10 FYi • Briefing


WHITHER VALIDATION?


With the launch of revalidation in December 2012, Jim Killgore looks back at two key events in its development


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T’S unlikely that any medical student, trainee or doctor in the UK will be unaware of the fact that after many years of development revalidation has finally been launched. An estimated 13,000 doctors will take part in the first wave of revalidation with the majority of the UK’s 230,000 licensed doctors expected to have undergone the process by 2016. Any doctor who is fully registered with a


licence to practise will be required to revalidate and this applies to doctors in foundation year 2 and specialty training (see page 3). Not everyone is happy with the added bureaucracy this will bring but the Government has long favoured a process by which licensed doctors demonstrate on a regular basis that they are up-to-date and fit to practise. This is intended to give extra confidence to patients that their doctor is being regularly checked by their employer and the GMC. Two major events within the last 25 years


have shaped development of revalidation as we know it today – and it’s useful to look back at the genesis of what is being called one of the greatest shake-ups of medical regulation in the last 150 years.


Heart scandal in Bristol Revalidation as an idea has been around for at least 40 years. Back in the 1970s a government committee set up to modernise medical regulation first suggested doctors might undertake some form of periodic “relicensure”. But the issue remained mostly dormant until 1998 when a high-profile GMC hearing found three doctors guilty of serious professional misconduct in connection with the deaths of 29 babies undergoing operations in the paediatric cardiac unit of the Bristol Royal Infirmary. The Bristol heart scandal dominated headlines at the time and a later Government inquiry into the matter yielded a damning 461-page report calling for a major change of


culture in the NHS. Problems at the Bristol unit first emerged


over 10 years before when a hospital report indicated that the death rate in operations carried out on babies under age one was twice the British average. A young anaesthetist named Stephen Bolsin joined the staff at Bristol in 1988 and noticed that operations conducted by one senior cardiac surgeon James Wisheart (also director of cardiac services) lasted much longer than average, leading to an increased rate of complications and mortality. Bolsin expressed his concerns to hospital


officials, among them Dr John Roylance, chief executive of the United Bristol Healthcare NHS Trust. But Bolsin’s whistleblowing did little good and led to him being rebuked and isolated from many of his colleagues. Wisheart continued to operate on babies


and between 1990 and 1994 he carried out 15 operations to correct atrioventricular septal defects (AVSD) in which nine children died (60


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