New era of five-yearly doctor checks starts


Health Secretary Jeremy Hunt: "Doctors will get a chance to address deficiencies"

Regular checks on doctors' skills will start from December, heralding the biggest shake-up in medical regulation for more than 150 years.

The UK's 220,000 doctors will have annual appraisals, with a decision taken every five years on whether they are fit to continue working.

But it will be April 2016 before the vast majority of the first round of checks have been done.

The health secretary said it was about addressing "deficiencies" in skills.

Jeremy Hunt said that if doctors failed to satisfy the standards of the General Medical Council (GMC) they would be prevented from practising.

But he said the new system was about identifying where there were "gaps" in knowledge or skills and giving doctors a "chance to put those issues right".

He said the vast majority of doctors "do a brilliant job" but when the government carried out a survey last year of 300 health bodies there were "serious concerns" with 0.7% of doctors - a figure Mr Hunt described as "significant".

"At the end of the day if the GMC is not satisfied that someone is up to speed then, yes, they will be prevented from practising," he told BBC Breakfast.

He said this would give the public confidence that the UK had the most thorough regulatory process for its doctors.

'Improve quality'

The move comes after years of discussions about the way doctors are monitored.

At the moment there are no mandatory checks on the performance of individual doctors, a situation which has been compared unfavourably to the airline industry where pilots face regular, on-going assessment.

Annual appraisals do happen in some places - particularly for medics in training - but they are by no means routine.

The new system

  • Revalidation by the General Medical Council will take place every five years.
  • It will run separately to the GMC's disciplinary regime that can lead to a doctor being struck off the medical register.
  • A decision on whether or not to allow a doctor to continue to practise will be based on annual appraisals and feedback from patients and colleagues.
  • It will be up to responsible officers in each organisation, normally medical directors, to make a recommendation to the GMC.
  • Minor issues may lead to revalidation being deferred for a short period while the problems are addressed.
  • Something that constitutes a risk to safety would lead to revalidation being rejected. The doctor would then not be allowed to work.
  • The revalidation process will start in December for senior medical leaders, including national and regional medical directors.
  • From April it will be rolled out among the general doctor population and within 12 months a fifth of doctors should have been through the process.
  • By April 2016 the "vast majority" of medics should have been checked.

There is, of course, a system of registration which the GMC is in charge of.

When serious complaints are made about performance, the GMC can start disciplinary procedures.

But this system essentially only picks up problems when things have gone wrong.

Revalidation has been designed to ensure issues are dealt with before they reach that stage.

GMC chief executive Niall Dickson said: "This is an historic moment. It is the biggest change in medical regulation for 150 years [since the creation of the GMC]."

He said the system should help improve quality, but he admitted the health industry had been "slow to recognise" the importance of such checks.

The introduction of regular checks - dubbed a medical MOT - has been talked about for more than 30 years.

Serious consideration started being given to the issue in the mid-1990s.

But over subsequent years scandals like that of the family GP and serial killer Harold Shipman and the deaths of the Bristol heart babies led to reviews and re-evaluations about what the process was intended to do.

Government and GMC officials have also had to have detailed discussions with the British Medical Association (BMA).

Dr Mark Porter, chair of the BMA's Council said it supported revalidation.

He added: "It is important to recognise, that while revalidation will undoubtedly enhance the rigorous testing that doctors undergo, clinicians are already offering patients a very high quality service and robust systems are currently in place to deal with any concerns.

"There is too much bureaucracy in the NHS and so we have to be careful that revalidation does not add to this unnecessarily."

Dean Royles, director of NHS Employers, said: "It is a very positive step forward and should herald greater patient safety and build confidence.

"Patients need and expect this. It has been a long time coming."

NHS medical director Professor Sir Bruce Keogh added it was a "powerful opportunity" to ensure standards of quality and professionalism are kept to across the country.

'4% concerns'

Each NHS organisation from hospitals to local networks of GP practices will have a responsible officer, such as a medical director, in charge of revalidation.

They will assess the annual appraisals along with feedback from patients and colleagues to make a recommendation about revalidation to the GMC every five years.

Minor issues that do not constitute a risk to safety may lead to revalidation being deferred for a short period, but major problems will result in the doctor not having their licence to practise revalidated.

Such a scenario could also lead to disciplinary procedures being started by the GMC, the ultimate sanction of which is being struck off the medical register.

During piloting and testing of the new system, concerns were raised over the performance of 4.1% of doctors.

In 2.4% of cases the issues were judged to be lower level, such as lateness, in 1% they were medium level, which included problems with behaviour including rudeness to patients, while in 0.7% the problems were serious and would have had an impact on safety.


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  • rate this

    Comment number 197.

