Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
All good in theory but how realistic in practice?
- Andrew Webster (13 May 2005)
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Response from a GMC Member
- Brian D Keighley (14 May 2005)
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The myths of revalidation
- Olusola O.A. Oni (14 May 2005)
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Good intentions
- David Levine (14 May 2005)
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Summative elements of revalidation
- Anthony Lister (14 May 2005)
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Revalidation, discretionary points and Clinical excellence awards: steps on the same ladder ?
- Anton E Joseph (16 May 2005)
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Tarring Doctors with the Shipman-Brush
- Jay Ilangaratne (16 May 2005)
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More Bureaucracy
- Oliver R Dearlove (16 May 2005)
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GMC prepares to deliver significant improvements
- Jo Wren (16 May 2005)
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Regulation, regulation, regulation
- Michael O'Donnell (17 May 2005)
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Revalidation on hold – a golden opportunity
- Geoff Wong (17 May 2005)
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Constructive Revalidation - Reaffirming the Hippocratic Oath
- John Onuorah (19 May 2005)
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Knowledge test? Yes please.
- Hendrik J Beerstecher (20 May 2005)
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Re: Knowledge test? Yes please.
- Neville W Goodman (20 May 2005)
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Revalidation and all that
- David E Powell (24 May 2005)
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Shipman and revalidation
- Peter KK Au-Yeung (26 May 2005)
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Andrew Webster, Registrar in Emergency Medicine Sir Charles Gairdner Hospital, Perth, 6009
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This is a well written article but I have a number of concerns that the proposals that are suggested will just require the huge majority of doctors spending a lot more time trying to remain validated instead of seeing patients. What will happen to the doctors in some regions who only work a few sessions a week after retiring, but are providing a valuable service to patients who would otherwise have no access to medical care. What regulation will there be for the many overseas doctors being flown in to staff the treatment and investigation centres. Are they going to have to meet the same standards, despite being paid a huge amount of money by the tax payer. I expect not. As a barrister headed the inquiry to investigate us, I would be interested to know what regulatory procedures in the legal world, do they have to take a knowledge test every 5 years? What happens to the 3%+ of porly performing lawyers? There is no easy answer to self regulation. What ever solution is put in place will no doubt mean even more paperwork to complete. Whether it is any more successful in identifying poorly performing doctors only time will tell. Competing interests: None declared |
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Brian D Keighley, General Practitioner The Clinic, Balfron, Stirlingshire G63 0TS
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Sir, Two articles this week (Esmail and Kmietowicz; BMJ, 14 May) give a partial and often inaccurate account of GMC policy development on professional revalidation and it is a singularly unproductive exercise now to analyse who said what to whom and when. It is clear, however, that the Council has been in an iterative process with a series of interested parties since 1998 in an attempt to introduce the most fundamental change to medical regulation since its foundation in 1858. Its policy development has had regard to the legitimate interests of three principal groups - Government and the NHS, patients and the public, and the various tribes that make up the UK medical profession. Both articles point to some notorious medical scandals that the authors hold were instrumental in goading the GMC into action. The initial meeting with professional leaders on revalidation convened by the then President, Sir Donald Irvine, in June 1998 was held in the context of a high-profile professional conduct case, but that meeting pre-dated the Report of the Bristol Inquiry into deaths amongst child cardiac patients and was absolutely nothing to do with Rodney Ledward or, indeed, Harold Shipman. It was recognised then that some doctors were not keeping fully up-to-date nor were they indulging in reflective practice. Irvine correctly proposed that there was a need to make registration with the GMC more meaningful to the public than a mere recognition that a doctor had reached a certain standard of professional knowledge in their early twenties. Both articles seem to promote the idea that doctors and their regulator should be filling the vacuum within the NHS and other employing organisations created by their failing to fulfil their public responsibility to monitor doctors' clinical