By Kieran Walshe, Professor of Health Policy and Management, Alliance Manchester Business School
Reforms to the way doctors are regulated by the General Medical Council have introduced new periodic checks of ‘fitness to practise’ for all doctors in the United Kingdom.
Together with colleagues at the Universities of Manchester, York and Plymouth we have been researching how they have worked.
Until quite recently, there were very few formal checks on doctors’ performance and fitness to practise by the General Medical Council, unless a complaint or concern was raised. But in 2012, a new system of ‘revalidation’ was introduced by the government, which required all doctors with a license to practise to undergo annual appraisals, and to have their fitness to practise confirmed once every five years by a senior doctor in the place where they work and by the General Medical Council. This has been a big change in the way doctors are regulated, and we’ve been researching how it has worked in practice.
While the introduction of this new requirement of revalidation was quite controversial, and met with some scepticism from the medical profession, we found that by and large it has been accepted and adopted by doctors and healthcare organisations, and by 2018 all doctors had been through their first experience of revalidation. It has certainly led to more scrutiny of doctors’ performance, and a closer relationship between organisations which employ doctors and the General Medical Council.
For doctors who work mostly in the NHS, these new arrangements have been fairly straightforward. Most of them already had annual appraisals, for example, but the new system of revalidation has given more authority and leverage to senior doctors and driven some improvements in the way appraisals and systems for clinical governance work.
But for doctors who work in other settings – such as private practice, or as locums – revalidation has been rather more challenging. Those organisations have had to set up new systems for clinical governance and get these doctors, many of whom were not participating in appraisal or clinical governance, to take part. We found that it can be hard for senior doctors in these organisations to have sufficient information about a doctor’s performance to recommend that they are fit to practise and should be revalidated.
It is quite hard to tell yet what effects these changes might be having on the quality of care for patients, and while our research produced examples of improvements, we could not measure the impact through data on, for example, mortality or readmission rates. We do know that the introduction of revalidation has led some doctors to decide to give up their license to practise medicine and to exit the profession.
We suggest that the system of revalidation could be improved in a number of ways.
First, we think that the arrangements for revalidation for doctors who are not working just in one organisation like an NHS trust need to be strengthened, and the way that information about performance is collected and shared between organisations and the General Medical Council could be improved.
Second, we suggest that the revalidation requirements could be made more flexible, and take more account of the type of work that doctors do, the specialty they work in, and their prior history of performance.
Overall, surveys have shown that most members of the public and the medical profession think doctors’ fitness to practice should be regularly checked, and support the introduction of medical revalidation. Our research suggests that the new system is working, but its effectiveness and impact could be improved.
