Sir Liam and licenses

Sir Liam Donaldson, the Chief Medical Officer, has published his report today on the ‘principles and next steps’ of medical revalidation. The bottom line seems to be that doctors will have to undergo relicensing every five years. We have annual appraisals already, but appraisals are meant to be supportive and reflective. The new system will have end points of pass or fail. There will be new posts created to run the new system. ‘Responsible Officers’ will be created and will be responsible, locally, for “the recruitment of medical staff; annual appraisal and multi-source feedback; monitoring indicators of clinical performance, handling complaints and concerns relating to the conduct and performance of individual doctors, and, where appropriate, referring on to the GMC for further action; and: collating the information from all these potential sources in order to support a recommendation on revalidation.”

It sounds like quite a lot of doctors will be needed to stop seeing patients and do these jobs instead. I also feel rather overawed by the amount of paperwork that Liam Donaldson is proposing. There are several mentions about the importance of ‘evidence’ in the report. However I don’t know of any evidence that backs up many of the proposals – in particular, the keenness for 360 degree appraisal. All these tell us is what other people are willing to say anonymously about you. It doesn’t tell what is a correct and fair assessment and what is unfair, misleading, or flawed. It also takes a lot of time. The new posts will also cost money. Will this make healthcare safer or doctors better? I don’t know on what evidence Sir Liam bases his assertion that “Revalidation will provide rigorous and evidence based assurance to patients that their positive view of their doctors is firmly based.”

I can understand, though, the fear that there are bad doctors who are working undetected. But there is another fear: that we are about to create a huge diversion away from patient care in  favour of more bureaucracy but with little benefit to patients.

Meantime, no one is examining the  vast amount of data which is already being collected about what doctors are doing right now.

All my prescriptions are done in my name and are almost entirely done via computer. Every few months I get a printout of what I have prescribed compared with my colleagues. These figures are sometimes looked at on a practice basis, or even as a group of practices, but I have never been asked for my individual information by anyone else, or even asked if I have looked at it myself. Mind you, I do know who looks at it with great interest: the pharmaceutical industry.

The amount of referrals I make to specialists and the amount and type of blood tests I request are all done with my name attached. They would be easy to add up and compare,but I don’t think anyone actually does. GPs keep a record of how many opiate drugs they have in their bags and who they administer them to. They are not routinely inspected. Death certificates are filled out every day by doctors but I am unaware of anyone observing what individual doctors are writing on the forms. 

I wonder if these proposals will end up in more resources being diverted into an ineffective intervention (relicensing.) And I wonder what else the money could be spent on: would spending the money making, for example, psychiatric care safer be of more benefit.

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