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 237.

    About time - but does not go far enough as we should all have a right of reply after 'every treatment'.

    We should all be able to see every doctors education, training and work record 'before every treatment' also.

  • rate this

    Comment number 236.

    The failures in bedside manner people are documenting are failures of human beings per se.

    Bare in mind that over half the visits to GPs are from people who are either not actually ill, or not very ill, you can understand where this comes from - woud you have much bedside manner for someone who is not ill swearing blind they are, because theyve looked something up on the internet...???

  • rate this

    Comment number 235.

    184. widgeon

    I accept that do fail at identifying the underlying causes, but my point at 175 was more in direct response to 163 calling doctor's hypocrites for smoking/binge drinking/being obese themselves...

  • rate this

    Comment number 234.

    @216 Steve - My wife is a nurse, their periodic "checks" are a joke.

    @217 David - I'm a doctor, we dealt with our incompetent colleagues before this system, providing we had the drive to do so.

    It's not going to improve things, it's going to waste colossal amounts of time and money. It's another "box-ticking" exercise.

    From what I have read, Shipman would have managed to pass this easily.

  • rate this

    Comment number 233.

    When it comes to knowledge, trust, abilities and consistency - I would choose a medical doctor anytime over a political imposter like the current Secretary of State for Health

  • rate this

    Comment number 232.

    The validation to be undertaken by its own nominated 'professionals', nice and cosy. I bet you the number of doctors struck off will be tiny and probably dwarfed by those exiting voluntarily with a nice cushy tax payer subsided pension. Prove me wrong.

  • rate this

    Comment number 231.

    I remember watching footage of Shipman when he was being interviewed by the Police in his cell. I seem to remember that such was his arrogance and ego that he turned his back on the officers and wouldn't even talk with them ( as if they were lesser people and beneath him) which I found absolutely chilling and the idea that there may be people like that still, well it doesn't bear thinking about!

  • rate this

    Comment number 230.

    The good Drs at our local surgery are outnumbered 3-1 by the overworked, the disinterested and the incompetent. But the biggest issue seems to be with empathy and basic respect. The low esteem in which much of the NHS holds older people is well-documented, ditto fat people, who are routinely treated like something the GP has stepped in. Can you train judgmental Drs to be more tolerant? I fear not.

  • rate this

    Comment number 229.

    My GP is awesome. Totally love that guy. My problems have always been with consultants. Officious little people in three piece suits who talk to you like you're an idiot and often fail to spot the obvious.

    Word of advice: never let one place a cannulae. Let a nurse do it. After the first three times they say "oops"... RUN!

  • rate this

    Comment number 228.

    In my (non-medical) jobs within an NHS hospital, I was once sat in a ward office and overheared one doctor say to the other "What would us doctors do without wikipedia". I only hope they were joking. And it doesn't end there ...

  • rate this

    Comment number 227.

    I have no confidence that the GMC can handle this nor any of the other bodies that review healthcare delivery...we all ready know that the NHS covers it own a*** at every level upto and including CEO, Medical Director.

    We only have to remember what happened at Stafford Hospital with the denial of problems that were ongoing for years leading to the unexpected deaths of hundreds of patitents

  • rate this

    Comment number 226.

    My doctor is brilliant, I guess there can be only a few doctors not up to the mark because they have direct exposure to patients and other doctors.

  • rate this

    Comment number 225.

    @217 David, if you have serious concerns about a colleague, one should be raising those concerns through the relevant "whistleblowing" system anyway. Appraisal is NOT going to appraise the success or failure of doctors actual work. It's going to appraise that they have documented continuing learning. It would be impossible and undesirable to appraise the work doctors actually do.

  • rate this

    Comment number 224.

    Well I can only go by my own experiances (and several people I know). My first GP was useless. For this reason I changed and the next GP found a problem with me that I do not want to discuss on here. That was all well and good but they cannot determin other problems I have. So I did get my first comment wrong. My first GP did miss something that was staring him in the face.

  • rate this

    Comment number 223.

    Undoubtedly some foreign organisation like ATOS which can be paid by taxpayers money to give the results the government require, the type of organisation with medical professionals who can only work to a tick box mentality that can be easily cross checked by those who don't know like MP's are the most likely to check on medical professionals.

  • rate this

    Comment number 222.


    David please read my comment - 197

    I wish more doctors took your approach

  • rate this

    Comment number 221.

    I have been registered at my medical practice since 1956 .That's 56 years ago!

    I have found that with both Labour and Tory governments it has been excellent. The receptionists have been 1st class and the Doctors and Nurses have never turned their backs on me,

    Poole General hospital is highly regarded as is Southampton General where I had a heart by-pass graft in 1999.Had Type2 diabetes since.

  • Comment number 220.

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

  • rate this

    Comment number 219.

    This should be embraced, Solicitors are annually forced to take continuing Development courses to keep them up-to-date etc on legal issues, new law and cases. If they fail they are struck off until they fix the issue. Mmany other professions - I find it hard to believe it has taken so long to impose such a normal commonsense approach to keeping patients life’s secure, safe and heathly.

  • Comment number 218.

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


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