Clinical Medicine

Introduction: a short history of regulation and revalidation

Revalidation is not a new concept. It is over 30 years since a process for the ongoing assessment of doctors was first considered in the US, but in the last six years, revalidation has been an increasingly dominant presence on the horizon of the medical profession (Bradley 24; Bruce et al.,65; McKay, 25). Revalidation was first considered in England and Wales in 1975 by the Merrison Committee, which was established by the Wilson Government to explore existing provision for the regulation of the medical profession and how this could be improved. The committee reported a growing interest in linking continued registration with periodic tests of competence but eventually dismissed the idea on the basis that the methods available for measuring competence where insufficiently robust (Merrison Committee, 54).

Revalidation in the US was deferred for the next 20 years until in 1995, the General Medical Council published Good Medical Practice (GMC,101) outlining a set of core standards and values to which all doctors were expected to adhere in their everyday practise. Good Medical Practice was the impetus for the publication of further standards by many of the Medical Royal Colleges, and importantly, it set a standard against which a doctor could be revalidated. Just three years later, the high profile hearing into the Bristol paediatric cardiac service was a watershed event for the development of revalidation (Ritchie, 65). In the fallout of the inquiry, it was recognised by the GMC that there was a “ … clear public expectation that medical regulation should include measures to assure patients that consultants, and general practitioners, continue to perform effectively throughout their working lives …registration should depend on continuing participation in and contribution to quality assured practice” (Irvine, 36). This was followed in early 1999 by a majority vote at the GMC conference in favour of introducing revalidation to the registration process for all doctors. A Revalidation Steering Group was established and after due consideration, concluded that revalidation should be based on the principles of Good Medical Practice.

In 2000, the GMC outlined the philosophy and advantages of revalidation and made the first link between annual appraisal and revalidation (GMC 121). The GMC argued that annual appraisal and revalidation were parallel and complementary governance and regulatory processes that would enable the holistic evaluation of both the professional performance and competence of doctors. Revalidation was to take place every five years and would involve an independent assessment by a group of doctors and lay people. Subsequently, annual appraisal was introduced for consultants and GPs in 2001 and 2002 respectively. During this period, the GMC conducted a pilot study of the revalidation of 20 doctors using five mock assessment panels. Results showed a close correlation between positive recommendations for revalidation and participation in regular appraisal (GMC, 121). A second pilot study evaluated the information required for revalidation. Results indicated that it was possible to revalidate 69 per cent of cases using the evidence and documentation collected by doctors for ...