Jim Odell - Manifesto Issues. Revalidation

Revalidation

The White Paper ‘Regulation of Health Professionals in the 21st Century’ has kicked up some important issues for Chiropractors, not least the prospect of revalidation based on risk.

Personally I think it is important for Chiropractors to recognise that whilst this process is not the invention of the GCC (as some I have spoken to seem to think) the final scope will be based on what comes forward from the Profession. It is this final scope that must be carefully debated and where my concerns lay.

My concern is that, if handled badly, revalidation could be just another stick that forces many chiropractors to leave the register and become manipulators or osteomyologsits. I would like to think that, if elected, my pre-Chiropractic career gives me a great advantage over the ‘long time’ and ‘committee’ chiropractors. I have designed and implemented key processes in a range of companies that had to be both efficient and effective.

On the face of it, a revalidation should present no problems for safe competent chiropractors, and if it follows the suggestion within the medical profession that ‘..the appraisal process will encompass both summative and formative components…’ and becomes a developmental process then all the better.

However, as with all Government documentation the devil is definitely in the detail and for me some of the key issues are:

• The definition and purpose of revalidation as ’…a mechanism that allows professionals to demonstrate that they remain up to date and fit to practise.’

This is an easy phrase but, if we take just how we ‘demonstrate’, we start down a long tenuous path, let alone ‘up-to date’ which implies some organisation determines what ‘up-to-date’ is.

• The use of the terms ‘relicensure’ and ‘specialist recertification’ as applied to specialists in the medical profession. Does this mean that potentially any chiropractor that lists themselves as for example a paediatric chiropractor or a sport injury chiropractor will have to be ‘recertified’ for these activities over and above just being a chiropractor?

• The report also says:
Professionals will fall into one of three groups for revalidation:
1. employees of an approved body – revalidation carried out as part of the routine staff management or clinical governance system
2. self-employed staff providing services commissioned by NHS primary care organisations – revalidation processes built into the relevant NHS arrangements and carried out under the supervision of the commissioning organisation
3. all others – regulatory bodies develop direct revalidation arrangements.

This introduces immediate ambiguities: some Chiropractors will fall into group 2, and the majority into group 3. If you, like me, fall into Group 2 then must we accept their revalidation processes? This then raises the question of whether we have to do two revalidation processes or will being in Group 3 cover us for Group 2 and vice versa?

I also have concerns that the current GCC have apparently used the risk assessment factors from the report and placed us in the high risk category. The list is simplistic to the extreme and to have already agreed in principle that we are a high risk group, based on this, is slightly worrying, but not unchangeable.

And whilst I do agree that the skill of differential diagnosis is a vital element of any process, it is not necessarily the key measure.

There must be a sensible approach to the revalidation of chiropractors and if the basis of the revalidation approach is to be on risk, we must consider very carefully how the assessment of risk is made.

One danger is that individuals in our profession who want a dynamic or radical shift in chiropractic towards the ‘medical mode’ will create a revalidation process that reflects medical and not chiropractic risk.

Whilst defining risk is fraught, the difficult part is managing implementation of the process. Not simply how, but by whom. Can the GCC really do this and if not who will and how much will it cost? These are all issue up for debate in the next few years and ones for which I would use past experience to good use on behalf of our profession - if you choose to elect me.