Revalidation for doctors halted : evidence over policy?

Interesting stuff: the Government telling the GMC that it wants evidence based revalidation. The first page of the letter is here (do send the other if you can) and a report is here. It’s not being stopped completely, but there is to be a further year of pilots before  a decision.

Good. Revalidation for doctors – which has had money and attention thrown at it post-Shipman – has always been controversial. Though doctors have always been required, one way or another, to prove they are keeping up to date (credits for each hour of learning, etc), it has become more formal, with appraisals annually – the norm, in the last five years, for most doctors. The content of these has been rather tedious, I have found:  a lot of paper, a tickbox rigamarole, and a format which doesn’t really allow for what I consider one of the main tenants of good practice – which is fundamentally, recognising when you don’t know something, and then going to find out. Has collecting the data about what I do and what I think I want to learn over the next year made me a better doctor? I can’t see that it has, and indeed there is no evidence that revalidation will identify failing doctors, find dangerous work, or even, as was mooted in post-Shipman times, find criminal activity. So we may end up with a system even more dangerous. We think we are catching the bad guys, and relax, when we are catching no one of the sort.

Personally, if we are to have external scrutiny, I’d prefer an exam, or peer review – and I mean normal, working GPs, preferably rotating just as jury service -discussing and  reviewing of my work. Then there is lots of other data, easy to pick up, already available but scarcely regarded thoroughly: referral patterns, prescribing. But what we should really be aiming for – and what the Coalition seems to have picked up on – is that if we are doing anything costing this much time and effort then we need something evidence based. There are now many GPs earning substantial figures for appraising their colleagues, part time. This use of money has to be  evaluated in the same way that any money being put into the Health Service does. Similarly, the amount of nonsense courses doctors and nurses can now  go on  –  to satisfy reappraisal – is a sign that any good such study leave might have done has vanished in the need to collect points, not useful learning. Not only do daft courses take staff away from patients, but the NHS has to pay for it: it’s a simply dreadful waste.

Stopping revalidation and looking for the evidence is a good thing.

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