Assessing fitness to practise

Editor—The controversial and impractical route for revalidation proposed by the General Medical Council based on legislation is for doctors to provide evidence that they are up to date and fit to practise. Ever since, the debate has ranged from how this might be achieved to questioning the validity of revalidation itself. I prefer the more complimentary “accreditation” to “revalidation.”

Government and regulatory bodies must ensure that the patients' trust in their doctors is not betrayed.

Many assessment protocols have been devised to evaluate a wide range of activities, but these require validation for the accreditation of doctors. Baker argues for the establishment of detailed criteria based on standards expected of a doctor.¹ But Wakeford believes that patients will have no confidence in a system in which a doctor's skills and standards of practice are reduced to a few sets of tick boxes.¹ But what trust will patients have in a system declared unworkable by the experts? Rather than becoming embroiled in the academic arguments for and against these extreme views could we not resort to a time honoured, routinely practised, common sense approach to this problem?

An appointment, entry into medicine, or the granting of an award invokes varying degrees of objective and subjective judgments. If accreditation is based on the principles of clinical governance in which a doctor is held responsible and assessed for delivering a high quality of service and maintaining the means to achieve it, then it would be eminently amenable to a similar approach. This is how we recognise a good workman—by the quality of his work.

The clinical excellence awards scheme is a good, simple, cost effective model on which to base the accreditation of doctors.