standards. Clinical governance is now, slowly, being developed and eventually will extend from systems and teams to individuals - but is it reasonable, as both authors suggest, that such monitoring should become the financial and moral responsibility of the regulator sitting in London and Manchester rather than local managers at the coal face? Whilst revalidation is a continuing process, it becomes summative only every five years. The NHS and its local systems must not be allowed to abrogate their responsibility for the safety of patients on a day to day basis. Nor should they demand that the GMC and its prime function of assuring fitness to practise and the meaning of the medical register be inappropriately promoted as the first line of defence for the maintenance of clinical quality and safety. Yours sincerely Brian D Keighley Competing interests: GMC Elected Medical Member for Scotland; Non- executive Director, BMJ Publications Ltd |
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Olusola O.A. Oni, Consultant Orthopaedic Surgeon 16 Sutherington Way, Anstey LE7 7TH
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Esmail (BMJ 2005; 330: 1144-7) yet again peddles myths used time and time again to justify revalidation. He insinuates that the public has lost confidence in the medical profession. This is not true. The public puts doctors at the top of the professional tree in poll after poll. The elites of medicine have lost their nerve and, that is the problem. He suggests that doctors are afraid of revalidation. We are not. What we, and our patients, do not want is to invest time and money in their harebrained scheme. We are loathed to support yet another cottage industry in medical governance. He asserts that revalidation is better than appraisal. He provides no evidence, only opinion. Appraisal, by definition, is a means of determining a doctor’s effectiveness. This requires that activity data be gathered and then analyzed. This data is currently available, albeit incompletely, but is not analyzed. It can be refined with the use of logbooks. That is all that is required to identify poor performance. It is as simple as that. Esmail claims that 3% of doctors are seriously deficient. Who says? Bolam1? Standards set by professors who hardly see patients and who preside over college examinations which these same doctors pass? Professional elites may be obsessed with assessment, patients are not. It is time to put a halt to the self-flagellation over Bristol and Shipman and concentrate on improving quality. The public has moved on, so should we. In 1975, ordinary doctors rebelled against the GMC and threatened not to pay their registration fees. The government intervened because this action would have brought the NHS to its knees. Following this revolt for the first time ordinary doctors were elected onto the council. A debate now needs to be had by the profession regarding the role of the regulator. A referendum is essential. Do we persist with self-regulation which allows a small self-appointed group to tell us what to do? Or, do we want a DVLA- style regulator which would leave us alone to get on with the immensely difficult task of caring for the sick? I know what I would vote for. Determining doctors’ fitness to practice is an inappropriate job for a regulator. That is the job of those who employ doctors. 1. Bolam v Friern Hospital Management Committee [1957] 1 WLR 583 Competing interests: None declared |
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David Levine, Consultant Physician West Cornwall Hospital TR18 2PF
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Esmail's polemic against the GMC and current appraisal practice is interesting. I'm certainly no apologist for the GMC but his view that, 'the GMC has nowhere to go but down' may tell us more about him than about the Council. I find myself wondering why he waited until after the inquiry to write this article. He tells us that he was Dame Janet Smith's medical adviser; was there really only the one? He says, under the findings, that, 'the main platform for revalidation should be the preparation by each doctor of a folder of evidence that shows what a doctor has been doing in the past five years.' He later states that, '...the process of appraisal cannot be a basis for revalidation.' This seems somewhat contradictory and suggests he may not be an appraiser. As a conscientious appraiser, and with experience of helping to train several hundred consultants in the process, I take a very different view. He later states that, 'revalidation is supposed (by whom?) to weed out doctors that (sic)are not fit to practice.' I like gardening but hate weeding; a more effective and ecological approach is to ensure the vigorous growth of desirable species to prevent the weeds from flourishing. I commend this approach to medicine. In his penultimate sentence he states that,'revalidation is not about catching another Shipman or about...' So why the inquiry leading to a review and to this article? Competing interests: AN INTEREST IN APPRAISAL |
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Anthony Lister, GP and GP appraiser Norwich NR2 4JA
