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Author	Francisco Machado
Last updated	20/04/99

Learning Objectives

Define revalidation
Appreciate why it is necessary
Who it will affect
What is its relationship to clinical governance
What will it mean for GPs

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Reflection

Think!!!

How do you feel about revalidation? Threat or opportunity? Why not debate this with your trainer or peers?
How can you demonstrate that you provide quality care?
How will your partners affect your ability to demonstrate quality care?
Who should pay for it?
What are the implications if it fails?

Case scenario
You work in a partership of 4 doctors. You have difficulty with some of the pratices of your partners. They do not want to co-operate with the local guidelines on clinical governance. What implications does this have for you and the practice??

Definition

Revalidation has been defined by the The revalidation Steering Group as:

" the processes by which doctors demonstrate on a regular basis that they are up-to-date and remain fit to practise".

Purpose

for the most doctors who maintain a good standard of professional practice it be "an unobtrusive celebration of their commitment and achievement as registered medical practitioners"
identify doctors whose practice is in need of attention
trigger a process by whereby these doctors- actively supported by their colleagues and employers have a real opportunity to put things right before their registration is affected
for the public it is an open and transparent process which indicate those doctors the profession and management have confidence. But it will also give patients better protection from dysfunctional doctors

For it to work.....

ensure that doctor's performance meets national standards
should reflect performance at work
be fair to doctors
be open and transparent to the public, employers and the profession
capable of involving all specialists and GPs whatever the circumstances of their practice
be simple, economical in time and effort and inexpensive. This may be the greatest problem!!!

How does it fit in with clinical governance?

It is being developed at the same time as clinical governance so it is likely that it will be developed in harmony.

Clinical governance

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Set standards for professional development of practice teams

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Failure to meet standards may lead to revalidation assessment

GMC suggested framework of how it might happen?

Six key stages

Stage 1	Local Profiling of performance profiles for revalidation of performance are likely to be developed by doctor and his peers not likely to be an examination might include a portfolio of continual learning audit of performance portfolio of organisational development regular appraisals It is intended that this profiles will take in account the views of the patients, employers and peers
Stage 2	Periodic external review to command confidence need external review compare with JCPTGP visits of training regions for GP training
Stage 3	Evidence of revalidation doctors would have to be issued with a certificate of revalidation that they would then present to the GMC for their registration to continue. Without it they would not be able to remain registered who will issue this certificate is not decided, ? RCGP ?JCPTGP
Most doctors will stop at this stage and go back to stage 1. There is no indication of how long it will take to complete the cycle and how often individuals will have to be revalidated.
Stage 4	Local Remediation doctors felt to be falling below standard will hopefully be identified early and supported locally to develop their performance this must be done sensitively the aim is to raise their performance to enable them to be revalidated
Stage 5	Referral to the GMC performance procedures	If marked deficiencies are found then the doctor will be investigated under the performance procedures in place to assess the knowledge, skills, attitudes and performance. If these are found lacking and the doctor does not improve he will be removed from register.
Stage 6	Action by the GMC on the doctor's registration

Link to registration

The process is seen as having to be linked to registration of the doctor because:

it needs to be a transparent process,
it needs to be consistent
it needs to be robust

It needs to have some weight behind it. If not gaining revalidation meant that you simply lost your job, but not your registration this could in theory mean that you would be able to get another post!!

Resources

these are likely to be immense
both human and financial
separate register for generalists
GMC will need more income, who is going to pay?? My feeling is that the profession will pay!

A copy of the Report of the Revalidation Steering Group can be seen on the GMC website.

The role of the Royal College of GPs

the college has always looked for quality
new ways of demonstrating this, FBA, MAP, Total quality award
leadership in quality issues
the college is asked for its opinion/leadership
likely to help with the peer visits

Exactly what the role of the patients will be is not known

Pringle M. Revalidation. BJGP 1999;49:259-260.

Resources

GMC site

BMJ articles

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