Revalidation: cracks at first, now chasms.

On 8 June 2005, Professor Mike Pringle gave the 2005 John Fry Fellowship Lecture, organised by the Nuffield Trust in London. He called it ‘Revalidation of doctors: the credibility challenge’. The audience was, in sections, invited and alert, great and good, knighted and elevated, yet some were fidgety and irritated. At the end, we were all stunned in part, taken aback at times, but on the whole most were impressed, I think, at the candour and grasp of the issues. Mike gave a stirring account of the history, the twists and the turns, the Bristol and the Shipman, the international developments, the current stand off, and drew his argument to a close with a round of 10 bullets that ricocheted among the canapés. He asked us to consider, in disarming clarity, what, in his view, and maybe the view of many more, the true aim of the most important test facing the medical profession is to be, when all is said and done. It’s to sort out goats and sheep. Lets stop pretending otherwise. At this point, best to recap, as he did, that the General Medical Council (GMC) had at first proposed that revalidation should assess doctors using a portfolio of evidence, based on standards, with lay involvement and with an understanding that the onus was on doctors to establish that they were ‘up to date’ and ‘fit to practice’. He reported that the GMC’s position had shifted significantly around 2001 to the view that taking part in five appraisals was going to be sufficient; a process that was subsequently augmented by the addition of a local clinical governance review. In this shift, lay involvement in the process had been downsized significantly. Dame Janet Smith’s Shipman Inquiry Report declared that this model of revalidation was ‘not fit for purpose’. The GMC when considering the report on the 15 December 2004 decided to uphold their conceptualisation of revalidation; essentially to ‘tough it out’. The