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Sir Professor Esmail's thoughtful article is absolutely spot on about one aspect of the current debate: appraisal is absolutely the wrong tool on which to base revalidation. As a GP appraiser, I do not and cannot seek to carry out a performance review of the appraisee. Appraisal is a formative tool on which to hang the professional and educational aspirations of the appraisee for the ensuing year or more. However, Professor Esmail on the one hand seems to eschew the notion of a summative test, whilst on the other hand promoting the notion of a knowledge test, submission of a consultation video (at least for GPs) together with other evidence about the individual doctor's practice such as prescribing data and audits. Forgive me if I am wrong, but that all sounds pretty summative to me and I actually wholeheartedly agree with this approach as a sensible way forward. The undue emphasis on the "revalidation folder" seems to me a side issue, whilst a knowledge test and video would seem to be the core of a sensible revalidation process for GPs. Whether the GMC will be able to embrace these concepts is a key question. If it can, then it might just be able to protect and hold on to professional self-regulation. We shall see. Competing interests: None declared |
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Anton E Joseph, Consultant Radiologist Mayday University Hospital, Croydon CR7 7YE
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The answer to the question posed in Sir Liam Donaldson’s call for ideas, namely “What should be the core purpose(s) of revalidation provides the best solution for this controversial problem. Revalidation should be planned from the perspective of both patient and doctor. The fundamental purpose of revalidation should however be to ensure that the patient receives safe and effective health care. This is possible only if the doctor is properly motivated. Provision of a safe and effective health care is the responsibility of every doctor and not a response to a demand by a politician or a supervisory body. It is a very sad indictment that such requirements have to be imposed by legislation. Professor David Hatch in giving evidence to the Shipman inquiry made an illuminating and positive contribution to what revalidation should be about. He stated that nobody had given him the opportunity to demonstrate his fitness to practice. It is therefore essential that Sir Liam’s review comes up with a scheme that satisfies the expectations of the public and would be attractive to the doctors. Following is an outline of how I see revalidation may be achieved in practice. Establishing fitness to practice (FTP) as a means of revalidation is an easy concept to grasp, but as it has turned out, difficult to put into practice. Clinical governance on the other hand is a more difficult concept (even Dame Janet Smith confessed to this, although she provided an erudite description of it in her report), but appears to be easier to implement. Clinical governance is a means of improving quality of service provided by health organisations. It could however be readily adapted for purposes of revalidation. A measure of the quality of service provided is perhaps more relevant to the patient than a doctors fitness to practice. Clinical governance for purposes of revalidation may be seen as: The means by which a doctor is held responsible and assessed to ensure thereby the provision of a high quality of healthcare and the maintenance of the means to achieve it. The precise criteria and measures of outcome is a matter of detail for a later date if this proposal finds favour with the review team. Revalidation is eminently suited for peer review. Although revalidation, as envisaged above and clinical excellence awards focus on different levels of achievement combining the two would have several advantages. The Clinical Excellence Awards (CEA), previously the Distinction Awards, is a tried and tested scheme and the Advisory Committee for Clinical Excellence Awards (ACCEA) have considerable experience in carrying out these assessments. The committee responsible for the discretionary points could perform this function under the aegis of the ACCEA. I was a member of a Regional Awards Committee and believe that the scheme would be amenable to serve a combined purpose. The public would also have greater confidence in the process if carried out by such a body. It would be highly cost effective compared to figures brandished by the GMC. Another highly cost effective measure is to be selective in those requiring revalidation. CEA and discretionary points are granted to those providing a high quality of service over and above requirements. It would be highly unlikely that individuals in receipt of such awards would be found wanting for revalidation. The criteria however might require some adjustment. If the government’s aim of wishing to see two thirds of consultants in receipt of awards or discretionary points an exemption scheme would be very worthy of consideration. Newly appointed consultants could also be exempted for a period of time before being required to undergo revalidation. It is essential to eliminate all negative concepts that have been associated with revalidation and incorporation into the awards scheme would create a positive ethos. Professor Hatch could tell us more. Finally submission for revalidation should be based on a simple questionnaire as for the awards. The preparation of a “folder of evidence” as suggested by Dame Janet Smith is best avoided. Preparation of the folder would be an essential part of appraisals. Details could be made available for revalidation if required. This is perhaps a very different route from the one that the GMC set out on. But it would get us to our destination ensuring that both patient and doctor are beneficiaries. Competing interests: None declared |
