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Are doctors fit to practice? Research shows the impact of government reforms to professional regulation

Most people think that doctors already go through some kind of regular check that they are up to date and fit to practice – like airline pilots, for example.  But in fact, a system to do this (called “medical revalidation”) was only introduced in 2012, after more than a decade of debate between government, the General Medical Council and the medical profession.

Designing and implementing a regulatory system to oversee the performance of the 230,000 plus licensed medical practitioners in the UK has been a difficult and lengthy process. Every doctor is required to have an annual appraisal in which they reflect on their practice by discussing information about their activities, including continuing professional development (CPD), quality improvement activities, significant events and complaints. Then, every five years the organisation where the doctor works has to review his or her portfolio of information and make a recommendation to the General Medical Council (GMC) on whether they should be revalidated or not. Ultimately, a doctor can lose his or her licence to practice if they are not revalidated. Every organisation that employs doctors is required to have a senior medical professional who has statutory legal responsibility for running this system, and making those recommendations to the GMC.

Both the Department of Health and the GMC have funded research on the implementation and impact of medical revalidation, and initial findings from this research have just been published. This blog highlights key findings from a survey of healthcare organisations, conducted by a team of researchers from the Universities of Manchester, Plymouth and York.  A report of a survey of individual doctors has also just been published.

We have found that revalidation has driven improvements in the use and sharing of information about medical performance within many organisations. Respondents said that the appraisal systems in their organisation had changed; mostly for the better. There have also been improvements in other systems for managing medical performance (CPD, complaints, quality improvement, significant events, doctors causing concern and fitness to practise), and it seems that these different sources of information about performance are being brought together and used more.  There have also been important impacts on the way that early concerns about a doctor’s performance are handled.

Information sharing between organisations and the GMC about doctor performance also seems to have improved, with the GMC’s Employer Liaison Service in particular providing better, earlier and more timely access to advice. It is not clear however that revalidation has driven a similar improvement in information sharing between organisations. Respondents commonly reported difficulties in obtaining performance information about doctors such as locums, who work across more than one organisation or when doctors move from one organisation to another.

Larger organisations with a substantial pre-existing clinical governance infrastructure have found it relatively straightforward to implement revalidation, although many say they have had to take on revalidation without a sufficient allocation of time to fulfil their duties. Smaller organisations who employ few doctors tend to regard revalidation as overly bureaucratic and a strain on their resources. 

Very few organisations want to see policy on medical revalidation reversed, but many think it could be made more effective and efficient.  Moving from a “one size fits all” single model of revalidation to allow appropriate variation in the way the policy is applied seems to have widespread support. Variations might relate to organisational size; to how close or distant is the employment relationship between the organisation and the doctor; or to the nature of different clinical fields or specialties. Revalidation processes might also vary depending on an individual doctor’s previous track record, though this might be more controversial.

The GMC has recently commissioned Sir Keith Pearson, Chair of its Revalidation Advisory Board, to lead a review of revalidation and produce recommendations by the end of 2016. The review will be informed by our research among other sources of information. We are now examining how revalidation works in detail in some case study organisations, and are exploring the impact of revalidation quantitatively.   Similar revalidation reforms are being introduced for other health professions in the UK, and these changes are being watched with interest by other countries in Europe and further afield. 

Alan Boyd, Research Fellow and Kieran Walshe, Professor of Health Policy and Management