Revalidation of doctors

The revalidation of doctors is in the news again.

The government continues to confuse two distinct issues. The question of a doctor’s competence, and the question of the risk that a doctor may commit a serious criminal offence.

Currently GPs have a system of annual appraisal. They appraise each other, and each appraisal costs the tax payer £1000, split between the two GPs.

These appraisals are a complete, utter, total waste of time and money. We looked at the process here. Have a look again. It is difficult to keep your face straight.

Appraisals do not pick up potential criminals because bent doctors are usually clever doctors. Shipman himself, as a well-liked doctor, would probably have been a appraiser.

The appraisals system was put in place instead of a post-graduate education programme under which GPs were obliged to do five full days post-graduate education a year, and prove that they had done it. Now, there is no obligation to do anything other than have a “meaningful” conversation with your appraiser. So most GPs are doing less post-graduate education.

It is right and proper that doctors like, for example, air-line pilots should have to demonstrate that they are up to date and competent. That they are “good” doctors. It is relatively easy to define and audit a “good” pilot.

How do you define a “good” doctor? That is more difficult. The “touchy-feely” New Labour way of getting GPs to save and file complementary letters from “grateful” patients is too silly for words.

Dr Crippen would suggest an examination.

Not an undergraduate exam asking doctors to go back down the rusty corridors of anatomy, physiology and biochemisty, but an exam assessing the skills and knowledge that could reasonably be expected of a competent, practising doctor. I would not expect the overall mark to be published. That would be invidious, though possibly entertaining. Instead, the doctor should have a meeting with an appraiser AFTER the exam, to discuss areas in which he needs to improve his knowledge. For example, a GP may be found to be shaky on dermatology. He would then address that area of weakness by sitting in on dermatology clinics, and would be expected to perform acceptably in the exam the following year.

There will be howls of anguish from some doctors. Exams? Not likely! But how else can we objectively assess the medical competence of a GP?

If you do not want exams, suggest something better.