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Jay Ilangaratne, Founder Medical-Journals.com
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It is said,"Revalidation is not about catching another Shipman or about judges dictating to doctors how they should regulate themselves"[1].Then one wonders what prompted the Shipman-Inquiry to comment on revalidation so extravagantly "by reference to the case of Harold Shipman"[2].So are we now to take that the Shipman-Inquiry wasn't even remotely contemplating of catching another Shipman when making such strong comments on revalidating doctors. Remoteness,causation,chance,and proportionality are very familar terms in law.Hence,I am surprised that an inquiry which was dominated by the legal profession, felt proportionate to comment on a revalidation process which has a very low chance, if any, of catching another Shipman.So was the Shipman-Inquiry really the appropriate forum to advance revalidation simply because of the murders of one doctor? Perhaps,a considerable amount of taxpayers' wealth could have been saved if revalidation was properly addressed in a more impartial forum without a general attack on the entire profession. At best,the good intentions as to revalidation, have come from the wrong forum with a wrong tone. References [1]Aneez Esmail. Failure to act on good intentions BMJ 2005; 330: 1144-1147. [2]http://www.the-shipman-inquiry.org.uk/bg_termsofref.asp Competing interests: Does not get paid for making critical views about medical organisations. |
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Oliver R Dearlove, Consultant Anaesthetist Royal Manchester Children's Hospital
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Dr Webster who comments above has hit the nail on the head. I feel it is a pity that it was not he who was on hand to advise the Chair of Shipman Inquiry. There is a great chance for further bureaucracy in revalidation of UK registered doctors, while making sure that independent treatment centres, the flag ships of government health policy employing other doctors are not fettered by such inconvenient questions as ‘have they been revalidated?’ The measures for revalidation of UK doctors: audit, reviewed practice, re-examination or whatever, have first to be shown that they work. That is, there has to be an evidence base for their use. For example if you are going to look at GP’s mortality, then you have to show it identifies mass murderers and not those GPs with nursing homes on their books, or else it is a waste of time and money, as Dr Webster points out. But one first has to decide what one wants to revalidate. One can either use revalidation to root out mass murderers, or one can use it to assess competence in practice. These two aims look completely different to me. If it is the second possibility competence in practice, [which had previously been agreed but then was un-agreed], then it means that the Shipman Inquiry recommendations – all £40 m of them, will be played down or ignored. So much for value-for-money or target oriented measures. In the New England Journal (1) last week, Prof Esmail, an adviser to the Inquiry wrote enthusiastically “Some of the best safeguards against another Shipman include a more questioning attitude towards doctors.” How many does he think are still out there? What are the results from the other safeguards? Bare statements without evidence are rarely credited in medical practice but seem to be the rule in revalidation. Oliver R Dearlove FRCA Ref 1.Esmail A perspective. Physician as Serial Killer – The Shipman Case. New England journal 2005 352 1843-4 Competing interests: These views are his own, and are not the views of his employer or any other organisation |
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Jo Wren, Media Relations Manager General Medical Council, NW1
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Dr Esmail is looking at things from the wrong end of the telescope when claiming that the GMC has failed to grasp the issue of scrutinising doctors’ performance. Surely the main lesson that has emerged from the various recent Inquiries is that employers of doctors (including primary care trusts) need to ensure that they have in place local systems that can deal quickly, effectively and fairly with poor or dangerous practice. That approach has - rightly - underpinned the Government's quality agenda since 1997, and it was re-affirmed by Lord Warner in March this year when he said: ‘The responsibilities of employers must be properly exploited before we load more onto regulators. We need proper clarity on the respective roles of each.’ What is needed, in other words, is a proper understanding of the role of clinical governance in improving the quality of care and protecting patients from harm, and of the relationship between clinical governance and GMC procedures, including revalidation. How curious, then, that Dr Esmail does not even mention clinical governance once. By contrast, Dame Janet Smith devoted an entire chapter of the fifth report to it. The GMC is determined to look forwards, rather than backwards. As our contribution to the Sir Liam Donaldson's review, established following the fifth report, we have set out a vision for the development of medical regulation over the next few years. That includes creating a robust system for revalidating doctors’ licences to practise. As the regulator we want local systems to be subject to robust quality assurance so that evidence such as patient surveys, complaints records, professional development, clinical audits and prescribing records provide the basis for confirming that doctors are up to date and fit to continue practising. We are certainly not “burying our head in the sand” but preparing to deliver the most significant improvements in professional regulation for 150 years. Amanda Watson
Competing interests: None declared |
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Michael O'Donnell, FRCGP. Former GP turned journeyman writer Loxhill GU8 4BD
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I’ve been impressed by the intellectual rigour Dame Janet Smith has brought to inspecting the undulating prairie exposed to the Shipman inquiry. Yet, after reading reports of her work, though not all the original documents, I am left with a couple of questions. Maybe Aneez Esmail [1], who tells us he was “medical advisor (sic) to the Shipman inquiry” – I hope there was more than one – could answer them on her behalf. Did she, at any stage consider, recommending the system that her own profession uses to revalidate solicitors, barristers, and judges. And, if she did consider it, why did she reject it? I hope she would agree that both professions merit a similar standard of regulation. My experience, over a lifetime which now seems extended beyond the point of necessity, suggests that incompetent doctors are responsible for no greater levels of morbidity, or even of premature mortality, than incompetent lawyers. We’re also told that Dame Janet advised the GMC at its recent conference that it should assume the power to reject “unsuitable” medical students before they qualify, proposing “a test of ethics as a useful and sensible means of weeding out and failing students who had not managed to absorb essential ethical principles that they would be expected to practise throughout their career”. [2] If the government does decide to enshrine that wholesome advice in legislation I hope it will impose the same regulation on law schools. More importantly I hope it will devise a new “suitability” test for all MPs before they enter Parliament and a system for their regular revalidation once they get there. You don’t need to monitor world affairs too closely to see that an unethical politician can be several hundred thousand times more lethal than a Dr Shipman. If the government were to embark on such public spirited legislation, it would, of course, need to set up another regulating body to revalidate and “weed out” the revalidators and “weeders out”, and a body to revalidate and “weed out” the revalidators and “weeders out” of the revalidators and “weeders out” … and so on. By which time, with luck, my life - in which I have found “unsuitable” people are, on the whole, more energising and rewarding than conscientiously “suitable” ones - will have drawn to a peaceful un- revalidatable close. 1. Esmail A. Failure to act on good intentions. BMJ 2005;330:1144-7 2. Pritchard, L “Weed out” unethical medical students, Dame Janet urges. BMA News, May 14, 2005 michael@odonnell99.freeserve.co.uk Competing interests: A deep mistrust of equivocating adjectives like "suitable" and "appropriate". |
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Geoff Wong, GP Principal Daleham Gardens Surgery, London NW3 5BY
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In reading Esmail’s article (1) and the host of Rapid Responses to it, I feel that two points are worth making. i) At last there seems to be an interest in this important topic! In 2004, no one could care less when an article was published by the BMJ on Revalidation (2), now it seems to have come to the fore and about time too, as it will affect all GMC registered doctors in the United Kingdom. ii) What is clear to me from Esmail’s article, Dame Janet’s Report (3), and many of the Rapid Responses is that there is still confusion as to the aim(s) and objective(s) of Revalidation. It is time to put this to rest and what surprises me is that, as doctors, we should know how. When the profession has been faced with new diseases/problems, one of the strategies often used is to look to the research evidence. In the case of the purpose of Revalidation, I suspect that there will be no ‘evidence’ to help us, so the next logical step would be to fund research into the ‘problem’. Thus one approach would be to design studies which help us to define what we all want or expect from Revalidation and in particular attention should be paid to finding out what other stakeholders want as