Traditionally, professionals such as doctors, lawyers and teachers studied, qualified, undertook professional training and were then left largely to their own devices. By and large, the only time
Traditionally, professionals such as doctors, lawyers and teachers studied, qualified, undertook professional training and were then left largely to their own devices. By and large, the only time their regulator would become involved in their practice would be if they failed to complete a set amount of annual CPD or their fitness to practise was called into question due to either their misconduct or poor health. More recently, a number of regulators have introduced systems where professionals' ongoing competence is assessed and revalidated. We look below at the model introduced by the GMC and whether, in light of recent controversies relating to barristers and teachers, revalidation is the shape of things to come for regulated professionals.
Revalidation for doctors was first mooted in the 1970s but the issue was put firmly back in the spotlight in the wake of a number of high profile medical scandals in the 1990s and early 2000s. One argument in favour of revalidation was that fitness to practise investigations only catch the most extreme cases and that patient protection and public confidence require that the GMC does more to ensure the ongoing competence of all doctors. Revalidation was introduced by the GMC in December 2012 and is in the process of being rolled out for all doctors. Doctors will be required to demonstrate at least every five years that they are up to date and fit to practise.
In order to revalidate, doctors have regular appraisals with their employer (or in the case of independent doctors a suitable individual) where they are assessed against the standards of Good Medical Practice. The doctor must provide supporting evidence to show how they meet the standards in practice. Their appraiser can either (i) make a recommendation in favour revalidation, (ii) request a deferral in order for them to obtain more information, or (iii) notify the GMC that the doctor has not engaged and is not expected to engage sufficiently with the appraisal process and they therefore cannot recommend revalidation. Revalidation is not designed to replace the fitness to practise regime or local remediation and the appraiser should refer any concerns about a doctor's fitness to practise in the usual way.
The GMC model has met with some criticism. According to a January 2014 article in trade paper Pulse, as of January 2014 only 23 of 8,000 GPs had concerns flagged about them as part of revalidation, leading some to question whether revalidation has been as effective as might have been hoped. In addition, a January 2014 survey of over 5,000 hospital doctors and GPs showed that 53% of those surveyed queried whether revalidation would help identify and deal with doctors who are not fit to practise. In response, the Chief Executive of the GMC told Channel 4 News:
"[Revalidation] is not a panacea, but a contribution to patient safety and we will develop the model over time. We recognise that it is a work in progress and we are already working to evaluate its impact. We will listen and learn from the experience of those who are going through the process."
It will be interesting to monitor the effectiveness of the GMC's model and we would expect a number of other regulators to wait and see how it progresses before establishing their own models. It is widely accepted that revalidation models can and should vary and that the GMC's model is not 'one size fits all'. Matters such as the context of a registrant's practice, whether they are employed by the NHS or are independent and the degree of risk should rightly influence the revalidation model. The NMC is currently consulting on its own revalidation model and hopes to introduce this from 2015. In addition, the General Osteopathic Council is due to consult on a revised framework for a continuing fitness to practise scheme for osteopaths in 2014. It is anticipated that the Regulation of Health and Social Care Professions Bill will not include any formal provisions regarding revalidation and that it will be for the Department of Health to issue regulations in this area. Whether and how they do may well act as an important barometer of the perceived success of the GMC's programme.
As far as the GMC is concerned, there appears to be relatively broad consensus that revalidation is a good thing, or at least that the system should be allowed to bed down. However, not all proposals to introduce regular assessments of standards have received unanimous support. The Legal Service Board's recent decision to approve the introduction of a Quality Assurance Scheme for Advocates ('QASA') has been subject to a claim for judicial review by a number of barristers, supported by the Criminal Bar Association. The introduction of a quality assurance scheme was originally recommended in the 2006 Carter review into legal services and seeks to address concerns from various sources about advocacy standards in criminal trials. The proposal is that QASA will regulate the quality of all advocates appearing in the criminal courts in England and Wales, whether they are barristers, solicitors, or legal executives, whether they are self-employed or employed, and whether they are acting for the prosecution or defence. Advocates will be assessed by the judges before whom they appear. The application for judicial review was rejected but the appellants are seeking to take the matter to the Court of Appeal.
In education, the Shadow Education Secretary Tristram Hunt recently told the BBC that Labour considers that teachers should have to pass regular 'classroom MOTs'. Ed Balls first raised the idea of a licence to practise in 2009 when he was Education Secretary, with the idea that teachers would be assessed by their heads every five years. This was opposed by the NUT and the plan had disappeared by the time of the 2010 general election. Hunt's proposal appears to have diluted some of the more controversial elements of the Balls plan (both the five-yearly cycle and the involvement of heads) but it is early days and the present government has not made any commitment to implement such a system. Much is likely to depend on who holds the reins of power after the next general election. Whether teachers' unions will ultimately be amenable to any such scheme remains to be seen and they have recently suggested that much will depend on the detail and whether this is to be achieved by training and development.
