Final Report > Chapter 25: Competent Healthcare Professionals > The systems for assuring competence > Maintaining professional competence during a working life

Maintaining professional competence during a working life

48 The arrangements to ensure that healthcare professionals maintain and develop their competence whilst working in the NHS are currently fragmentary and apply differentially to the various groups of professionals. As far as professional requirements are concerned, for some healthcare professionals, for example nurses, the pursuit of continuing professional development has long been required as a condition of continued practice. It may be thought surprising, however, that as we write this Report this is not so in the case of hospital consultants. Once they have acquired the necessary qualification, they can currently practice for life without any formal requirement to undergo any further professional development as a condition of continuing practice. Schemes do exist in some of the Royal Colleges. But currently, as an indication of the fragmented approach we referred to earlier, whether professional development is required by the College of a doctor depends on the relevant Royal College. For instance for members of the Royal College of Surgeons and the Royal College of GPs, it is compulsory. For members of the Royal College of Paediatrics and Child Health and the Royal College of Physicians, although continuing professional development (CPD) is expected, it is not compulsory. But whether or not the College requires CPD affects only the relationship between the doctor and the College. It currently has no wider implication for working in the NHS. A number of proposals and indeed changes have been made, particularly since this Inquiry was set up. But it is important to remember that it remains a matter for individual doctors whether and how they maintain their skills and knowledge during a working life of 30 or more years. Patients have no assurance that the doctor they see has the appropriate level of knowledge and skill. This cannot continue.

49 It does not require much reflection to see that from the patient's point of view this state of affairs is unsatisfactory. Of course, in practice, the vast majority of consultants are constantly developing their skills and knowledge, but the patient's wellbeing should not depend solely on the individual hospital doctor's motivation. It is not enough to argue, as has been the case in the past, that the hospital doctors can be left to recognise their own needs and limitations. Furthermore, it is very often those who do not feel the need to submit themselves to further development and training, who, in the absence of some formal system, may pose the greatest threat.

50 Similar issues arise as regards the system of appraisal. Whereas it has been commonplace for nurses and for junior hospital doctors to undergo annual appraisal, it has not been so for hospital consultants. Only now, in the middle of 2001, for the first time, is a system of appraisal for consultants being introduced. Many consultants have never undergone an appraisal in their working lives. Furthermore, in the case of GPs since technically they are independent contractors and have no employer, no system of appraisal for them has been developed. Without regular appraisal, the NHS has no formal means of assisting systematically with professional development nor any means of monitoring an individual professional's performance.

51 It is important to note that some of the shortcomings we point to are widely acknowledged, by the Government and by the GMC, and that, for example, important changes concerning appraisal and revalidation are under discussion. We believe that the formal systems and resources to support professionals in maintaining their competence need to be part of a comprehensive framework whereby the NHS and all the healthcare professions, jointly, embrace three separate but interconnected practices: continuing professional development, periodic appraisal and revalidation. [20] These three activities are not, and must not be seen as, oppressive activities, as just another burden on healthcare professionals. Nor should they be seen as activities from which one or other professional group is wholly or partly exempt. Rather, as most healthcare professionals now recognise, participating in CPD, appraisal and revalidation represents the affirmation of their professional status: that they are willing to keep themselves professionally fit on behalf of patients, and that they are accountable for so doing. Historically, compared with nurses and GPs, hospital doctors have been slow to develop systems to assure competence during working life. That has started to change, but in the interests of patients, the pace of change must quicken. In what follows, therefore, we use the specific example of hospital doctors, but the general points we make apply equally to all the healthcare professions.

Footnotes

[20] Revalidation, in general terms, is a mechanism whereby healthcare professionals are required regularly to demonstrate to external assessors that they remain fit to practise, and thus are entitled to continue to be registered or recognised as a doctor, nurse or other healthcare professional