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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Less attractive than Death or Taxes
- Adam J Pringle (6 November 2006)
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Re: Opposing points of view relegated to rapid responses
- Sharon Davies (6 November 2006)
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Adam J Pringle, GP Lawley, Telford, TF4 2LL
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The editor suggests revalidation is inevitable, and so should be welcomed - yet the same journal contains the headlines 'NHS data are not good enough to gauge doctors' performance' and 'Patient safety needs closer monitoring'[because estimates of death because of safety patient incidents range from 840 to 34,000]. I, and every other doctor still working in active clinical practice that I am aware of, oppose the imposition of an untested system of 'revalidation' that is incapable of defining a good doctor, and which imposes bureaucratic burdens on the 95% of us seen as good doctors as punishment for the regulators inability to address the other 5%. Sir Liam's analysis of the problem is reasonable, but his conclusions are fundamentally flawed, and we, as a profession, have no reason to think they will be implemented as he intends or expects. First, let us look at the bits that might be of benefit. He recommends a system to support doctors with health concerns -yet he recommended the same thing seven years ago, and has nothing to deliver it, despite train drivers and pilots having similar support for a quarter of a century. He recommends a rigorous training system - yet has destroyed the old system, to introduce MMC - which has never been tested, and is still incomplete. Under his tenure, we have, this year, a twenty percent cut in funds for GP training, and the de facto eradication of study leave funding in the hospital sector. He recommends using 'appraisal', as part of a summative process - yet when it was introduced three years ago wwere all promised that it was a 'formative' process. I think this gives us clear rounds for a total lack of faith in his ability either to design a system, or to deliver the system that he has designed. Now let us lok at the punitive parts. The failings are manifest, and widespread. Individual GMC affiliates will clarly be at least as vulnerable to corruption and influence as the GMC itself, and so will fail, and be seen to do so. The next Dr Shipman will be safely ensconced as an affiliate. Who guards the guardians? Revalidation and reaccreditation must fail, because there are no reliable criteria to separate good doctors from bad - and yet we will all waste time and effort jumping through hoops. Would Sir Magdi Yacoub have been removed from the register, if he hadn't completed his revalidation folder? The bureaucracy he proposes is incredible - and will consume 5-10% of clinical time (if we are to have 2 appraisals, psychological assessment, 360 degree feedback, a visiting team, and reports on every locum) and a lot of other resources. Who pays? Who sees the patients? A rational approach would be to identify what you wish to measure (in this case a good doctor), and then design, test and validate your measures, before using them in practice. Sir Liam proposes the exact, unscientific opposite, having stated clearly that there is neither an agreed definition, nor any reliable validated test. A sensible man would focus on the 'problems'.The DVLA regulatory effort focuses on drivers who are high risk - convictions, alcohol, drugs, health problems etc, and has repeatedly rejected re-testing normal drivers as bureaucratic, expensive and unworkable. Driving is a simpler and cheaper process to measure than medical practice. A scientist, particularly one with some knowledge of public health, would design a screening process to identify bad doctors by using the WHO criteria for screening - yet Sir Liam's proposals fail every test bar one. His premise is based on a paper he himself wrote, suggesting 5% of doctors were problems over a five year period - yet this is surprisingly close to the proportion of doctors referred to NCAS. The problem repeatedly presented is of doctors who are known to NCAS as problems, yet not at a point where GMC sanction is appropriate. So why is Sir Liam, and the others who are with him, failing to put forward proposals to give NCAS more teeth, instead of burdening us with this monstrosity. He believes the medical establishment has been corrupt in the past, and so supports appontment - yet the NHS appointments commission is appointed by the government, so he is placing us in the hands of politicians, despite his denials. The medical establishment may well be corrupt. The only people who speak in favour of these proposals are those who may benefit - the educationalists who have left practice, and who hope to be the well paid affiliates, the lay members who stand to be appointed to more sinecures, and the college leaders, whose colleges will rake in profits from being monopoly providers of accreditation. The failure of any of these people to declare this conflict suggests this is the case (including Michael Buckley, Ian Gilmore, and Donald Irvine in this weks BMJ), and also suggests they should not be allowed to push through these badly designed reforms unopposed. I should, perhaps, also include the BMJ, given the easy ride Sir Liam had in his interview, and the BMJs relegation of opposing points of view to 'Rapid responses'. I write as an individual, but more importantly, as someone whose views have been published on-line (on doctors.net), where I have received support from over 1,000 of my colleagues, and heard no dissent from anyone still in clinical practice. Sir Liam Donaldson's proposals are fatally flawed, and their implementation, as they stand, will be an unmitigated disaster. Competing interests: None declared |
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Sharon Davies, Letters editor BMJ
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Readers may be interested to see that we lead this week's letters with two responses critical of the BMJ interview and the revalidation proposals.[1] [2] 1 Pickering WG. The BMJ interview: Sir Liam Donaldson. BMJ 2006;333:970. (4 November.) http://bmj.bmjjournals.com/cgi/content/full/333/7575/970 2 McQueen D. The BMJ interview: Sir Liam Donaldson. BMJ 2006;333:970. (4 November.) http://bmj.bmjjournals.com/cgi/content/full/333/7575/970-a Competing interests: None declared |
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