Annual assessments for doctors 'will improve care and cut legal costs'

http://www.guardian.co.uk/society/2012/nov/06/annual-assessment-doctors-revalidation-study

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Giving all doctors annual assessments and detailed checks every five years will result in better care for patients and reduce compensation claims, but may see an exodus of experienced medics from the NHS who are reluctant to be tested, a government study has warned.

The announcement last month that doctors would undergo "fit to practise" checks for the first time surprised the medical world after a decade of seemingly fruitless negotiation. The system, called revalidation, will begin in December.

In new evidence, the government argues that the cost of the checks – about £100m annually – will be outweighed by benefits to patients and the profession. Better care and fewer court cases against medics will save nearly £1bn over 10 years, so revalidation would almost pay for itself, the government says.

The study, released on Tuesday, shows that about one in hundred patients who would have died or suffered harm in the course of being treated would "be avoided" because of revalidation. Even more striking is the drop the cost of litigation in cases where doctors are taken to court over mishaps resulting from their care.

The Department of Health (DoH) says payouts for medical mistakes has spiralled from £400m in 2003 to £860m in 2011. "The prevention of deaths and incidents of harm, as well as the introduction of a stronger culture of accountability, is expected to result in fewer incidents that would lead to litigation payouts. The data showed that a 3% reduction in future payouts as a result of revalidation can be anticipated," said the report.

However, the DoH says the new tests may see an exodus of experienced staff from the NHS. "One possible consequence of revalidation … is that some doctors may choose to leave the system rather than undergo appraisal and revalidation processes that would be new to them. This may particularly be the case for older doctors, who would take with them many years of experience and expertise."

Health minister Dan Poulter, who still works a session a week as a hospital doctor, said the UK will be the first country in the world to regularly review its doctors, batting away criticisms that the scheme is too expensive and would divert money from frontline services.

"Revalidation will cost an estimated £100m each year, or less than 0.1% of the NHS' total budget. The evidence published today shows that this cost is outweighed by the enormous benefits that regular fitness to practise reviews will bring – increased trust in doctors, safer care, fewer claims for clinical negligence and positive cultural change in the profession," he writes in an article for the Guardian.

"As a doctor myself, I welcome this support for my own clinical practice. It will make medicine safer by eliminating poor practice through supporting those doctors who need to improve some of their clinical skills, and by tackling the tiny minority of doctors who are not fit for their roles."

Poulter says that even the "best, most qualified doctors can be let down by poor communication. Regular appraisals will target the quality of their bedside manner and include genuine patient feedback, so that all doctors … are supported to improve their relationship with patients and to build up that essential trust".

The report also pointed out that doctors working outside of the NHS would also face regular check-ups. The DoH says that only one in 20 of the 157,000 practising doctors in England work solely in the private sector. "The … data showed that there are considerably lower appraisal rates in the independent sector".

However, the government acknowledges that there will be an extra cost to private health. "These are costs which might be expected to be passed on to the consumer, who would in turn experience the resulting benefits."

The General Medical Council will be responsible for revalidation, which will be on the basis of a dossier of evidence of a doctor's competence compiled over five years. This will include annual assessments and patient questionnaires.

Negotiations with doctors' leaders at the British Medical Association over how revalidation would be carried out has caused some of the long delays. The BMA has traditionally been wary, while saying that it supports the principle.

Plans were under way at the time of the Shipman inquiry in 2005, but Dame Janet Smith, who chaired it, was strongly critical, saying the proposals would not ensure that failing and bad doctors were picked up, so they had to be reworked.