10 June 2009
In Autumn 2009 the General Medical Council (GMC) will introduce the licence to practise. The licence to practise will give a doctor the legal authority to undertake activities that are currently restricted by law to doctors who are registered with the GMC. Any practising doctor working full-time, part-time, privately, within the NHS or as a locum will need to hold a licence to practise as well as GMC registration. For example, doctors will need a licence to practise to write prescriptions, hold a post as a doctor in the NHS and sign cremation certificates. The GMC does not say that it is mandatory for doctors writing medicolegal reports to have a licence to practise as long as they do not imply that they do.
Currently, once a doctor has full registration with the GMC, he or she is free to practice until a significant problem arises. However, most doctors are also appraised annually by their employers.
After Autumn, once a doctor has a licence to practise, he or she will have to demonstrate every five years that they are up to date, fit to practise and complying with the relevant professional standards. This, in summary, is the process known as revalidation. Once a doctor is identified as having impaired fitness to practise, further investigation will take place and, any doctor failing the process will almost certainly need to do some remedial work or may be suspended. An obvious benefit is that doctors working in the private sector will also need to be revalidated. The revalidation process is still being developed and even practising doctors are not sure how it will actually work.
Every doctor holding a licence to practise will be linked to a Responsible Officer. One of the roles of the Responsible Officer will be to recommend to the GMC whether or not a doctor should be revalidated.
Some specialities are proposing knowledge assessments as part as continuing professional development and this could contribute to the revalidation process. One of the tasks required for revalidation is participation in an independent process for obtaining feedback from patients.
Practising doctors are concerned that the reforms will bring extra administration and bureaucracy. Also, there is uncertainty about the numbers of doctors who are likely to fail the revalidation process and there is therefore concern that hospitals and GP surgeries may be understaffed and that this could undermine patient safety. It is generally accepted that it is unlikely that revalidation would have caught Harold Shipman. Some doctors believe that the extra work that doctors will need to do to prove what they are mostly already doing could force many older doctors into early retirement.
The GMC says that it aims to minimise additional burdens as a result of revalidation and that the system will be based on elements such as annual appraisal and audit that are already taking place.
A more transparent system for assuring quality in the medical profession can only mean safer doctors, as long as a sensible approach is taken so that we are not left with understaffed hospitals and overworked doctors as a result of revalidation.
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