well. Patients, politicians and the profession need to come to an agreement as to what Revalidation is for. Why? Because, at its most basic level, revalidation is a form of assessment (examination) and all assessments must have clear aim(s) and objective(s). Only when such aim(s) and objective(s) are clearly defined can the assessment process be designed (4). Such a basic first step is particularly important in high stakes assessments that may go on deprive someone of their livelihood. Furthermore, we should not try to design any assessment process without learning the lessons from other countries that have tried to regulate or re-license their medical workforce (e.g. the USA, Canada and Australia). Though, these countries do not have identical health care system and work force training, there may well be lessons to learn from a through literature review of how, why, to whom and in what respects and in what circumstances their procedures do or do not work. I hope that this time round, we will get a Revalidation system which will be fit for purpose, that not only reflects the expectations of patients, the profession and politicians, but also has tried to learn the lessons from the past and from other countries. References: 1. Esmail A. Failure to act on good intentions. BMJ 2005;330:1144- 1147 2. Wong G. Revalidation: swallow hard. BMJ 2004;328:1077 3. Shipman Inquiry. Fifth Report. Safeguarding patients: lessons from the past – proposals for the future. London: TSO, 2004. http://www.the- shipman-inquiry.org.uk/fifthreport.asp (accessed 17 May 2005) 4. Schuwirth L, van der Vleuten C. Changing education, changing assessment, changing research? Med Educ 2004;38:805-812 Competing interests: None declared |
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John Onuorah, GP Addison House Surgery, Hamstel Road, Harlow.CM20 1DS
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The core essence of all medical practitioners is to uphold the Hippocratic Oath in doing no harm. This clearly involves an unequivocal goal of doing no harm to the patient. The process of improving the lot of all patients that we come in contact with includes the application of knowledge (personal and collective experience ) with an unambiguous measure of altruism. The goals of revalidation should be to ensure that these two properties are never in short supply. Measurement of our altruistic ability essentially has to be by the recorded experience of our patients' feedback. The measure of our professional knowledge has to be very objective and assessed by professional peers at a local level with guidance from relevant professional organisations/Royal Colleges. We will all feel more confident of our professional practice with the awareness of keeping up to date with current developments as well as affirmation of previous knowledge. It would then be up to the local employer to collate these data on a regular basis - ? 3-5years and take any remedial actions it may deem necessary in a constructive manner. Practitioners with persistent deficiencies should then be referred to the regulator for full assessment of fitness to practice. A satisfactory outcome to all parties involved - patients, doctors, doctors' employers and regulators should be a transparent, constructive and recurring process of favourable patient feedback as well as the assurance of well informed professionals. A climate of fear and vindictiveness will only serve to produce defensive professionals who unfortunately will have their altruistic objectives a paltry second in line to protecting their skins - the ultimate loser being the patient. Competing interests: None declared |
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Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA
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The safety of the patient should be our first priority. The basic requirements for safe practice should be in place first and basic knowledge is the most basic requirement. However, all practitioners assessing patients and not only doctors should pass a knowledge test. The same level of basic knowledge should be a requirement for all. And yes, I am referring here to Nurse-practitioners, First Contact- practitioners and practitioners of the various professions allied to medicine. To focus on doctors is a gross oversight; this is the group most likely to pass basic knowledge tests. To let the various other 'practitioners' run riot whilst trying to make the most qualified, educated and intelligent jump through hoops is just a ridiculous waste of resources. Competing interests: None declared |
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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I fear you have mistaken the purpose. Yes, we don't want incompetent doctors, but what is also being sought is a way of controlling doctors. The professions allied to medicine have no power, and can safely be left alone. Competing interests: None declared |
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David E Powell, Retired Pathologist South Wales SA32 7HF
