GMC no longer favours folder of evidence for revalidation

Editor—Wakeford is right to fear that the portfolio based methods for revalidation currently being piloted by the General Medical Council may prove “hideously expensive in time and money, and potentially inaccurate and unfair.”¹,² In a pre-pilot exercise conducted by the GMC, participants experienced difficulty in compiling folders of evidence about their practice because of the lack of systems for collecting relevant data, and they could not provide evidence relating to all sections of Good Medical Practice (the GMC's core statement of professional values and responsibilities). None the less, they spent up to two days working on their folders. The dummy revalidation groups who evaluated these folders were unable to recommend revalidation in most cases because of the inadequacy or irrelevance of the data presented.

This process implemented nationally would take up between 1% and 3% of every doctor's time at an administrative cost of at least £50m. These figures are unlikely to be reduced by introducing annual appraisal for all NHS consultants and general practitioners. Quite apart from the inappropriateness of using a formative process as a means of assessment, appraisal is expected to entail reviewing the evidence in each doctor's folder and will not obviate the need to collect and evaluate that evidence. The GMC would, furthermore, be unwise to base revalidation on an NHS process whose quality it is powerless to control.

Fortunately, an alternative, reliable, well validated, and vastly less expensive method exists. The Ramsey peer associate questionnaire combined with a patient satisfaction questionnaire is an accurate measure of doctors' performance technically and in terms of communication, respect for patients, and personal and ethical standards.³,⁴ This approach offers a more than adequate basis for confirming the fitness to practise of most doctors and for identifying the few whose practice gives cause for concern. Its advantages over the onerous and costly folder of evidence are so great that it should now replace the folder as the GMC's preferred method.

In addition, legal advice indicates that, although the GMC may require doctors periodically to submit evidence of their fitness to practise, it may not stipulate that the evidence must take a particular form. Even if the GMC were to back the folder it would be open to doctors to submit the results of peer associate and patient questionnaires as an alternative. Given the simplicity and proved validity of the method (which might become commercially available if the GMC did not offer it), many would opt for it, and the GMC would find its preferred approach spurned by the medical profession.