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ss triple helix - summer 2000,  Appraisal, Governance, Revalidation: Nothing but Aggro?

Appraisal, Governance, Revalidation: Nothing but Aggro?

Every doctor in the UK is about to face unprecedented quality control under the processes in the title. What's going on? And how should Christians respond? Clinical governance is about quality in institutions and was recently defined [1] as 'a framework through which NHS organisations are accountable for the quality of their services and the environment in which clinical care is given' [1] . Similar systems will apply to the private sector and other non-NHS institutions.

Each individual doctor will have to maintain a folder, describing what they do and containing such evidence of performance as educational activity, audit, and the views of their patients. As part of an annual appraisal, another registered doctor will review this folder, identify problems, and make constructive remedial suggestions. Every five years there will be a more formal process of revalidation, based on these appraisals. Most will sail through but the tiny minority who are not automatically revalidated, or who refuse to take part, will be referred into the General Medical Council's fitness to practise procedures. No revalidation - no registration. No registration - no work as a doctor.

It sounds draconian, but the need for such an emphasis on quality was being identified long before high profile cases in the mid-1990s. Many are understandably sceptical and have concluded these processes are not the whole answer to deficiencies in the NHS: 'It is all very well to proclaim the merits of revalidation and of clinical governance, but most practising clinicians have little confidence that either of these projects, as yet unfunded and somewhat ill defined, will improve the lot of the patient, or indeed maintain confidence in the profession'. [2] For example, more resources and more improvements all round in attitudes might help. But the reality is, these changes will be here a year from now. So how should we respond?

Christians will play their full part because of respect for authority: 'Everyone must submit himself to the governing authorities, for there is no authority except that which God has established'. [3] As with every aspect of their work, Christians should give this their best shot: 'Whatever you do, work at it with all your heart, as working for the Lord, not for men'. [4] Christians of all people should support accountability: 'man is destined to die once, and after that to face judgment' [5] and should care about the quality revealed at that ultimate audit: 'work will be shown for what it is, because the Day will bring it to light'. [6]

Let's pray about the quality of our medicine, practise as best we can, play a full part in the continuing consultations before the above becomes enacted in law - and let's start preparing those folders!

  1. Smith R. The GMC: where now? BMJ 2000; 320:1356 (20 May)
  2. Toft A. Has humanity disappeared from the NHS? BMJ 2000; 320:1483 (27 May)
  3. Romans 13:1
  4. Colossians 3:23
  5. Hebrews 9:27
  6. 1 Corinthians 3:13
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