Many of you will be aware that revalidation has hit the headlines again this week, with the publication of a letter from the new Secretary of State Andrew Lansley to Peter Rubin, chair of the GMC – a copy of this letter can be found here.
Regardless of what you read in the newspapers, revalidation is moving forward and I believe that the Secretary of State’s letter is a constructive addition to the debate. As you know, the RCGP has been working very closely with the GPC, and other stakeholders. I have been out and about around the country, most recently at a session with defence service doctors, and I always bring back good questions, even if I don’t know the answers when I’m there! A lot of the work we have been doing recently has focused on GPs who are practising as locums, or working in rural and remote areas. Over the past couple of weeks I have had very constructive meetings with the GMC and I had a positive discussion with medical directors of PCTs on clinical governance, revalidation and a need for continued funding for the Practitioner Health Programme which supports doctors in difficulty last week at the College.
There do seem to be problems in some of the hospital specialties about the standard that doctors will need to meet in order to revalidate, but in general practice we have always taken the view that revalidation is about professional development, and that for revalidation to be a success it will also depend on appropriate clinical governance systems in Primary Care Organisations across the UK, appropriate funding and a solution to the question of remediation.
I have always tried to ensure that the College is open about its deliberations, which is why we have published the guide to revalidation – of which the fourth edition goes live imminently. We want to make sure that revalidation is appropriate for all GPs, regardless of how and where they work.
With that in mind, I support the Secretary of State’s view that piloting should be extended so that we can learn more, particularly about the costs, and how we can make this as bureaucracy-light as possible. It will also give primary care organisations more time to sort out their clinical governance systems and appoint responsible officers. We know that the profession – particularly in some of the specialities - doesn’t feel as engaged as it might; we have benefited from regular meetings with the GPC, who have acted as critical friends – not shy to challenge, but always ready to support when appropriate.
Of course I will continue to update you on progress, and Mike Pringle, RCGP Medical Director for Revalidation, and I will continue to tour the country meeting with GPs and responding to your questions as revalidation moves forward.
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A response that the lack of confidence the secretary of state has in the ideas, process, and people will cause you to significantly change what you think and what you plan to do would be more reassuring.
ReplyDeleteIt would at least suggest that the approach which failed so signally with MMC and MTAS because despite the system clearly not being workable nobody called a halt until it was fit for its purpose and the complete lack of taking responsibility for such cockups, and stopping trying to do the same thing again the same way might be something you and your cohort were capable of apprehending a need for change in, and going on to make that change - IE behave differently.
Your arrogance is remarkable, even for the chairman of a college.
And you are wrong.
The Secretary of State's letter seems to indicate fundamental concerns with the process of revalidation.
ReplyDeleteI suspect many jobbing GPs share those concerns.
The proposals at present are unworkable, cumbersome, and time-consuming. You must be aware that senior GPs have already resigned, rather than subject them to a revalidation process which, however it is designed, will have the affect of burdening busy professionals with a mound of paperwork. Others will no doubt follow. You cannot afford to be sanguine about this loss of medical talent and expertise.
It no longer seems to ber necessary to jump at the dictates of the political classes; there appears to be the chance for dialogue. It seems the new SoS is open to new ideas. It would be a challenge for the RCGP to be as open to new ideas as the new SoS.
Starter for ten - what is revalidation meant to achieve?
We are all aware it grew out of Janet Smith's unwarranted attack on the profession, during the mishandled and misguided Shipman enquiry.
It has now grown to be a bloated monster. It will not, in its current format, catch a serial killer. I doubt it will even catch poorly performing doctors.
So could you please start by stating what revalidation is meant to achieve? Because the current morass does not have the confidence of the profession, and, in part, that is because of the muddled thinking around the whole project.
Janaka Pieris
Revalidation is dead.
ReplyDeleteIt is a shame to see that you do not (want to) understand that the profession hates the concept, does not want it and considers your attempts as vain empire building.