    @191 - Good point

    The older doctor who gave me bad advice resulting in me having to have emergency surgery has a terrible reputation in the area where i live.
    He was forced to apologize to me infront of the head of patient care,only after i complained about him, yet he's still practising medicine.

  • rate this

    Comment number 196.

    First, scrap the GMC and have a 'jury' decide on complaints against doctors in an open forum.

    At least we may then see incompetent practitioners struck off and not a prolonged enquiry followed by a cover up.

    Then have a panel of the public to review hospital performance.

    Doctors have shown they are not able to investigate and correct bad medical practice.

  • rate this

    Comment number 195.

    In my opinion , I would trust the GMC to get rid off, incompetant or dangerous GPs about as much, as they did before the Shipman murders!

  • rate this

    Comment number 194.

    If only we had a chance to address Jeremy Hunt's deficiencies.

  • rate this

    Comment number 193.

    This will NOT be done properly. Doctors will just be nicer to their patients/collegues to hide the fact that they're thick. This will not asses their ability to correctly diagnose/treat! They should be required to take regular exams (not muliple choice tests!). Fail=Out. Why is this justified? Because some GPs are over paid! Most of the new doctors are only doing it for the money and status.

  • rate this

    Comment number 192.

    With regard to attitude to patients, one GP I visited had a reputation for being rude to women.I needed an urgent appointment so I took my husband with me.I was assaulted in front of said husband resulting in actual bruises.The GMC would not even listen to my husband who had to step in to release the man's grip on my arm. If the man's attitude had been addressed this would not have happened.

  • rate this

    Comment number 191.

    They could start with the introduction of a patient satisfaction survey for each practice / doctor and publish the results.Those indicated with low satisfaction in key categories would show which practices needed priority appraisal by the GMC.

  • rate this

    Comment number 190.

    Hooray, will this stop the doctors at my previous surgery from claiming that they can't treat asthma - you have to go to a walk in centre for that and deal with a consultant who openly boasted to me that he is an expert and doesn't need to read up to date research as he passed his exams 20 years ago. And then gets shirty when my GP insists that he has put me on very out of date medication?

  • Comment number 189.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 188.

    Re toprated 12. "why are MPs not regularly checked?"
    Great idea.
    Lets start with the 27 MPs who unbelievably are renting out their 2nd taxpayer funded homes to other MPs while renting another property for themselves, pocketing thousands at our expense. You can't make this up. They just do not get it do they?

  • rate this

    Comment number 187.

    Good idea. I feel that sometimes GPs pass their exams, but over a long period fail to keep up to date with new drugs and medical techniques.

  • Comment number 186.

    All this user's posts have been removed.Why?

  • Comment number 185.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 184.

    175. NaughtyNaughty
    "its their job to advise and inform of the dangers of drinking/smoking/obesity"
    They often fail to diagnose that these are the symptoms of depression and anxiety. Doctors refuse to treat these, causing patients to self-medicate.
    If these reviews change this then that will be an achievement.

  • rate this

    Comment number 183.

    181. nagivatorjan

    3rd opinion?

    At least you have a doc.. I haven't seen mine for 5 years... the NHS claim he still works at the surgery but I think I've got more chance of meeting Lord Lucan!

  • rate this

    Comment number 182.

    Oh yes. more regulation from the centre. The people down in London know what's best. Let them check everyone, charge a fee for doing so, and elevate the costs of healthcare.

    What is absolutely certain is that we as customers can't tell the difference between sensible advice from a doctor or idiot ramblings. No, we have a complete inability to change doctors... ..


  • rate this

    Comment number 181.

    175 NaughtyNaughty - you've not met my doc - sticks you on tablets which give you chronic lethargy and tiredness as well as fixing the problem you had, denies they cause these problems and tells you you are gaining too much weight (can't exercise) - another doc listens and changes tablets - result is energy and weightloss.

  • rate this

    Comment number 180.

    "GPs are padding their salaries by ordering up every test in the book as often as possible since the rules changed under the last govt."

    What one earth are you talking about? Unless you are seeing a private GP and getting the tests privately, which I'm willing to stick my neck out and bet that you aren't, then there is no financial benefit to GPs in doing this.

  • rate this

    Comment number 179.

    "Its their job to advise and inform of the dangers"
    No. It's their job to treat you for the complaint with which you presented, not (as is increasingly happening) telling you 'no referral until you've lost 3st'.
    "its your choice whether you listen to this advice"
    Again, with increasing state-sanctioned discrimination on basis of BMI etc, that 'choice' is now under threat.

  • rate this

    Comment number 178.

    The problem is that this regime is to be supervised by the General Medical Council, a body with a poor record of defending patient's interests. How was Freddy Patel allowed to continue practising when the GMC were aware of a number of complaints against him? The GMC are too slow and far too inclined to support doctors over patients.


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