From 1 January 2005 every UK doctor will need a license to practice. Most will be able to secure revalidation of their license by annual appraisal. This has led to confusion and unease about whether revalidation is intended to detect poor performance, and if so, whether the process will suffice, argues an expert in this week's BMJ.
In 2001, Professor Tim van Zwanenberg analysed the development of policy for the revalidation of general practitioners. Negotiations involved the profession, the government, and the General Medical Council (the profession's regulator).
The purpose of revalidation was seen as securing public trust, promoting continuing professional development, and detecting poor performance.
None of the stakeholders objected to revalidation, but all identified the tension inherent in a single process, which was designed both to improve the many and to detect the few poor performers. In particular, would revalidation redress unacceptable variation in practice or prevent high profile medical failure?
It is difficult to escape the conclusion that the purpose of revalidation is as a form of professional regulatory enforcer, says the author. Whether patients and the government will be satisfied remains to be seen, particularly if (and predictably when) a recently revalidated doctor is found to have been a poor performer.
Ultimately it may be more sensible to separate revalidation from appraisal, he concludes.