With all the substantial changes we are seeing concerning the running of the NHS in this country, there is one big revolution that seems to have been in the slow lane recently - revalidation. I'm sure it has become a casualty of both a change in government and the tough economic climate, but will become a reality in some shape or form.
We are all doing appraisals but how revalidation will actually work has yet to be made crystal clear. In case you think this is still on the backburner, you are wrong. According to the univadis GP News service (click here), the House of Commons Health Committee has asked the General Medical Council (GMC) to be tougher on doctors who are performing poorly, as part of the revalidation process. This raises an important point about revalidation; who ultimately controls the mechanism? Will it be the doctors, perhaps through the GMC, or will it be the politicians, with their hands on the levers of power. This is important to clarify, because if it is professionally led then doctors will feel confident in the system, and have some form of ownership. If the politicians have substantial control, it could be used as a way of trying to identify poorly performing doctors. Of course there is nothing wrong with that, as long as it doesn't turn into a witch-hunt.
The fact that revalidation has taken so long to implement tells us what a complex beast it is. It will be expensive to administer and if not fully accepted by the profession, could end up just becoming a tick box exercise that will be subject to gaming as doctors learn to play the system to gain the desired result.
I'm sure the public feel comfortable with the idea of revalidation and it makes a good political point. However, to be a useful tool in a doctor's professional self-development, it needs to be effective, useful and not too expensive to administer. I think the outcomes and mechanisms should be clearly laid out, with the whole process run by the profession, although subject to independent scrutiny.
One way to make sure that this happens is for the newly forming GP consortia to take control of the process. However, I would still like the GMC to have an overall supervisory role.
Once the parameters of appraisal and revalidation are set, I would prefer that the politicians to stick to politics. The minute there is significant political meddling, it could make the exercise less worthwhile.
Dr Harry Brown, editor-in-chief
By Dr Harry Brown