UK doctors must show fitness to practise every five years

Doctors with a licence to practise in the United Kingdom from the General Medical Council (GMC) are now legally required to undergo revalidation, that is, to provide evidence of ongoing fitness to practise every five years.

“We are confident that the introduction of revalidation will make an important contribution to patient safety and to improving the quality of care that patients receive from their doctors,” said Professor Sir Peter Rubin, the chair of the General Medical Council, in an email. “Indeed, we believe significant potential benefits for patients have already begun to emerge during preparations.” The new regulation came into effect Dec. 3, 2012.

The revalidation process entails an annual appraisal, which includes evidence of feedback from patients, evidence of participation in continuing medical education and other requirements based on the GMC’s core guidance document Good Medical Practice (www.gmc-uk.org/GMP_2013.pdf_51447599.pdf).

Doctors who are registered, but do not have a licence to practise, are exempt from undergoing revalidation. However, doctors holding a licence to practise, but not currently working or who are working predominantly outside the UK, are required to revalidate.

The GMC is advising doctors now practising overseas to consider the option of remaining registered with GMC, but relinquishing their licence to practice in the UK so that they won’t need to revalidate.

Undoubtedly, it will be difficult for licensed doctors based outside the UK to undergo the required annual appraisal, which must be overseen by a “designated body” — namely an organization within the UK employing a doctor. Doctors working outside the UK can apply to have their licence restored through a “relatively straightforward” process, according to the regulations.

In Ireland, the European country with the most physicians registered in the GMC outside the UK, doctors have been legally required since May 2011 to enrol in “professional competence schemes” to make sure they remain fit to practise.

Opinions are mixed on the new revalidation requirements for registered doctors practising overseas.

The revalidation requirements could deter doctors from working overseas, suggest some observers.

Image courtesy of © 2013 Thinkstock

“I don’t think it is wrong for a medical regulator to do everything in its reach to ensure the quality of the professional’s work under their jurisdiction and responsibility,” states Dr. Rui Tato Marinho, professor of gastroenterology and hepatology at the University of Lisbon, Portugal, in an email.

“The quality of medical practice depends a lot not only on the right management of the system but also on the ‘human factor’ that is always omnipresent in every medical activity. The human factor requires a periodic refreshment: scientific knowledge, work developed, attitudes in real life, measurable results, etc.”

But revalidation requirements for physicians practising chiefly outside the UK could make reintegration difficult, “due to bureaucratic issues,” said Dr. Julio Bonis, a family doctor working in Spain, in an email. Bonis was previously registered in the GMC with a licence to practise while working in Spain.

Others are concerned about potential difficulties for British-trained doctors wanting to work outside the UK.

“There is limited guidance about how experience gained overseas will be recognized for appraisal and revalidation,” states Dr. Luisa Pettigrew, a family doctor in London, UK, in an email. That experience may be subject to interpretation on the part of the doctor, their appraiser and the local medical officer, said Pettigrew. There’s also a lack of clarity over who would pay for re-entry training, if it’s required.

“These can be significant factors in putting doctors off from gaining what could be a very valuable experience overseas,” said Pettigrew. This is especially pertinent given that there is increasing evidence suggesting that skills gained overseas can be of value to both countries.”

Ideally, there would be European-wide revalidation that is “compulsory and valid for all the countries in the European Union,” says Bonis. “If this revalidation attains worldwide prestige, it could enable all European doctors to move around the world. The problem is that the labour market in the European Union is a single one, but the professional bodies have borders. It doesn’t make much sense.”