Revalidation for Doctors

I thought I should do a short blog about revalidation. Most doctors will now know what this means. For those of you who aren't doctors, it's the process that allows doctors to demonstrate to the General Medical Council that they are up-to-date and fit to practice. From April this year it will be mandatory for all doctors. The basis of this is an annual appraisal where each doctor must produce evidence of:

• Their Continuing Professional Development (all the courses and training they have attended)
• The Quality Improvement activity they have done
• Any significant events they have been involved in
• Multisource feedback from their colleagues
• Multisource feedback from patients they look after
• Any complaints or compliments regarding them

In Wales, doctors will all collect this information on an online database (the MARS system), and will need to show that they have met once a year with a trained appraiser to review this. Any actions they need to take to maintain their skills must be described in a personal development plan.

I have two roles in all of this. Firstly, as a doctor, I have to make sure that all six sorts of evidence are up-to-date for me, and that I have reflected properly on that evidence. A fortnight ago I met with my appraiser to go over all of this, and I'm happy to say that I'm now ready for my revalidation by the Chief Medical Officer at the end of next month. Although it took me a little while to get used to the MARS system, it was easy to use and made it very easy to store my evidence so it could be retrieved quickly and easily in future. It will certainly make preparing for my appraisal much easier, and I have resolved to keep my evidence file updated every month so I don't have to enter everything at the end of the year. Secondly, as the Responsible Officer for the health board, I have to make sure that all doctors have collected their evidence, been appraised, and have a development plan that addresses any issues that have surfaced.

Although it is still early days, the revalidation process feels like it will be a real step forward in assuring the quality of all the doctors who work in the health board. That must be a good thing for patients.

The Francis Report

The publication of the Francis report yesterday was a sobering moment for anyone who works in healthcare. The systematic lack of care described in Stafford Hospital makes gruelling reading. What makes it worse, if we are honest, is that we all know that instances of poor care sometimes take place in our own hospitals, even if they do not reach the epidemic proportions described in the report. How could this happen? Francis identifies a number of causes. Now I have read the report, these seem to me to be three important issues:

Firstly, the danger of focusing on the anything other than the needs of patients. Any director, nurse, doctor, therapist or manager who forgets that, first and foremost, they are there to serve patients is on a slippery slope. And if the board fails to make quality of care its first priority, there can be little surprise if staff become disengaged from organisational priorities. Some people who worked in the Mid Staffordshire Trust lost sight of the needs of its most vulnerable patients, especially older people.

Secondly, we should not tolerate poor standards and risk to patients. It must be right, however much tension it might cause between us from time to time, that we challenge each other to provide a proper standard of care. That is a sign of a healthy organisation. We should also aim for excellence in our care processes. A certain amount of data recording and measurement will always be necessary to make sure we're doing the right things, and we also need to be careful to communicate information properly when we hand over patient care. But we should have a low tolerance for care processes which are wasteful, or cause unnecessary waiting or repetitive collection of the same data.

And thirdly, there is a professional challenge to make sure that we create a positive culture in our healthcare organisation. The challenge to show proper leadership, and followership, is one we must all rise to. We must all make sure that the organisation we work in is open in allowing concerns to be raised freely; transparent in showing how well, or badly, it is doing; and candid in telling people when we have got things wrong.

My first job at Lewisham

The first place I was every paid for working as a doctor was Lewisham Hospital.  On August 1st,1986, I started my medical career as a houseman in general and orthopaedic surgery.   Things were a bit different in those days. We came to work in long white coats, and when one of my colleagues went off sick I spent two months working one in two, something that would be unimaginable for training doctors today (thank goodness). My boss, Lord McColl, had the unusual distinction of having consulted on healthcare systems for both Mrs Thatcher and Colonel Gaddafi.  So I was interested to hear that the casualty department at Lewisham Hospital is now the subject of service reconfiguration. It is clear that people in Lewisham feel the way this has been done, in response to funding difficulties in a neighbouring healthcare trust, is unfair.  But the truth is that one way or another we do need to change the way we deliver healthcare. Apart from anything else, the way we are currently organised does not provide a good service to older people. Too many of them get caught in delays in our emergency departments, and are left waiting unnecessarily in hospital to go home.

Senior managers in the NHS in England are now engaged in a national debate on quality of care and service reconfiguration. There is no doubt that this debate will be sharpened with the publication of the Francis Report this Wednesday. This week's British Medical Journal contains a response to an interview with the head of the new NHS Commissioning Board which was recently published in the Independent newspaper.  Marion McMurdo, the Professor of Ageing and Health in Dundee, wrote in (www.bmj.com/content/346/bmj.f453) with a view that I thought captured the challenge to healthcare providers so well I’ve reproduced it here in full:

“Let's fix our health care system to make it responsive to the needs of the patients who require it. Let's change training and education to ensure that its staff possess the skills to manage people with multimorbidity, including older people. Let's enable prompt diagnosis and invest more in downstream systems designed to allow old people to leave hospital when ready to do so. Let's have equity of access for all patients who require it, and begin the overhaul of the NHS to make it fit for the 21st century.”