Skills check-up

01 December, 2010 / Infocus

The term revalidation has been floating around the medical profession for some years now. Plans to introduce it for doctors in the UK have been under discussion for quite some time.

The current proposals for the introduction of revalidation were triggered by The Shipman Inquiry, chaired by Dame Janet Smith, which concluded that the NHS and General Medical Council did not have the systems or culture in place that would have allowed the conduct of someone like Harold Shipman to be detected.

Following publication of the report, Sir Liam Donaldson, Chief Medical Officer for England, was asked to undertake a broad review of medical regulation which led in 2007 to the publication of the White Paper: Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st century. This led to the passing of legislation in 2008 granting the powers to establish revalidation.

In spite of delays, the General Medical Council recently confirmed its plans to introduce medical revalidation in 2012. The General Dental Council (GDC) is also moving ahead with developing its own scheme and is currently consulting on the issue.

As a dentist working in Scotland, I am well aware of the demands regulation is putting on the profession. The second part of the Scottish Government’s consultation on the regulation of independent healthcare has recently closed, the Protecting Vulnerable Groups scheme started at the end of November and already in place are the health board inspections, vocational training practice inspections and, of course, registration with the GDC.

But our plans for revalidation are about individuals. It’s about protecting patients by ensuring you’re giving them the best possible care. You may well be at the top of your game as far as technology and practices go when you first register with us, but we want to ensure it stays that way throughout your entire career. The scheme, for the first time, will provide a proactive way of checking that dental professionals carry on meeting our standards after they join our registers.

The GDC’s fitness to practise procedures are reactive rather than proactive; they assume that dental professionals meet its standards unless information to suggest otherwise is received. That is not good enough. Patients believe and expect that dental professionals’ compliance with standards is checked on a regular basis and are surprised to find this doesn’t happen. Revalidation will bring reality into line with their expectations.

Now is the time to have your say on what we’re planning through our consultation, which is open on our website now and runs until January next year. The consultation document sets out the GDC’s proposals for revalidating dentists. We don’t plan to consider in-depth whether revalidation is necessary for dental care professionals (DCPs) until the random audit of their first cycle of continuing professional development (CPD) is complete in late 2013. However, their views on this consultation would be very welcome.

Put simply, the philosophy behind the proposals is to avoid over-regulation by making as much use of existing systems within dentistry as possible. It should be seen as a very useful extension of what dental professionals are already doing with CPD – which is an earnest attempt to keep themselves up to date. It’s far from a panacea, nothing can remove all risk, but what we need is a scheme that isn’t too burdensome and that will give that additional reassurance to patients and the public.

Revalidation will make clear the minimum standards that all dentists must meet. It is expected that the majority of dentists will already be meeting these standards and should have no difficulty revalidating. However, the system will provide an opportunity for those in difficulty to identify and tackle any problems before they become serious.

A standards and evidence framework will set out the standards dentists must meet under the four domains of clinical, management and leadership, communication and professionalism. The framework will also set out the evidence that will be acceptable to demonstrate compliance with each standard.

Dentists will gather this evidence over five years, and revalidate at the end of each cycle. We are proposing a three-stage process at the end of each cycle:

  • Stage 1 – compliance check, which will apply to all dentists
  • Stage 2 – remediation phase, which will provide an opportunity to dentists who do not pass Stage 1 to remedy deficiencies
  • Stage 3 – in-depth assessment, which will apply to dentists who fail to demonstrate their compliance at the end of the remediation phase.

Dentists who refuse to engage with the process, or who do but who fail to revalidate, will ultimately be removed from the register, with additional requirements for restoration to the register. However, there will be an appeals process.

We are keen to get feedback from a full range of stakeholders including patients and organisations representing the interests of patients. In order to secure a wide range of views we are also carrying out other activities alongside the formal consultation. These activities include research into patient and public views, dedicated focus groups, meetings, and piloting activities as the project progresses. Once the consultation has closed we will collate all the responses we have received and GDC staff will carry out a consultation analysis and produce a report for the Revalidation Working Group to consider. This report will be published on the GDC website and will influence the proposals the working group makes to council for revalidating dentists.

Readers of Scottish Dental magazine can respond to the consultation by email onor by filling in the form at or by writing to: Revalidation Consultation, General Dental Council, 37 Wimpole Street, London W1G 8DQ.

About the author

Dentist Denis Toppin is on the council of the GDC and is also chairman of the Revalidation Working Group. A returning registrant member to the council of the GDC, Denis was born in Glasgow where he returned to study and work.

He qualified as a dentist in 1977 from the University of Glasgow and has been working in general dental practice ever since.

Denis developed an interest in dental education through his involvement in dental vocational training as a vocational training trainer, adviser and regional adviser as well as through teaching undergraduate dental students clinical practice in restorative dentistry. He also teaches on numerous postgraduate courses. He holds a masters degree in education.

He was a member of the Scottish Dental Practice Board for the maximum six year period and he currently holds a part-time post of Assistant Director of Postgraduate General Dental Practice Education with NHS Education for Scotland.

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