But, then, what should one expect from the head of a organisation like the RCGP - irrelevant, arrogant and with the head up the backend are the attributes coming to mind when I think of the college.
You know maybe, just maybe, the academics and professional educators who grossly overpopulate the RCGP should try and have a little insight and realise that they are anything, anything but 'jobbing GP's' In claiming this, they alienate the thousands of docs who are jobbing GP's
ReplyDeleteMaybe they should then think about the college as being about supporting those genuine full time docs, rather than engaging in self publicity and mutual self congratulation.
I looked back in your blog and saw you never get (m)any responses. And today this. By the way, the traffic comes your way entirely by courtesy of DNUK. Which is where the actual discussion is happening.
ReplyDeleteMaybe this should tell you something: The college is irrelevant. It communicates in irrelevant ways. What it thinks is not what the profession at large thinks.
The qualities of Insight/Capacity and Humility seem to be alien abstracts to you and your ilk.
ReplyDeleteConsequently your 'ramblings' carry no intellectual vigour.
Might i humbly suggest a period of quiet reflection and due deliberation as to the reality we exist within.
PS Does not 'The Point of Kairos' display the frenzied peacock psyche of the deluded ?
I am deeply disappointed that you do do appear to be listening to the views of the vast majority of "coal-face" GPs. The end result of revalidation would be less time spent with patients and a whole generation of the workforce lost to early retirement - to be replaced by doctors flown in from overseas, where we have little or no control on the professional standards with similar disastrous results to the Ubani case. Please listen to your members - revalidation would harm patient care, if it was to be implemented.
ReplyDeleteI agree with all the comments above; as a GP Trainer, College Member and full time GP it is quite clear to me that revalidation has lost its way, fundamentally because it was never clear what it was for in the first place.
ReplyDeleteI cannot agree with your interpretation that it is time to gird up and carry on regardless.
This foolish process must stop
Prof Field
ReplyDeleteWhat is happening in UK Medicine is a disaster. Below is part of my contribution to the GMC consultation of revalidation. This Blog won't allow the whole thing.
Revalidation is, by definition 'unprofessional'.
Competence:- the competence to oversee and implement a system like revalidation does not exist and never will. This is another reason to abandon it.
Why there has never been a ‘grand-father clause’ mentioned is beyond me. Expecting doctors well into their careers to undergo a process such as this is a remarkable oversight, lack of respect and flaw and one reason why the health system will lose many highly experienced doctors. This lack indicates to me incompetence on the part of planners and if this is extended it is probable (not possible) that such incompetence will exist throughout these proposals.
The concept behind revalidation is seriously flawed and ill-defined. I have never seen any reason to support it, let alone, to justify it.
The GMC by way of justification and as its reason for the introduction of revalidation Professor Rubin, Chair General Medical Council says:
“As Doctors, we are among the most trusted of all professionals. We have to ensure that this trust in doctors continues to be justified.”
Using this quote: where is the justification for revalidation? It is clear that there is none.
On the second part of the quote: “We have to ensure that this trust in doctors continues to be justified?” I agree that this is the case, exactly the same as it always has been.
Without revalidation this trust has been maintained. So there is no justification for revalidation on this ground either.
This trust has been maintained despite the events surrounding shipman (lack of capitals intentional).
The reality here is that revalidation is being forced upon a profession by politicians and doctors complicit with politicians, and it is in disrepute in this respect alone. However, these individuals have used the shipman case to add justification and weight to the need to invest hundreds of millions of tax-payers money into a system doomed to failure while ignoring the fact that patients have in the past and continue to hold the medical profession in high esteem.
shipman is not a reason or justification for revalidation and, once again, the opposite is the case. The damage done by revalidation will be a further legacy to shipman and in death the damage he is responsible for will continue. I am astonished that the medical and political authorities have not seen this.
If revalidation goes ahead it is going to lead to a human disaster. This is especially the case in view of the costs involved which will deprive the very patients, who already hold us in high regard, of funding for treatments and services that they should be getting but will not because such monies will be wasted on a system that has no justification whatsoever. This will amount to a crime against humanity.
