Fit to practise

The Revalidation Support Team
Department of Health-funded body to support the implementation of revalidation

The introduction of medical revalidation throughout the UK means doctors who wish to retain their license to practise in this country will need to demonstrate they are up-to-date and fit to practise.

The Revalidation Support Team
Department of Health-funded body to support the implementation of revalidation

The introduction of medical revalidation throughout the UK means doctors who wish to retain their license to practise in this country will need to demonstrate they are up-to-date and fit to practise.

Demonstrating fitness to practise is not simply a matter of providing a snapshot of a doctor’s ability or knowledge, as might be achieved by taking an examination, but rather by a continuous process of collection and collation of information to build a picture of the doctor’s performance over a period of years.

The key principle of revalidation is the collation of information about a doctor’s practice, from local internal clinical governance systems, quality improvement systems, appraisal and patient and colleague feedback, held by the regulator, the General Medical Council (GMC).

The process a doctor will undertake to demonstrate they are eligible for revalidation involves a collection of information on their practice. This ranges from systems of clinical governance, clinical audits, quality improvement, to regular appraisals and patient and colleague feedback, complaints, compliments and significant events.

The triangulation of this information, alongside evidence of the individual’s commitment to learning by reflecting on the implications for changing and improving their practice, generates a picture of the overall performance of the doctor.

This detailed overview of the doctor’s practice enables the responsible officer of the organisation for which the doctor works to make a judgement on whether he or she should be recommended for revalidation.

The introduction of a ‘system of revalidation for doctors’ was first discussed as long ago as 1995. At that time, there were detailed high-level discussions about the feasibility of developing the then recently introduced system of medical appraisal into a more comprehensive system of revalidation.

Since then, work has been done to define the aspects needed to implement revalidation consistently, across every specialty and across the UK.

Responsible officers
The NHS Revalidation Support Team (RST) works alongside the GMC, the Department of Health and designated bodies, to deliver an effective system of revalidation for doctors in England. The GMC published two documents, Good Medical Practice Framework for Appraisal and Revalidation and Supporting Information for Appraisal and Revalidation, which underpin the revalidation process.

The RST is currently producing the Medical Appraisal Guide (MAG), which will provide practical details of how medical appraisal should be undertaken to support revalidation and the statements and expected outputs  of appraisal.

A designated body is an organisation that employs or contracts with doctors and is designated in The Medical Profession (Responsible Officer) Regulations 2010.

A responsible officer is a licensed doctor with at least five years experience and has been nominated or appointed by a designated body.

On 1 January 2011 it became mandatory that each designated body appoint a responsible officer in the UK.

A designated body is an organisation that employs or contracts with doctors and is designated in The Medical Profession (Responsible Officer) Regulations 2010.

A responsible officer is a licensed doctor with at least five years experience and has been nominated or appointed by a designated body.

The responsible officer, often a senior doctor and in most cases the Medical Director, is appointed to make a recommendation to the GMC on the fitness to practise or otherwise on each of the doctors for whom he or she is responsible, on the basis of information collected on the doctor’s practice. There is a mechanism for the allocation of every doctor to a responsible officer – a clearly articulated set of ‘prescribed connections’ based on the doctor’s main employer. The prescribed connections are laid out in The Medical Profession (Responsible Officer) Regulations 2010.

Appraisal systems
In order to achieve revalidation, each doctor practising in the UK must undergo a regular – in most cases yearly – appraisal. The information from the appraisal system is triangulated against the information generated by the organisation’s clinical governance systems. This enables an overall pattern of performance and behaviour to be generated. Once every five years the responsible officer makes a recommendation to the GMC as to whether the doctor is fit to practise in the role they currently hold.

The GMC then makes a decision, based on the responsible officer’s recommendation, as to whether the doctor should be granted a licence to practise for a further five years. Doctors changing roles between revalidation cycles will need to demonstrate to their appraiser and responsible officer that they have undergone suitable training to take on the new role and they have put in place an appropriate plan for CPD that matches their new responsibilities.

The responsible officer also has a duty to oversee the clinical governance and appraisal systems of the organisation and to put processes in place to ensure that any failures are picked up early. The effectiveness of the responsible officer’s decision-making is dependent upon robust collection and collation of information at the local level and on the consistency and rigour of appraisal.

Revalidation is not without its challenges. Many current systems were not initially designed to capture information specific to individual practitioners. Therefore one of the key starting points for revalidation is an assessment of the strength or otherwise of the organisation’s information systems.

The regulations place the responsibility on employing organisations to resource the systems needed for revalidation to the appropriate level, while the responsible officer also has a duty to ensure that revalidation is properly resourced.

Alongside the challenges posed by revalidation come a number of benefits, both to doctors and the organisations in which they work. The process of appraisal not only enables doctors to review the entirety of their practice in a supportive environment, but helps them to identify areas in which they feel they may need to develop and allows them to strengthen their skills and work with their appraiser to produce a personal development plan.

The process enables doctors to ensure they undertake continuous professional development that is closely aligned to their needs. The information needed for appraisal and the underpinning management systems encourages the organisation to engage effectively with doctors as well as, in many cases, improving the information basis for patient safety and monitoring the quality of care.

Revalidation will be implemented from late 2012 across the UK. All doctors wishing to hold a license to practice must take part in revalidation and all organisations providing healthcare are obliged to support their doctors throughout the process.

It is suggested that doctors:

Identify their responsible officer and make contact with them.
Collect a portfolio of information about their practice, audit outcomes, complaints, compliments, patient and colleague feedback, appraisal summaries, and examples of quality improvement.
Establish what the local arrangements are for the collection of patient and colleague feedback.
Establish who their appraiser is.
Familiarise themselves with the clinical standards as set out by their Royal College.
It is suggested that responsible officers:
Make contact with the appropriate SHA responsible officer.
Establish through the prescribed connections process, the doctors for whom they have responsibility.
Undergo the training provided through the SHA.
Understand the regulations and guidance.
Make contact with the appropriate GMC Employment Liaison Advisor.