledging that patient groups especially wanted it to go further. “It’s all about making sure licensed doctors are working within governed environments. There should be some assurance, not about their 20-year-old licence, but their current competence to do the job,” he added.
Revalidation timeline
Connections have already been made between more than 120,000 doctors and their designated body, 724 of which have been identified around the UK, with about 630 ROs in post.
Dickson sketched the timeline: the ROs and medical leaders revalidated first, by March 2013; 20% of all doctors revalidated by March 2014; the “vast majority” by March 2016; and everything being done by March 2018.
He said: “We will lead the world on this. 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. We are being watched by others.
“It is a top-down process, it’s come out of legislation, but it will ultimately only work if it lights a fire of enthusiasm. If it becomes burdensome and tick-box, if people don’t see the value in it, of course it won’t work.”
Trust and communication
Ann Lloyd, a new trustee of the Patients Association and former chief executive of NHS Wales, said the basic desire of patients is simple: good quality care from a health professional they trust.
She said it would come as “a bit of a shock” to most patients to find out their doctor is not already ‘revalidated’.
She said: “It is vitally important that the trust and confidence that patients have, in the main, in their health professional is protected and enhanced. Revalidation is part of the growing conjoining of the experience of patients and practitioners in delivering a much better service for them.
feedback about health services because of the risk of some imagined retribution, especially if they are in hospital for a long time.
She said: “It’s very galling, when you think you’re running a good organisation that communicates well and is doing absolutely everything it can to improve care, to get that sort of feedback.”
“We almost despair”, she said, when patients keep quiet ‘in case something happens’.
Quality
Professor David Haslam told the audience that revalidation must be part of a wider shift to
to revalidation
“The Patients Association has been working with the GMC on how to engage patients more effectively, to enable them to really contribute to revalidation. It’s great that patients are being involved, through their feedback, in the revalidation process right from the outset.”
Too often, Lloyd said, patients and their families are reluctant to complain or give
“Quality won’t be assumed: it will have to be demonstrated.”
a culture prioritising quality across healthcare and in which both clinicians and patients felt happy and keen to give feedback and raise concerns.
He said: “I can’t believe there’s anyone in the health service who goes through a year without seeing anything that should be flagged up as a concern.
“Everyone should be flagging these things up: it shouldn’t be a mark of failure, but a mark of caring.”
Whistleblowing is all well and good, he said – but by then it is too late. If someone feels they have to blow the whistle on poor practice, it shows that the system has already failed.
He wants “systematic feedback across all healthcare interactions” to become the norm, contrasting the situation in the NHS with a recent holiday, where on his return he found an email asking him for feedback – but there is nothing similar for someone who’s had a transplant.
He said: “For the first time, there will be an ongoing focus on whether doctors are up to the mark; and with this comes a real culture shift. Quality won’t be assumed: it will have to be demonstrated.”
The wider context
The final speaker, Dr Penny Dash, spoke of the changing context for healthcare – away from the primary challenge being acute need, and towards older populations with long-term needs.
She noted some of the quality challenges that remain, from excess deaths of healthy newborn babies outside of working hours, to poor care for people with diabetes.
She said that other organisations’ approaches to quality could be useful in determining what doctors can be assessed against. She was keen that revalidation should become embedded in the thinking of NHS boards, and not seen as a separate process of consequence only to doctors and the GMC.
The ‘Reaping the strategic rewards of
revalidation’ event was chaired by Sir Keith Pearson and held jointly by NHS Employers, the GMC and the NHS Revalidation Support Team.
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national health executive Jul/Aug 12 | 25
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