Revalidation requirements need greater clarity

A NEW review of medical revalidation urges greater clarity in required supporting information, as well as re-doubled efforts to reduce workload and duplication for GPs also engaged with the CQC and NHSE in England.

The review into the operation and impact of revalidation throughout 2016 was carried out by Sir Keith Pearson, independent chair of the Revalidation Advisory Board. This involved gathering practical feedback from a wide range of individuals and organisations involved in the process, as well as analysing the findings of research into revalidation since its implementation.

Overall the report is positive. In his executive summary, Sir Keith states: "Revalidation has already delivered significant benefits. Firstly, it has ensured that annual whole practice appraisal is now taking place. Regular, supported reflection upon specified types of information, including feedback from patients and colleagues, is starting to drive changes in doctors’ practice.

"Secondly, evidence shows that revalidation has strengthened clinical governance within healthcare organisations, helping them to identify poorly performing doctors and support them to improve. In time, I am confident that these developments will lead to safer and better care for patients."

He adds: "Revalidation is still a new process; it is important that we learn from the first cycle to make it more effective in the next. I do not believe major overhaul is needed. Rather, I have made recommendations to improve some aspects of revalidation, for the benefit of both doctors and patients."

Among the key recommendations in the report he calls for updated guidance on the supporting information required in appraisal for revalidation to make clear what is mandatory (and why), what is sufficient, and where flexibility exists.

He also calls for innovative ways to improve the input of patients into revalidation using technology to make the process more "real time" and accessible to patients – with the possible use of instant patient feedback after each consultation. Local healthcare organisations should also promote revalidation to their patients, explaining the assurance that it provides and why their feedback matters.

Sir Keith believes the system needs to be more robust for doctors who work outside mainstream clinical practice and those who move around the system, such as locums. He calls for the GMC to continue working with the CQC and NHSE in England to reduce workload and duplication for GPs, and to work with relevant organisations in Northern Ireland, Scotland and Wales to identify and respond to any similar issues.

There is also the suggestion to replace the term ‘revalidation’ with ‘relicensing’.

Responding to the review, Charlie Massey, chief executive of the General Medical Council, said:

"It is reassuring to hear that revalidation is settling in and beginning to impact on clinical practice, professional behaviour and patient safety. But it is still relatively new, and we acknowledge the difficulties and challenges identified by Sir Keith in his report.

"We agree with Sir Keith’s recommendation that more should be done to raise the profile and understanding of revalidation with the public, how the process contributes to improving the quality of patient care, how they can be involved and to encourage more feedback about doctors.

"I am concerned by the findings that some doctors are asked, as part of their revalidation, to provide evidence or carry out activities above and beyond what is required and detailed in our guidance.

"As Sir Keith recommends, we shall work with the royal colleges and with employers so that our guidance, and theirs, are clear about what are mandatory requirements for revalidation and where there is scope for flexibility. Everyone needs to be clear on what is, and what is not, necessary for revalidation."

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