Revalidation must have public confidence, says BMA

May 20 2005

Whatever system of revalidation is chosen for doctors, the British Medical Association (BMA) believes it must have the confidence of the public, best achieved through a transparent professionally-led process. To succeed, says the BMA, revalidation must be seen to promote high standards, detect poor practice and have strategies for improving a doctor's performance where this is needed.

In its response to the Chief Medical Officer's (CMO) review of clinical performance and medical regulation following the Shipman Inquiry, the BMA supports the process of revalidation - a periodic check on doctors to demonstrate that they should continue to hold a licence to practise.

Revalidation should be a positive process about registration, reflective practice and development, not simply a method for identifying "bad" doctors says the BMA. "The core purpose of revalidation is to ensure that a doctor is up-to-date and competent to continue practising" says the BMA. The firewall that protects patients should be provided by properly resourced local quality assurance systems and clinical governance processes. Poor performers should be identified locally much sooner than at the end of a five year revalidation cycle.

The BMA states: "The vast majority of doctors provide high quality clinical care to their patients. A reliable and practical system of revalidation is needed for all doctors in a form that will confirm this, but will also seek to improve their performance."

Revalidation should be separate from the appraisal process already in place for doctors on an annual basis. The revalidation system should be structured so that the appraisal process - which is primarily developmental - can easily contribute to it. The same evidence could be used in both processes.

Clinicians could find themselves spending less time on patient care if regulation was made too burdensome, warns the BMA. "Doctors are concerned that any new system for revalidation will be time consuming and over-bearing. If too much time is spent by doctors in meeting the demands of regulation, this will reduce the time available for clinical care" says the BMA. "Any arrangement put in place should not introduce an onerous workload or have intimidating undertones as it may pose a threat to recruitment and retention and would potentially encourage early retirement amongst older doctors" says the BMA.

A no-blame culture is needed if lessons learned from patient complaints are to be fed into the annual appraisal system. The BMA response says: "The difficulty is that the NHS is perceived by many who work in it as apportioning blame and the success of encouraging staff to identify and report poor performance will be dependent on the introduction of a no-blame culture".Such cultural changes take a long time to embed themselves into the thinking of organisations as large as the NHS".

"While we are anxious to ensure the public is well protected and that the system is as robust as possible, it will almost certainly be necessary to adopt an incremental approach to the introduction of revalidation if we are to avoid unacceptable disruption to medical care by setting performance thresholds that are too high." When strengthening the regulation of medicine, care needs to be taken to avoid disincentives to take on high-risk procedures or patients, or to innovate more generally, warns the BMA.

It describes the General Medical Council as a pioneer in developing regulation well beyond that in other countries and says time is needed for GMC changes to bed down.

http://www.bma.org.uk