Senior doctors’ non-clinical work may suffer because of revalidation, says academy
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7142 (Published 23 October 2012) Cite this as: BMJ 2012;345:e7142Most hospital doctors believe that revalidation will take substantial time over and above their time for appraisal, and as a result some input into non-clinical activities may be lost, says a report of a survey by the Academy of Medical Royal Colleges.
However, no strong evidence was found that the direct care of patients would be compromised in the short term by the requirements of the revalidation process, the academy reports.
Its survey, which was done in 2011 to explore how revalidation would affect the responsibilities of hospital doctors, contains the views of more than 2600 doctors working in the NHS (80% of whom were consultants and 20% staff and associate specialist (SAS) doctors) in Scotland and the north east of England.
The response rates were 41% for consultants and 39% for SAS doctors in Scotland and 34% for consultants and 28% for SAS doctors in the north east of England.
Most consultants expected that revalidation would take up significant time over and above appraisal (82% of Scottish consultants and 84% of consultants in the north east of England), and around half thought that the time spent on their most recent appraisal was more than that required in previous appraisals (45% of Scottish consultants and 66% of those in the north east of England).
Less than half of the doctors who responded to the survey expected to absorb revalidation into their current NHS time, with many saying that they would instead find time in non-work or leisure time. Almost a third of consultants said that, if faced with reducing their NHS work to accommodate revalidation requirements, they would limit their non-clinical work.
The current consultant contract allocates 25% of the working week to non-clinical activities, such as service development and clinical governance. The proportion of time spent on direct patient care by consultants depends on which sex they are, whether they are working part time, and their specialty.
Overall, hospital doctors in the survey worked in excess of their contracted sessions, with more than 77% of their contracted time devoted to direct clinical care. Several doctors in the survey had 9:1 contracts (nine direct clinical care programmed activities a week to one supporting professional activity). Such contracts skew the balance of the consultant contract negotiated in 2003, the academy says.
Paul Flynn, chairman of the BMA’s Central Consultants and Specialists Committee, said that the potential time taken up by revalidation has “always been a concern for doctors” and that revalidation shouldn’t be “unnecessarily burdensome.”
He said that the revalidation process, which is based on annual appraisals, “probably strikes the right balance,” although he did warn that problems could arise when doctors have to collect information to back up their appraisals, because the electronic systems have often been designed for financial purposes rather than collecting clinical data.
He added that the time required for appraisal and revalidation will be particularly hard to find where employers have reduced time for supporting professional activities.
Kate Tansley, revalidation project manager at the Academy of Medical Royal Colleges, said that the academy supports the introduction of revalidation, which was given the green light by England’s health secretary, Jeremy Hunt, last week.1 She pointed out that the academy’s report was based on a survey in 2011 and that revalidation should be carefully monitored to review any potential concerns that may arise.
The Impact of Revalidation on the Clinical and Non-Clinical Activity of Hospital Doctors is available at www.aomrc.org.uk/publications/reports-a-guidance.html.