With the advent of revalidation, doctors will be assessed for fitness to practice every five years. Dr Gerard Panting explains how the pharma industry is ideally placed to help the medical profession stay on top of its game – and improve its access to clinicians at the same time.
Talk to doctors and they’ll tell you that their lot is not a happy one. No sooner have they come to terms with one set of changes when along comes another.
Keeping up to date with it all and seeing a few patients as well, leaves little time for anything apart from the most tempting of invitations.
Access to doctors may be more difficult now than ever before, with too many people chasing too few appointments. However, doctors and other clinicians are hungry for information on issues close to their hearts and the chance to discuss what’s bothering them, and are over the moon to be presented with ready-made solutions that can be easily adapted to suit their needs.
So what is bothering doctors?
In February, the government published its White Paper in response to the Chief Medical Officer’s consultation on medical regulation and the Foster Review looking at all the other health professions regulators. All this boils down to a radical set of changes with a significant impact on all doctors, no matter how they earn their living – even those who have retired.
The government’s response to all these documents is a mix of firm proposals and less well developed ideas requiring yet more consultation with “stakeholders” and the devolved administrations, and a few short-term working parties. As ever, medical regulation and the General Medical Council take the limelight and, to some extent, are singled out for special attention.
Revalidation and the GMC
The proposals stop short of doing away with the GMC altogether but are nevertheless radical. Like all the regulators, it is destined to become a smaller board-like organisation whose members are to be appointed, not elected, and the current medical majority is to disappear. All this is to ensure independence and counter any notion that the regulators tend to look after their own.
The GMC is no longer to be responsible for deciding disciplinary cases, although they will still receive and investigate complaints. The task of deciding whether the doctor is guilty of failing to live up to the required standard will fall to a new adjudication body, which will decide the doctor’s fate on the balance of probabilities and not beyond reasonable doubt – a significant reduction of the current standard of proof.
Revalidation is seen as a good idea.The GMC will be responsible for issuing a licence to practise, renewable every five years, relying heavily on the annual appraisals occurring during the revalidation period.The appraisal process is to be beefed up, with objective testing and data analysis as well as developmental elements.
GMC Affiliates are an innovation: one in every strategic health authority will help employers (including PCTs) with doctors who are struggling and help to oversee the revalidation process. Affiliates will have clout, being able to require doctors to attend interviews with complainants and to put a ‘recorded concern’ on a doctor’s registration – and if the doctor does not agree, a full fitness to practise investigation swings into action.
What else is changing?
Away from the GMC there is yet more change in store, on recruitment to NHS posts, clinical governance, death and cremation certification, the coroner system, prescribing, storing and administering controlled drugs, complaints systems, raising concerns about other health professionals, and more precise definition of acceptable boundaries of professional conduct and relationships with patients. GPs may also be required to notify their PCT if they get caught up in a clinical negligence claim and PCTs will have new rights to access patient records when investigating performance issues about a GP.
How can you help?
The impact all this will have for every doctor in the land means that there is a fantastic opportunity here for the pharmaceutical industry. Good quality meetings, well-written summary materials and learning programmes of all descriptions mean that there is a way to reach everybody.
Top of every doctor’s need to know list is what they need to do to make revalidation as straightforward as possible.A Revalidation Made Easy website, combining a clear account of all the up to date requirements with links and educational tools would be a real boon. Doctors could bring themselves up to speed on a particular topic, and then prove it through an online assessment process. It is worth bearing in mind that over 20% of all clinical negligence claims are to do with prescribing, so therapeutics is a good place to start.
On a more local or regional level, meetings that both bring doctors up to date on all the regulatory issues they need to be on top of, and offer high quality clinical content in a novel format are a sure fire winner.
That doesn’t mean a dreary diet of presentations one after the other – it means designing a programme which looks at issues from a different point of view.
One way to engage the audience, and a technique TWG uses, is to create a programme around a clinical theme, say cardiology or gastroenterology, and appoint participants as experts to give their opinions in clinical negligence cases.This allows participants to take a detached look at clinical management, criticising what happened in a hypothetical case without being vulnerable to criticism themselves. Our experience shows that it works – the audience remains awake, has a good time and learns a lot, both about the clinical issues and the legal process. And, needless to say, everyone attending is very grateful for the invitation.
A successful meeting relies on planning, creating the right clinical scenarios and ensuring that expert facilitation on the day promotes participation, with no one person allowed to dominate proceedings and so boring everybody else. It will also become increasingly important for doctors to be able to show that they have benefited from the experience, so end-of-course assessment is a must, and with this CPD approval will be easier to come by, which in itself is a great lure.
Engaging doctors is about rational self-interest – by providing the information, or even solutions, that doctors need, the problem of access will become a thing of the past.