Reforming medical regulation to improve safety

In 2012, after over a decade of policy development with key stakeholders, important reforms to medical regulation were agreed. These required all doctors to be able to demonstrate that they were up to date with training and fit to practice, a process known as medical revalidation.

The way it was introduced was controversial. The General Medical Council (GMC) and the Department of Health and Social Care (DHSC) commissioned us to carry out research projects to understand its implementation and impact.

We found that despite professional concerns about medical revalidation, its implementation had continued and been increasingly accepted by the medical profession. However, many doctors had ongoing concerns about the practicalities (bureaucracy, workload, and effectiveness).

Our research on the NHS consultant workforce in England found that the introduction of medical revalidation increased the likelihood of doctors leaving practice, particularly for those whose revalidation was deferred. Our fieldwork uncovered two important changes:

• a shift towards a model of employer-led regulatory oversight with employers and their senior medical leaders exercising closer scrutiny of medical performance;
• a closer relationship between healthcare organisations and the GMC with much earlier discussion about doctors whose performance had caused concerns.

Our findings contributed to the GMC’s independent review of medical revalidation and to the development of policy.

Relevant publications

• Reforming medical regulation: a qualitative study of the implementation of medical revalidation in England, using Normalization Process Theory.
• Reforming regulatory relationships: The impact of medical revalidation on doctors, employers, and the General Medical Council in the United Kingdom.
• Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine.