Revalidation must serve doctors and the public
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《英国医生杂志》
For it to succeed the system of regulating doctors in the United Kingdom must do more than simply provide a means of identifying "bad" doctors, says the BMA. It should also promote high standards, provide a platform for reflecting on and developing practice, and provide a positive confirmation of doctors?registration, the BMA says, in a response to a review of revalidation being conducted by the chief medical officer, Professor Liam Donaldson.
The BMA supports the process of revalidation, proposed by the General Medical Council, whereby doctors in the UK are periodically checked for their fitness to practise. And it believes that medical registration should continue to be professionally led. However, to gain public confidence, the process needs to be transparent and sufficiently robust to identify poorly performing doctors, it says.
The BMA states: "The vast majority of doctors provide high quality clinical care to their patients. A reliable and practical system of revalidation is needed for all doctors in a form that will confirm this but will also seek to improve their performance."
Professor Donaldson was charged with reviewing the regulatory process for doctors after the fifth report of the Shipman inquiry in December criticised the proposed scheme of revalidation (BMJ 2005;330:10). Revalidation, which was due to be launched in April this year, was suspended in January because of concerns in the report that the scheme would not provide an adequate evaluation of a doctor抯 fitness to practise (BMJ 2005;330:9, 1 Jan)
In its response to the review the BMA stresses that the process of revalidation needs to be provided by properly resourced, local quality assurance systems and clinical governance processes so that poor performers are identified before their five yearly revalidation check is due.
Revalidation should be separate from the annual appraisal process already in place for doctors, says the BMA. But it should not be so burdensome that it encroaches on clinicians?time with patients. The evidence that doctors collect for appraisal could also contribute to revalidation, it says.
"Any arrangement put in place should not introduce an onerous workload or have intimidating undertones, as it may pose a threat to recruitment and retention and would potentially encourage early retirement amongst older doctors, says the BMA. It also warns that care is needed when strengthening the regulation of medicine not to discourage doctors from taking on high risk procedures or patients or innovating more generally.
The BMA also calls for a "no blame culture" so that lessons learned from patients?complaints can be fed into the annual appraisal system. The BMA response says: "The difficulty is that the NHS is perceived by many who work in it as apportioning blame, and the success of encouraging staff to identify and report poor performance will be dependent on the introduction of a no-blame culture ?Such cultural changes take a long time to embed themselves into the thinking of organisations as large as the NHS."(Zosia Kmietowicz)
The BMA supports the process of revalidation, proposed by the General Medical Council, whereby doctors in the UK are periodically checked for their fitness to practise. And it believes that medical registration should continue to be professionally led. However, to gain public confidence, the process needs to be transparent and sufficiently robust to identify poorly performing doctors, it says.
The BMA states: "The vast majority of doctors provide high quality clinical care to their patients. A reliable and practical system of revalidation is needed for all doctors in a form that will confirm this but will also seek to improve their performance."
Professor Donaldson was charged with reviewing the regulatory process for doctors after the fifth report of the Shipman inquiry in December criticised the proposed scheme of revalidation (BMJ 2005;330:10). Revalidation, which was due to be launched in April this year, was suspended in January because of concerns in the report that the scheme would not provide an adequate evaluation of a doctor抯 fitness to practise (BMJ 2005;330:9, 1 Jan)
In its response to the review the BMA stresses that the process of revalidation needs to be provided by properly resourced, local quality assurance systems and clinical governance processes so that poor performers are identified before their five yearly revalidation check is due.
Revalidation should be separate from the annual appraisal process already in place for doctors, says the BMA. But it should not be so burdensome that it encroaches on clinicians?time with patients. The evidence that doctors collect for appraisal could also contribute to revalidation, it says.
"Any arrangement put in place should not introduce an onerous workload or have intimidating undertones, as it may pose a threat to recruitment and retention and would potentially encourage early retirement amongst older doctors, says the BMA. It also warns that care is needed when strengthening the regulation of medicine not to discourage doctors from taking on high risk procedures or patients or innovating more generally.
The BMA also calls for a "no blame culture" so that lessons learned from patients?complaints can be fed into the annual appraisal system. The BMA response says: "The difficulty is that the NHS is perceived by many who work in it as apportioning blame, and the success of encouraging staff to identify and report poor performance will be dependent on the introduction of a no-blame culture ?Such cultural changes take a long time to embed themselves into the thinking of organisations as large as the NHS."(Zosia Kmietowicz)