It is essential that regulated professionals are competent to practise. They hold positions of trust, often have fiduciary duties to their clients and much of our health and well-being is in their hands. To the extent that models of revalidation try to underpin and improve competence, it is difficult to argue with them. However, as the examples above illustrate, it is always likely to be a matter of debate as to whether a particular model of revalidation is necessary for the profession in question, and, given the costs involved of implementing and maintaining such a system, whether it is sufficiently effective. At present, it is not clear whether the potential benefits of the system are likely to be embraced by the wider professions and we would expect any move towards pan-regulatory revalidation to be very much on a piecemeal basis.
Revalidation for doctors was first mooted in the 1970s but the issue was put firmly back in the spotlight in the wake of a number of high profile medical scandals in the 1990s and early 2000s. One argument in favour of revalidation was that fitness to practise investigations only catch the most extreme cases and that patient protection and public confidence require that the GMC does more to ensure the ongoing competence of all doctors. Revalidation was introduced by the GMC in December 2012 and is in the process of being rolled out for all doctors. Doctors will be required to demonstrate at least every five years that they are up to date and fit to practise.
In order to revalidate, doctors have regular appraisals with their employer (or in the case of independent doctors a suitable individual) where they are assessed against the standards of Good Medical Practice. The doctor must provide supporting evidence to show how they meet the standards in practice. Their appraiser can either (i) make a recommendation in favour revalidation, (ii) request a deferral in order for them to obtain more information, or (iii) notify the GMC that the doctor has not engaged and is not expected to engage sufficiently with the appraisal process and they therefore cannot recommend revalidation. Revalidation is not designed to replace the fitness to practise regime or local remediation and the appraiser should refer any concerns about a doctor's fitness to practise in the usual way.
The GMC model has met with some criticism. According to a January 2014 article in trade paper Pulse, as of January 2014 only 23 of 8,000 GPs had concerns flagged about them as part of revalidation, leading some to question whether revalidation has been as effective as might have been hoped. In addition, a January 2014 survey of over 5,000 hospital doctors and GPs showed that 53% of those surveyed queried whether revalidation would help identify and deal with doctors who are not fit to practise. In response, the Chief Executive of the GMC told Channel 4 News:
"[Revalidation] is not a panacea, but a contribution to patient safety and we will develop the model over time. We recognise that it is a work in progress and we are already working to evaluate its impact. We will listen and learn from the experience of those who are going through the process."
It will be interesting to monitor the effectiveness of the GMC's model and we would expect a number of other regulators to wait and see how it progresses before establishing their own models. It is widely accepted that revalidation models can and should vary and that the GMC's model is not 'one size fits all'. Matters such as the context of a registrant's practice, whether they are employed by the NHS or are independent and the degree of risk should rightly influence the revalidation model. The NMC is currently consulting on its own revalidation model and hopes to introduce this from 2015. In addition, the General Osteopathic Council is due to consult on a revised framework for a continuing fitness to practise scheme for osteopaths in 2014. It is anticipated that the Regulation of Health and Social Care Professions Bill will not include any formal provisions regarding revalidation and that it will be for the Department of Health to issue regulations in this area. Whether and how they do may well act as an important barometer of the perceived success of the GMC's programme.
As far as the GMC is concerned, there appears to be relatively broad consensus that revalidation is a good thing, or at least that the system should be allowed to bed down. However, not all proposals to introduce regular assessments of standards have received unanimous support. The Legal Service Board's recent decision to approve the introduction of a Quality Assurance Scheme for Advocates ('QASA') has been subject to a claim for judicial review by a number of barristers, supported by the Criminal Bar Association. The introduction of a quality assurance scheme was originally recommended in the 2006 Carter review into legal services and seeks to address concerns from various sources about advocacy standards in criminal trials. The proposal is that QASA will regulate the quality of all advocates appearing in the criminal courts in England and Wales, whether they are barristers, solicitors, or legal executives, whether they are self-employed or employed, and whether they are acting for the prosecution or defence. Advocates will be assessed by the judges before whom they appear. The application for judicial review was rejected but the appellants are seeking to take the matter to the Court of Appeal.
In education, the Shadow Education Secretary Tristram Hunt recently told the BBC that Labour considers that teachers should have to pass regular 'classroom MOTs'. Ed Balls first raised the idea of a licence to practise in 2009 when he was Education Secretary, with the idea that teachers would be assessed by their heads every five years. This was opposed by the NUT and the plan had disappeared by the time of the 2010 general election. Hunt's proposal appears to have diluted some of the more controversial elements of the Balls plan (both the five-yearly cycle and the involvement of heads) but it is early days and the present government has not made any commitment to implement such a system. Much is likely to depend on who holds the reins of power after the next general election. Whether teachers' unions will ultimately be amenable to any such scheme remains to be seen and they have recently suggested that much will depend on the detail and whether this is to be achieved by training and development.
It is essential that regulated professionals are competent to practise. They hold positions of trust, often have fiduciary duties to their clients and much of our health and well-being is in their hands. To the extent that models of revalidation try to underpin and improve competence, it is difficult to argue with them. However, as the examples above illustrate, it is always likely to be a matter of debate as to whether a particular model of revalidation is necessary for the profession in question, and, given the costs involved of implementing and maintaining such a system, whether it is sufficiently effective. At present, it is not clear whether the potential benefits of the system are likely to be embraced by the wider professions and we would expect any move towards pan-regulatory revalidation to be very much on a piecemeal basis.