Revalidation isn’t centred on patients, claims report

There is little evidence that the focus of revalidation is on patient care or that it will have a direct effect on the doctor-patient relationship, argues an independent report into the progress and process of the policy.1

The report, from the Peninsula College of Medicine and Dentistry at Plymouth University, comes just weeks before revalidation is expected to be given the green light by the government, for an official start date in December this year.

The new report draws on a review of key policies relating to revalidation dating back to the Merrison report in 1975, when the idea was first mooted.

The authors applied thematic analysis to understand revalidation’s role within the wider clinical, cultural, and political context and sought opinions on the policy from 31 medical, political, and legal leaders.

The report found that the concepts of regulation and professionalism had become interchangeable within the rhetoric about revalidation. But, the report says, regulation uses revalidation as a way to identify “bad apples” and set minimum standards, while professionalism sees it as a process by which all doctors improve, requiring evolving standards and a developmental model.

A clearer definition of both is needed, the report argues, and this should be determined by the needs of patients, another area where revalidation is lacking, it says.

It found little evidence that revalidation in its current form either originates from or has been shaped by patients or is explicitly centred directly on care.

“While a passing nod had been made to the patient, patients were not central to the revalidation process, and this requires careful consideration,” commented the lead author, Julian Archer.

“Revalidation is one of the most significant policy developments in the history of the NHS and has implications for patient experience, patient safety, and quality improvement,” he added.

Revalidation should shift its focus so that it directly influences the doctor-patient relationship rather than the doctor-regulator relationship, as is the case now, the report recommends.

And it calls for greater clarity of the definition of quality and how standards are set or might shift over time. Steps should be taken to ensure that a solid evidence base is built up as revalidation is implemented, so that progress can be continually evaluated, it says, adding that there have been “too many givens.”

Niall Dickson, chief executive of the General Medical Council, said, “The days of speculation and debate are over, but as this report recognises, revalidation will develop over time, and we need to learn from experience as it is rolled out.”