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 277.


    OK, first things first we need to see your license fee before you can comment on HYS.

    Secondly, how much extra tax will you pay to put the system in place to have right to reply after every consultation with your Dr...???

  • rate this

    Comment number 276.

    Could they face an ethics test as well?. Not just an exercise in cost benefit assessments of therapies, which passes for ethics in so many ethics committees, but one based on human values, secular and religious.

  • rate this

    Comment number 275.

    Recently i had a hip operation after 22 years of wating, on the same leg i had a sciatica as well which started in 1990. Now I'm releived from all that pain that I went through. In the past I was told that there is nothing they could do for me, so I was waiting for that pain to kill me.

  • rate this

    Comment number 274.

    I personally don't like Doctors and their god complex, but they do a necessary job but are massively overpaid for it. On HYS some are complaining about time away from patient care caused by assessment, simple solution, CHOOSE to be either NHS Doctor or PRIVATE doctor, not both. Wanting . The recent strike on £80,000 per annum pensions, did anybody actually have any sympathy for them?.

  • rate this

    Comment number 273.

    "seems sensible"
    Like 'turn East'?
    (Germany 1939)

    Imagine equal society, with 'rational' trust in others

    Not just in 'your doctor' (dedication allowed, family secure, society OK), but in 'team', able & free to inspire each other (& to question), helped by administrators, with trusted voice in management

    Back to self-inflicted 'reality'

    Destroying each other, our callings, our hopes

  • rate this

    Comment number 272.

    Good grief ... have the BNP all taken a day's leave from work? Let's hope that none of you people ever had to reply on the immigrant doctors you despise so much

  • rate this

    Comment number 271.

    254. Its All Pants
    omg!!!! this does not surprise me at all!
    I don't get that comment? You seem shocked that there's proper procedures in place to ensure foreign trained docs are competent and up to Brit standard before they can work here. Believe it or not SOMETIMES the system does actually work!

  • rate this

    Comment number 270.

    This makes a lot of sense....long overdue.

  • rate this

    Comment number 269.

    Having the ability to memorize and regurgitate information at a test sitting seems a poor way of judging competence in diagnosing and treating conditions when confronted with a living organism. One might be able to pass a written test on the theory and technicalities of painting a picture but be unable to produce anything that would qualify as art.

  • rate this

    Comment number 268.

    It'll turn out to be window-dressing, just like every other attempt to control "doctors". The BMA is the most rapacious of unions, determined to defend its members at all costs, whatever the rights of wrongs of any case, and the GMC is the same. The only ones who will go will be those whose faces, for some reason, don't fit with the medical establishment.

  • rate this

    Comment number 267.

    A direct, cheap way to measure performance would be a patient satisfaction questionnaire after every appointment. But it must address satisfaction with the SYSTEM, as well as the doctor. The first question should be "Are you satisfied with the amount of time spent on your problem?" I have had a 3 minute appointment that served its purpose, but usually I feel my time allowance is rationed.

  • rate this

    Comment number 266.

    Re 258 - You were lucky !
    My wife has low blood pressure and was prescribed a diuretic by a consultant (no BP check). The GP suggested to 'just try it'. My wife didn't take the drug of course because the GP failed to put the patient first. We gave good reasons for not taking the drug to the GP, like kidney failure / death, the GP seemed more worried by peer pressure.

  • rate this

    Comment number 265.

    256.mofro - I made a complaint about the 1st GP but didn't get anywhere with it. I never pursued the second GP as I am still at the practice. From experience I know that there are a couple of excellent GP's there. Unfortunately, it comes down to not wanting to 'rock the boat' and potentially lose access to these GP's for the whole family!

  • rate this

    Comment number 264.

    9 years ago my GPs partner missed that my daughter had a tumor i.e. cancer, stopping her eating. If it was not for me being a concerned mum and Hillingdon hospital listening to me and getting an "urgent" scan appointment she may not be here now. She was 24, she is now 32 and healthy. The Doctor concerned needed to be more up in technology and a human side i.e. listening to the patient.

  • rate this

    Comment number 263.

    History & prescription 'written by victors'

    NHS never allowed strength, 'top doctors' distracted, young kept down,
    'prophecies' of doom self-fulfilling, now from UK- to US-style failure

    'Revalidation of mediocrity': cheerfully 'good enough' for Hunt & private sector

    Same trick coming for BBC, never allowed free conscience: Dame Janet again to miss the context of Fear & Greed, in power over all

  • rate this

    Comment number 262.

    The problem is that if the appraisals are too time-consuming or onerous then they might have a demoralising effect. I don't trust the Government to strike the right balance, they failed to do this with teachers in FE and the IfL shambles. They tend to poke about and disrupt professions instead of facilitating them.

  • rate this

    Comment number 261.

    About time too far too many so called Doctors that are actually Quacks

  • rate this

    Comment number 260.

    I wonder what sort of score Jeremy Hunt would get at his next appraisal? I would certainly give him 100% for the smuggest expression on any politicians face that I have seen in ages. Why he still has a job in the cabinet with a prime role I will never know.

  • rate this

    Comment number 259.

    Seems sensible - it's common practice in many trades from engine-driving on the railways to teaching or piloting commercial aircraft. You just need to make sure that there are appropriate avenues for appeal - rather than the way in which, for example, Ofsted judgements cannot be easily challenged.

  • rate this

    Comment number 258.

    For those criticising their GP remember they are general not specialists in your problem, Personally I was prescribed an unsuitable drug by a consultant when I found out I contacted the GP urgently & had it stopped there and then She was most apologetic and grateful despite the consultants instruction which is difficult for a GP to override & as I pointed out it was not her fault.


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