1. Background
The Chief Medical Officer of England published his white paper in February 2007, entitled “Trust, Assurance and Safety – the regulation of health professionals in the 21 st Century”, setting out proposals to ensure that all the statutorily regulated health professionals have arrangements in place for the revalidation of their professional registration through which they can periodically demonstrate their continued fitness to practise. This paper has now been superseded by “Medical Revalidation - Principles and Next Steps 2008”.
Revalidation essentially means positive evidence of the doctor's entitlement to practise, not simply the apparent absence of concerns. Therefore it is important to emphasise the requirement of active participation from the medical profession. It has been acknowledged that implementation of the revalidation process will be incremental in order to deliver a robust and quality-assured system. Furthermore, it will be based on evidence drawn from local practice, with robust systems of clinical governance to support it.
Revalidation will have two components: relicensure and recertification.
2 What is relicensure?
All doctors wishing to practise in the United Kingdom will require a licence to practise, issued by the General Medical Council every 5 years. The process of relicensure will be supported by the following elements:
- Satisfactory completion of annual appraisal, undertaken at the place of employment encompassing the four domains of the GMC's Good Medical Practice. Annual appraisal will form a primary basis for revalidation as an annual process within a five-year revalidation cycle. It will help identify problems locally and would enable doctors, employers, and those who contract with doctors to deal with them effectively locally. The GMC has developed an “appraisal module” based on four domains of Good Medical Practice , i.e.
- Knowledge, skills, and performance,
- Safety and quality,
- Communication, partnership, and teamwork, and
- Maintaining trust.
The RCOG would develop a specialty-specific version to support recertification.
- The appraisal will be supported by an independent 360° multi-source feedback from colleagues (medical and non-medical) and patients at different stages of the revalidation cycle.
- Any concerns identified in the above process, adequately addressed through local governance systems.
- Evidence of good medical practice from other sites where the doctor practices.
- Evidence of participation in Continuing Professional Development.
- Collection of outcome data (individual and team-based) to fit in with the job plan and day-to-day clinical commitments.
Any issues identified, either regarding a doctor's attitude or clinical practice would need to be resolved locally before the medical director or a responsible officer would be able to state that relicensure should be confirmed.
- As a first step towards the introduction of revalidation, the GMC will issue licences to all doctors who require one during 2009. It is estimated that about 150,000 doctors are in active practice in the United Kingdom. All registered doctors will be entitled to be licensed to practise. Issuing licences to all those who need one will be the first step towards the implementation of revalidation. All doctors will be expected to have appropriate indemnity insurance in advance
3. What is recertification?
The White Paper also proposes that all specialist doctors practising in the UK not holding a recognised training post should demonstrate that they continue to meet the particular standards that apply to their medical speciality at intervals of no longer than 5 years. The Colleges and Faculties will have the responsibility for signing off a positive statement of assurance that the individual practitioner has demonstrated that he/she has met the appropriate standards for specialist recertification. This statement would then be submitted to the General Medical Council.
The proposals for recertification suggest that evidence for this process will be drawn from a range of sources and activities such as:
- satisfactory appraisal every year for a five year period
- satisfactory multi-source feedback (report from the host organisation)
- Continuing professional development (Participation in CPD will be an important means by which doctors can demonstrate their continuing fitness to practise in their specialist field).
Our Recertification Working Party has recommended that our current Continuing Professional Development Programme needs to be revised to support the revalidation process. We envisage that evidence should be collected from the following sources:
- clinical audit to demonstrate excellence in clinical care
- Evidence of Continuing Professional Development by participating in educational activities relevant to clinical practice ,locally, regionally, and nationally
- An element of knowledge-based assessment as part of the CPD programme would include an element of learning and an element of testing; this would be a mandatory requirement to validate the whole process of recertification. We envisage this development will be based on our existing, successful programme using TOG (The Obstetrician and Gynaecologist).
- simulator tests - obstetrics skills laboratory, etc
- observation of practice
4. Delivery of Programme
In the United Kingdom, every doctor will have a “responsible officer” - the responsible officer will be a senior doctor in a healthcare organisation, normally but not always the Medical Director, who takes personal responsibility for local governance processes. Every region in the United Kingdom will have a “GMC affiliate” who would provide a link between national and local workplace regulation. The responsible officer and the GMC affiliate will also liaise with the Royal Colleges and Faculties. The responsible officer would be ultimately responsible for undertaking a final five-year check for the revalidation cycle, to ensure that:
- successive appraisals and multi-source feedback are in order to support revalidation
- any concerns flagged up during the intervening five years have been resolved.
5. What is happening in obstetrics and gynaecology?
For the purpose of developing recertification process, a working party has been established (under the chairmanship of Dr Tahir Mahmood, Vice President Standards). The working party is collaborating with professional societies and expert advisory groups to define standards in each subspecialty area. We are also engaging with other Royal Colleges through the Academy Revalidation Development Group . This interaction will ensure that all the colleges are following a consistent approach in developing their revalidation processes to meet the needs of their respective specialities.
Our working Party is not only developing new work streams but will also build on previous work completed by the College, Revalidation in Obstetrics and Gynaecology: Criteria, Standards and Evidence (2002) and Bridging the Gap Between Appraisal and Assessment (2006). The key strands being explored are:
- outcome measures to assess clinical practice
- assessment
- specialty-specific multi-source feedback (MSF) tool
- CPD Programme – fit for purpose.
- update of the RCOG Report Revalidation in Obstetrics and Gynaecology: Criteria, Standards and Evidence to bring it into line with the GMC's new Framework based on Good Medical Practice
- The working Party will be reporting to Council in January 2009.
Dr Tahir Mahmood FRCOG
Vice President Standards
Chair of Working Party on Recertification
Mrs Charnjit Dhillon
Director of Standards
Member of Working Party on Recertification
August 2008