Doctors to be tested for competence yearly

All doctors face annual test of their competence

Biggest change to regulations in 150 years

David Rose
The TimesJuly 23, 2008
http://www.timesonline.co.uk/tol/life_and_...icle4381245.ece


All of Britain’s 150,000 practising doctors are to undergo annual reviews to weed out poor performers, in the biggest reform of medical regulation for 150 years, The Times has learnt.

Family doctors, hospital consultants and private practitioners will have to apply to renew their licences every five years, according to plans published today by the Chief Medical Officer.

The system – the first of its kind in the world – is designed to identify doctors who repeatedly make poor clinical decisions. Inspectors will use evidence from patients’ questionnaires and feedback from colleagues. Doctors “unable to remedy significant shortfalls in their standards of practice” risk being removed from the medical register, the report says.

Critics said that it would mean doctors spending less time with patients and practising “defensive medicine”.

The report by Sir Liam Donaldson, Medical Revalidation: Principles and Next Steps, outlines how senior doctors will be appointed to assess the competence of GPs and hospital consultants in their area to ensure that patients’ lives are not being put at risk.

The medical colleges, which represent different clinical specialties, will have to develop tests to check that doctors are keeping abreast of advances.

Trials will begin within two years. At the moment doctors face no formal reassessments of their competence, clinical skills or performance between entering independent practice as a GP or consultant and retiring. An airline pilot would be assessed about 100 times over a similar period.

The proposals were produced with the General Medical Council (GMC) and the Academy of Medical Royal Colleges. Many doctors may be concerned about bureaucracy diverting them from patient care.

To date, the Government has only recommended to trusts that they carry out regular reviews of how doctors’ skills are progressing, based on conversations with the individual concerned. That system, according to today’s report, is “patchy and not fit for relicensing [the renewal of doctors’ licences] across the country”.

The new regime will make annual reviews mandatory. They will cover the full range of performance factors, including prescribing habits, interaction with patients and personal problems such as alcohol or drug misuse.

The GMC, which was founded in 1858 to regulate doctors’ fitness to practise, recommended continuing reviews of doctors’ credentials ten years ago, after a series of scandals over medical incompetence. Weaknesses in the monitoring system for GPs were also revealed by the case of Harold Shipman, who murdered up to 250 of his patients, usually with narcotic drugs that he had stockpiled.

Appraisals will be considered a “continuing process” leading up to licences being reissued every five years. Medical students and those who work in short-term appointments or as locums will also face annual checks.

The report emphasises that the system will be “focused on raising standards, not a disciplinary mechanism to deal with the small proportion of doctors who may cause concern”.

Yet Sir Liam has said in the past that “most doctors know of another doctor who, on balance, they would prefer not to treat their own family”.

Sir Graeme Catto, President of the GMC, said that it had dealt with 5,168 complaints about doctors last year – 1,300 more than in 2000 – but only about one in three led to an investigation, and fewer than 5 per cent to a hearing. A total of 60 were struck off.

He described the report as a “wake-up call” for doctors and local NHS organisations. “We have been recommending a system of revalidation for ten years,” he told The Times.

“It has taken so long to get up and running because of the complexities and scale of the task – covering doctors across the whole of the UK.”

Sir Graeme denied that the reforms would lead to a culture of “defensive medicine”, with doctors worried about the consequences of their actions. “It’s very easy to concentrate on the bad apples, but we hope that this new system will mean that more problems can be identified and addressed at a local level, before they become serious.”

Michael Summers, vice-chairman of the Patients’ Association, said: “We have been waiting for this since the Shipman inquiry and earlier. It is important that patients have a much greater voice in this process and doctors should feel a responsibility to report colleagues where necessary.”

Hamish Meldrum, chairman of the British Medical Association, said: “As the Chief Medical Officer points out in today’s report, the majority of doctors provide high-quality care and strong commitment to their patients. It is essential that the CMO’s proposals are not unduly burdensome for doctors, that they enable them to develop and improve their skills and do not result in them having to spend less time with patients.

“We want to see a system that is good for patients and fair to doctors. The system should not be seen as a tool to weed out the very small number of doctors who underperform – there are other processes in place to do this.”

Trials should begin by next year, but Dr Meldrum said that the BMA was concerned about the timescales.

The Department of Health denied that the processes would lead to extra bureaucracy. It said that in the best NHS organisations medical directors were already performing the role of responsible officers.

Dame Carol Black, President of the Academy of Medical Royal Colleges, which will receive a £3.9 million grant, described revalidation as a “unique opportunity” for all doctors to demonstrate to patients, the public, their employers and peers their competence to provide high-quality medical care. “This work is progressing well, with input from employers, lay representatives and other agencies. It is a process that will reinforce the trust that patients have in their doctors.”