Will GMC revalidation of GPs assure their quality?

#GPFUQ 3 Will GMC revalidation of GPs assure their quality? No - we only need a few failures to destroy the credibility of revalidation. 

We have started the first cycle of revalidation of UK Doctors in 2013. Now all doctors working in the UK must have passed 'revalidation' by the GMC to continue to be licensed as doctors. The plan is for revalidation every 5 years. The standard needed to achieve revalidation is fairly low and can't assure quality.

So what might be better? There are a couple of options that might drive improvement and greater confidence in quality assurance of doctors. 

1. Annual Maintenance of Competence schemes or 

2. Medical indemnity or GMC fees linked to perceived riskiness. 

Annual Maintenance of Competence

Do we need annual maintenance of GP competence? The US boards of medical specialities have years of experience recertifying doctors competence, and they are shifting from the episodic recertifying examination of doctors competence every 5 -10 years to a continuous maintenance of competence? (MOC) cycle that assures a doctors professional standing, lifelong learning and self-assessment, cognitive expertise and performance in practice throughout the term of the maintenance of competence. The specialist or craft societies (like the RCGP) are not involved in the recertification process and just help members pass the exams. If the GMC revalidation process does not assure quality then this may be our future.

MOC usually has four components:

1. Professional standing is a check that doctors licence to practice is not compromised, and may need references and feedback from colleagues or evidence of institutional appointments.

2. Life long learning and self assessment. Most schemes require continuing medical education hours ranging from 10-50 hours each year. Self assessment is by examinations, tests and educational modules.

3. Performance in practice. This is a challenging assessment of doctors performance. Doctors are assessed for how closely their practice compares with accepted standards of care. This includes assessing confidential patient satisfaction measures, use of evidence based or best guidelines, review of operative records or logs of procedures, office record reviews or audits, practice performance improvement modules, specific board feedback, case based oral examinations, linkage to practice data or outcomes though guideline measures and national benchmarks. The goal is to use the tools and techniques that are credible, valid, reliable, practical and feasible and improve doctors performances.

4. Cognitive Expertise. This required passing an examination within the course of the MOC cycle.

Does all this sound familiar? Most of the MOC components already exist in UK general practice, and only await the full assembly by a competent authority.

Professional standing is tested by DBS (Disclosure and Barring Service) checks, and the annual NHS appraisal. Life long learning and self assessment is included in the annual appraisal process and resultant personal learning plans. 

Performance in practice is very similar to the GP contract markers like Quality outcome frameworks points scheme.

Cognitive expertise is the only component missing and eventually may be a feature in the recertification process. The only debate is what sort of examination will this be? Should we all get ready to take the knowledge test MRCGP examination every 5 years? Is this the future of GP education?

Medical indemnity or GMC fees linked to personal risk 

GMC investigations and hearings are expensive, insurance claims for medical negligence are expensive. We currently have flat fees for GMC registration and fairly flat and similar fees from the providers of medical indemnity. More expensive annual fees for practitioners who can't demonstrate maintenance of competence, or for whatever reason appear to be at higher risk may provide a continuous incentive for improvements inbetween the 5 year cycles of revalidation.