The Chief Medical Officer, Sir Liam Donaldson, has announced a shake-up in the assessment of doctors which is set to be the biggest change to the regulation of the medical profession in 150 years.
The need for further regulation has long been put forward by organisations representing the medical profession, including the General Medical Council (GMC). The issue was highlighted by the inquiry into the actions of Harold Shipman, who murdered up to 250 of his patients, often with the use of narcotic drugs that he had stockpiled. The inquiry criticised the regulation of doctors as not being focused enough on patients. But given that Harold Shipman was a criminal who may well have passed the new proposals, what will further assessment and regulation achieve? Will it result in better standards for patients, or an increased burden on doctors and the practice of 'defensive medicine' with doctors having less time for patients?
The intention of the reforms is to standardise what is currently a patchy system of monitoring and not to be a disciplinary mechanism. Doctors face no formal reassessments between entering practice as a GP or consultant and retiring. This lack of reassessment has been compared to airline pilots who are assessed approximately 100 times during their career.
The present system is carried out on the basis of an annual appraisal to consider a doctor's prescribing habits, career development and general performance. This has been described by the Chief Medical Officer as not appropriate for the renewal of licences. It is thought that some Trusts are not carrying out the appraisals each year and there is concern over the consistency of the assessments. There is also no process for gathering feedback from patients which is a key element of the new proposals.
The new system has two strands: relicensing (confirming that doctors practice in accordance with the GMC's standards) and recertification (confirming that doctors conform to the standard appropriate for their speciality of medicine).
The relicensing component will require a uniform module of appraisal, based upon the GMC's Good Medical Practice, while there will be scope for other aspects of the appraisal to be a matter for local employers.
The recertification component will involve a clear set of standards developed by the relevant medical Royal College in conjunction with specialist associations. The basis of the assessment will be rooted in the evidence of doctors' actual practice and focused on an ongoing five year process, rather than a single 'high stakes test'.
While the introduction of revalidation is of understandable concern to some, the benefits of a more rigorous system of relicensing and recertification can only serve to justify the generally positive view that patients hold of doctors in the UK. The new initiative should provide better and safer clinical care for patients by ensuring that doctors are up to date with the ever changing field of medicine in which they practise.
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