A way forward

Introduction

The General Medical Council's proposals for recertifying doctors in the United Kingdom every five years have been thrown into confusion. A recent judicial inquiry into the case of Harold Shipman, who murdered at least 215 patients, found that the method for revalidating doctors based on regular appraisal would not detect poorly performing doctors.1 The government suspended plans for revalidation and ordered an urgent review led by the chief medical officer.2 This article gives a proposal for a way forward. Although the article is from general practice, the framework described is applicable to other specialties.

Problems with current model

The GMC's proposal for revalidation requires doctors to keep a portfolioshowing participation in appraisals and completion of an agreed personal development plan. They also have to provide a statement of “no concerns” fromtheir primary care organisation and evidence of probity and health. To understand the problems with the current model, we have to be clear about the definitions of appraisal, clinical governance, and revalidation (box 1).

The three methods of assessing performance overlap.5 This overlap has advantages and disadvantages. On the one hand, data collected for appraisal can be used for revalidation, thus reducing the burden of assessment. On the other hand, a summative process such as revalidation could hijack a formative process such as appraisal. A fundamental observation of the Shipman report was that although appraisal and clinical governance inform revalidation, they are not sufficient to evaluate a doctor's practice. The current proposals therefore give an “illusion of protection,” particularly as patient safety and reassurance of the publicare important functions of revalidation. What can be done to overcome this fundamental shortcoming?

Making revalidation work

My proposal for successful revalidation is based on 10 guiding principles (box 2). Below, I describe …