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It may be that retirement from 40 years employment in hospital practice is an automatic disqualification from making any contribution to the revalidation debate. However, the BMJ of 14th May provokes an irresistible urge to do so. First, we have the ever-brooding presence of Dame Janet Smith (p1104), who now extends her brief to that of medical students, recommending that they be put on the GMC's register. She advises that students who "have not managed to catch on and absorb essential ethical principles", be weeded out. The judge calls for "some means" of ensuring this. Judgements of this nature, in my view, confirm the impracticability, as well as the unjustified nature, of some of her previous recommendations. It is extraordinary that her extremely dispersed views should have been promulgated under the unique aberration that was Harold Shipman. Can we be sure that Shipman would not have passed such a test? The generally deferential responses from the profession's official bodies, can be understood only in the light of a succession of well- publicised "scandals", such as Bristol, Alder Hey and individual cases of poor practice. In many instances the medical response has been defensive and reactive, where we appear to be over anxious to placate and go along with changes that have deleterious consequences in clinical practice and research. Thus, we now have ridiculous obstacles placed in the way of the use of clinical records and "surplus" human tissue or fluids, all of which is already enshrined in statute. I find Professor Esmail's contribution (p1144) particularly disquieting, and, at the same time, revealing. The person who was medical advisor to the Shipman inquiry, asserts that the reforms proposed "will strengthen the GMC, preserving self-regulation..." How can Esmail claim this, whilst, at the same time, state "In my view, the GMC has nowhere to go but down". His hostility to the GMC is not concealed- even where the GMC admits its faults, or changes its practice, these are seen as ploys to divert criticism. Esmail goes on to admit that the proposed changes in revalidation and appraisal, would be costly and onerous for the GMC, but has no solution, other than that the additional £10 million would have to be raised from its members. Esmail has no hesitation in informing us that "I do not fear revalidation". Here speaks the true professional, answerable to himself. But this gives the lie to his entire argument regarding the external control of the profession. Why set up this vast machinery to monitor people who are so sure they will satisfy its criteria - or is Esmail prepared to submit purely in order that someone else may be failed or seen to need "remediation"?. In the midst of all the discussion little attention is being paid to the quality and efficacy of the methods themselves, in the form of revalidation folders; local revalidation groups; appraisal and the degrading, if not dishonest, collection of points for attending meetings, of questionable relevance, even if they are held in the most desirable and remote locations. One of the most revealing and disturbing results of the trend to allow others to dictate a profession's regulation, whether personally or corporately, is the increasing role of politicians on issues where they can have little first-hand knowledge. Thus, the government of the day, in the form of a Secretary of State, who is one day responsible for health and the next for defence, can take decisions on the nature and duration of undergraduate medical education; the time needed for the training of a consultant (which is always less than the current, despite the claimed need for higher standards) and the enhanced roles for those that are not medically qualified. In the latter case, it is remarkable how little we hear of their need for revalidation. I am etc. D E B Powell, MA, MD, FRCP, FRCPath. Competing interests: I expect, and resent, my life-membership of the GMC, to be modified unilaterally. |
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Peter KK Au-Yeung, Specialist Anaesthetist Hong Kong
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I can only put it down to my absence from the UK, BUT what has Shipman got to do with the GMC and revalidation? The GMC is supposed to protect patients by spotting the incompetent or sick doctor at the earliest opportunity and institute remedial or therapeutic action if appropriate, or if not, strike them off so that they are removed from patient contact. Nowhere is its remit the pursuit of mass murderers, even if one of these happened to be a doctor. Despite intentions of reviewing the law on murder, the murderer is at present still supposed to have "malice aforethought". Surely any system designed to protect patients from incompetence or ordinary psychiatric morbidity is ill-suited to catching the deliberate and malicious murderer. In any case, what is the competence of the GMC in matters murderous? Is any attempt by the GMC to catch murderers a prime example of acting outside one's own sphere of expertise, an action that the GMC itself does its utmost to discourage? Let us get revalidation back to letting doctors prove they have the competence to treat patients at the level of expertise that they lay claim to, and let the experts in catching murderers (such as the Police) get on with catching murderers. Competing interests: None declared |
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