Title: Evaluating the Development of Medical Revalidation in England and its Impact on Organisational Performance and Medical Practice
Funder: Department of Health and Social Care

Abstract: Background: the introduction of medical revalidation, through which all licensed doctors will be required to demonstrate their ongoing fitness to practise, is a major innovation in medical regulation involving important changes to formal regulatory arrangements, ways of managing medical performance in healthcare organisations, and the relationships between doctors, the professional regulator and healthcare organisations. Its implementation and impact are of central interest to other health professions and regulators in the UK and elsewhere. Aims: this project sets out to examine the mechanisms by which revalidation is intended to work and its place within wider systems for managing medical performance in healthcare organisations; to map and describe its implementation and the way revalidation processes work; and to assess the impacts of revalidation and its costs. We set out six specific research questions in our Aims and Objectives section. Research plan: we set out four main workpackages (plus one concerned with project management and knowledge mobilisation). WP1 will develop and map the underlying programme theory of revalidation through the review of existing research and sources of evidence, documentary review and analysis, and interviews with key stakeholders. WP2 will draw on these programme theories to map and measure the implementation of revalidation in healthcare organisations in England over time. It will do this through two national surveys of all designated bodies in England; case studies of 12 selected DBs representing a diversity of organisation types, scales and levels of progress in/models of revalidation; and two surveys of all doctors working in the 12 selected DBs on their experiences of, costs of and self-reports on effects of revalidation. WP3 will specifically focus on the effects of revalidation on the management of suboptimal medical performance, using qualitative fieldwork in our case study organisations and a structured analysis of processes and judgement making in a cohort of selected cases from those organisations. WP4 will examine the impact of revalidation and related systems for managing medical performance through a quantitative analysis of secondary data sources in NHS acute care looking both at individual level and organisational level effects. Research team: We bring together a research team from the Manchester Business School at the University of Manchester, the Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA) at the University of Plymouth and the Centre for Health Economics and Department of Health Sciences at the University of York. We have extensive relevant research experience in relation to medical revalidation and regulation, quality and safety in healthcare organisations, and medical performance measurement and management. Potential impact: the introduction of medical revalidation provides a singular opportunity for empirical research which will inform and support future policy and practice in health professions regulation in the UK and internationally. We are committed to working proactively with stakeholders in this research, both to engage them in the research process and to seek to disseminate and mobilise knowledge from research findings.

Lay abstract: There have been many changes to the regulation of health professionals (like doctors, nurses and therapists) in England over the last decade, intended to protect the public by ensuring professionals are fit to practise and making them accountable through effective regulatory arrangements. In the past, once they had qualified, health professionals were subject to little or no scrutiny during their career unless their performance gave cause for concerns or there were complaints about them. After more than a decade of debate and development, in 2012 the General Medical Council introduced a new requirement for all doctors to be &ldquo;revalidated&rdquo; at least once every five years while they hold a licence to practise. This involves the appraisal of their performance and is usually undertaken by their employer. Medical revalidation is a major change to the regulation of doctors, and its implementation is being watched with interest by other health professions regulators who are considering similar requirements for nurses, therapists and other groups. Our research sets out to see how the new arrangements for medical revalidation are being implemented both in the NHS and more widely, and to see how they are used to assure and improve medical performance. We will use a number of sources of data including national surveys of organisations which employ doctors; case studies of a selection of different types of organisations involving interviews, observation and documentary analysis; surveys of doctors undergoing revalidation in those organisations; detailed casework on examples of suboptimal medical performance and how they were managed; and the analysis of large existing data sets on doctors working in the NHS acute sector and their performance. Overall, our findings about how revalidation works, the way it has been implemented, and its costs and impacts, will be of great use in the refinement and future development of revalidation and similar initiatives to the General Medical Council and other health professions regulators, to the Department of Health in England and government in the other countries of the UK, and to regulators and health professions in other countries.

Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE