Government plans to revalidate doctors every five years

BMJ 2008; 337 doi: (Published 24 July 2008) Cite this as: BMJ 2008;337:a988
  1. Owen Dyer
  1. 1London

    All doctors working in England are to face annual appraisal of their skills and performance and will have to reapply for a medical licence every five years, according to plans announced by the UK chief medical officer, Liam Donaldson.

    For most doctors not in substantive training posts revalidation will involve two components—relicensing, subject to their adherence to generic standards, such as the General Medical Council’s Good Medical Practice guidelines, and specialist recertification, which will depend on meeting criteria to be set by the relevant medical royal colleges.

    Both the GMC and the Academy of Royal Medical Colleges worked with Sir Liam to develop the proposals, which the GMC’s president, Graeme Catto, called “the biggest change to medical regulation in 150 years.”

    Although GPs and some specialties already have appraisal systems written into their contracts, Sir Liam’s working group argued that implementation was “patchy.” Under the new plans, appraisal will be overseen by a local “responsible officer,” typically the medical director of the local trust or healthcare organisation, who will be accountable for monitoring doctors’ skills and performance.

    The appraisals will include patients’ and colleagues’ assessments, which will be obtained using questionnaires. “The involvement of patients and public in the process will help define what counts as good health care,” said Sir Liam, noting that doctors’ communication skills would be assessed as well as their clinical knowledge.

    Sir Liam’s working group considered but rejected, at least for now, a proposal to distinguish “excellent” performance from that which is judged “satisfactory.” Initially, the report says, appraisers will merely be asked to decide each year whether the doctor is meeting the necessary criteria for revalidation or is falling behind and needs to improve to earn a new licence.

    The scheme is to be introduced in stages over roughly two years. In the first half of next year, the GMC will issue licences to all doctors who need one. The first appraisals are provisionally set for April 2009.

    The government will hold public consultations on the appraisal process starting in October this year and launch pilot schemes in 2009. It is currently holding consultations on the introduction of responsible officers. Designing the specialist recertification process is likely to take longer.

    The changes could mean an end to limited prescribing rights currently granted to retired doctors, Sir Liam’s report hinted.

    Hamish Meldrum, chairman of the BMA, cautiously welcomed the plans: “The BMA is supportive of plans to appraise doctors in order to develop and improve their skills.”

    “However, it is essential that the chief medical officer’s proposals are not unduly burdensome for doctors and result in them having to spend less time with patients. It is vital that the new system is good for patients and fair to doctors.

    “The vast majority of doctors are dedicated to providing high quality care to their patients. It is important that these proposals are not used to weed out the minority of doctors who are underperforming; there are other processes in place to do this.

    “The BMA does have some concerns about the timescales for piloting and implementation, and we could not accept a situation where certain specialties were chosen for early roll out simply because it was considered easier to progress with them first,” said Dr Meldrum.

    The Royal College of General Practitioners, with the General Practitioners Committee, has also launched the updated Good Medical Practice for General Practitioners with the GMC’s endorsement. The document will underpin the process of revalidation for GPs.

    The college’s chairman, Steve Field, said, “Revalidation will be a major challenge for the profession over the next few years, and it is something to which we must all commit as it will improve and demonstrate the quality of care we provide to our patients.”

    Hugh Stewart, head of case decisions at the Medical Defence Union, said, “It would be inappropriate to introduce a time consuming process that keeps doctors away from their patients, and we welcome the assurance that the burden of revalidation will be minimised—for example, the proposal that relicensure and recertification will draw on largely the same evidence.”


    Cite this as: BMJ 2008;337:a988


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