BMJ  2006;333 (4 November), doi:10.1136/bmj.333.7575.0-f

Editor's choice

Concerns about revalidation

This week brings an end to the consultation period on Liam Donaldson's report on professional regulation in the United Kingdom. There's been no shortage of comments on the report (this week's BMJ carries some more on p 965), with emotions running high on many issues. How should Donaldson respond?

On the face of it his recommendations represent a huge challenge to the profession—an end to professional self regulation with loss of elected representation, removal of the General Medical Council's control of undergraduate education (which effectively excludes it from setting standards at entry to the profession), and the setting up of an independent tribunal to take on final adjudication in serious cases of fitness to practise.

Voices raised against Donaldson's proposals, many of them in the BMJ's rapid responses, decry the planned move to a civil burden of proof in cases of professional misconduct and to appoint local GMC affiliates. They ask who will pay and how much it will cost in terms of time away from patients. They ask what will happen to those who fail and whether large numbers of older doctors will take early retirement rather than go through validation. And underlying all these concerns is the ultimate question: will Donaldson's proposals really deliver better care of patients?

But as Mike Pringle said when the report was first published (BMJ 2006;333: 161-2[Free Full Text]) there is much to admire in Donaldson's recommendations. He brings important clarity to the distinction between relicensure and recertification. In so doing he has created a proper role for the royal colleges, which some would say they have lacked in the past, and which Ian Gilmore, president of the Royal College of Physicians, welcomes (p 969).

Donaldson also gives the GMC a much needed kick, in threatening to remove so much of its power. Last week, Jonathan Gornall laid blame for what he saw as Donaldson's heavy handed intervention at the door of the GMC, for its failure to seize the initiative in the wake of Janet Smith's highly critical report (BMJ 2006;333: 906-11[Free Full Text]). To his credit the GMC's president, Graham Catto, seems at last to have responded. Catto has outdone Donaldson on proposals to create a less medically dominated council and, as Jim Johnson agrees (p 966), has made a robust defence of the GMC's role in education, with a three pronged proposal to oversee undergraduate, postgraduate, and continuing medical education.

Given Donaldson's mandate for change, even those most opposed to his proposals must accept that revalidation is now inevitable. Better still would be to embrace it as part of, rather than a threat to, medical professionalism. For his part, the chief medical officer needs to bring the UK's doctors with him rather than alienate them further, especially at a time when they already feel their professionalism is under attack from growing political interference. To do this he will need to show, in his revised recommendations, that he has heard their concerns.

(fgodlee{at}bmj.com)

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