I am writing this contribution to the GMC because, as a professional man, I want no part in anything that is unprofessional or that can in the future lead to damage or to, what I see, as a crime against humanity.
My final point is that I believe that this whole system should be stopped dead in its tracks. There should be no more investment of any kind in it. The GMC should then lead a discussion on a proper system for Continuing Professional Education for the medical profession. This is the way to improve the standards of doctors and to ensure that the public maintain its high regard for doctors and this esteem would get higher in the presence of a proper and functioning system of Continuing Medical Education.
Yours faithfully,
Brendan O’Reilly
LRCP&SI, MB, BCh, DCH, D.Obst(NUI), FRCSI, FRCSEd, MRCGP.
I've been a GP for 16yrs.Passed MRCGP in '93. I am all for continuing medical education. I am utterly dismayed by the plans for reacreditation, and especially its bizarre and anal over-complexity. I looked at the RCGP website, and I've never come across a more depressing and impenetrable document as the reacreditation guide, it just made me want to slit my wrists.
ReplyDeleteRevalidation was thought up by the last government as a means to control doctors, and the RCGP has, by becoming involved with it, moved from being an academic institution to an agency of government control.
ReplyDeleteThe vast majority of GPs do not want it and the vast majority of your fee paying members do not want it. Indeed, the college's continued support of revalidation calls begs the question of why ordinary GPs should continue to support the college financially.
So let it die in peace.
I am sorry to hear that you are still not listening to doctors who will be most affected by these overambitious and expensive ideas
ReplyDeleteI retired at the start of April after 40 years in general practice. In that time, I had three complaints, none of them upheld, yet I was never revalidated. The question will be just what will you be revalidating, and who will the revalidation be for.
ReplyDeleteIt is not for the benefit of the profession. Adding another hurdle for a stressed profession to overcome will increase the stress. This is hardly conducive to the good of the practice. Will it improve the confidence of the public in the profession. Again this has to be no, especially as the profession is the most trusted group in the country.
What will be revalidated? Will it be a repeat of the final MB ChB exam, or will it be another rehash of the RCGP exam. Will either of these enhance the reputation of general practice? I think not as most people have no idea what these exams mean.
When a revalidation system is set up, do you not think the process might be taken over by the government? There will be a difference between what a doctor might consider important and what a government might want. Do you not think it possible, or even likely that the revalidation might move over to questions such as how much the GP costs the government, and rates of referral and this sort of criterion being used for revalidation. GPs might be forced to follow government edict rather than considering first the good of the patient. Certainly watching how the GMC has coped with government pressure gives one no great hope that the revalidation will stay with professional standards.
Finally, I would say that when one enters general practice, every day one increases ones professional skills with the experience of seeing and dealing with maybe forty patients every day. As long as one stays up to date, one can only improve as time goes on. Any tests on performance must only measure what can be measured at the point one enters the profession as the new entrant can't be expected to have gained the skills which the experienced doctor has. Now I would agree that personally I have forgotten the statistics of disease and lots of testable data, but I have acquired far more in the actual management of patients.
A GP will keep adequately up to date because of professional pride and not because of revalidation. The qualities of a good GP will not be improved by testing, and bad GPs will easily get round revalidation ( One only has to listen at post-Grad meetings, hearing what GPs say they would do there, when you know what they actually do in practice ) I would advise you not to continue with revalidation which is wanted by neither profession nor public, and only benefits those outside the profession who would seek greater control and not for the good of our patients.
Dear Oh Dear,
ReplyDeleteYou have stirred up a hornet's nest here.
I would like to support revalidation, I really would. But my fear is that it is being used as a tool of a Government Quango to try and control ordinary doctors.
The college needs to tread carefully here, and not be overwhelmingly supportive.
There is very little support for it in the sticks; just deep suspicion.
Dear deluded president.
ReplyDeleteYou may have heard of the phrase "A leader is someone who gains financially while the followers gains spiritually".
How exactly do you think you're faring on the second part?