Leading in a time of change

PROFESSOR Sir Peter Rubin has had a hugely varied career in medicine. He has been involved in extensive research on the safe and effective use of drugs in pregnancy, written books on clinical pharmacology and helped establish the Nottingham Veterinary School, the first new vet school in the UK for over half a century.

But it was partly chance that led him to the GMC in 1998. Professor Rubin was dean of the faculty of medicine and health sciences at Nottingham when it was the University’s turn to nominate a dean to the Council. Since then he has never looked back.

He remains professor of therapeutics at Nottingham and consultant physician at the Queen’s Medical Centre and a non-executive director of Nottingham Health Authority. In June 2010 he was awarded a knighthood for services to medicine in The Queen’s Birthday Honours List.

Why has the decision been made to extend the pilot period for revalidation?

The Health Secretary, Andrew Lansley, recently extended the piloting phase for a further year in England so we can be absolutely confident that local systems of appraisal and clinical governance, on which revalidation will be based, are in place and working effectively.

We need not only to ensure that revalidation adds value for both patients and doctors but is also practical and workable in the context of the pressured and busy environments in which most doctors work. Revalidation will only be introduced once we are satisfied that the local systems necessary to support doctors in meeting the requirements of revalidation have been properly tested. We are determined to get it right and want a straightforward process which is genuinely helpful for doctors, patients and employers.

Will revalidation stand solely on the quality of local appraisal systems?

The annual appraisal will be the main way in which doctors will demonstrate that they are up to date and fit to practise in their chosen field. We know, however, that the quality of appraisal in different parts of the UK is inconsistent at the moment and this needs to change.

At least part of every doctor’s annual appraisal should involve an evaluation of their performance against the professional standards set by the GMC. For most doctors, this annual evaluation of their practice through appraisal will be nothing new. In future, it will help them and their appraisers to link their performance to national standards and identify any areas for action and address any concerns long before they are required to revalidate.

How would you respond to the worry that revalidation will eat up valuable clinical time with the administrative burden?

We know it needs to be simple. Revalidation relies primarily on appraisal, which in turn is based on showing that we as doctors are up to date in our area of practice. Much of that is to do with continuing medical education, which we all do anyway.

Recording what you’ve done as you go along, for example in an e-portfolio as I do, will help enormously to minimise the time spent in preparing for appraisal. Multisource (360 degree) feedback should be done once or twice in a five-year cycle. With a bit of planning, it can again be pretty smooth – for example, I send MSF forms to new patients coming to my hypertension clinic and collate the replies periodically.

How about the concern that revalidation may be used to settle old scores within a PCT or other health organisation?

No one should face discrimination or unfair treatment in the workplace. All of the stakeholders involved in the introduction of revalidation, including the GMC, are fully committed to ensuring that revalidation is a fair and transparent process for all doctors.

In the responsible officer draft regulations, which have now been laid before Parliament, the Department of Health requires the PCT, or other 'designated bodies' to ensure there is no ‘conflict of interest’ or ‘appearance of bias’ between practitioners and the responsible officer appointed. The regulations also place a duty on organisations to appoint an additional responsible officer where there is a conflict of interest or an appearance of bias between a doctor and the first appointed responsible officer.

We have also developed a Good Medical Practice Framework for appraisal and assessment to be used in all appraisals for doctors, which should help to ensure further consistency in the process.

What do you see as the main benefit in the merger of the PMETB (Postgraduate Medical Education and Training Board) with the GMC?

For the first time ever, one UK organisation sets the standards for all stages of medical education and training, operates the register of doctors and ensures they are competent and fit to practise. The GMC can ensure that every stage of education and training successfully prepares the doctor for the next one and standards are continually improved. Our education strategy 2011-2013, which we are in the process of developing, will set out exactly how we will do this.

How do you feel being the chair of the GMC at this crucial stage in its development?

I feel hugely privileged to be doing this job at this time. Leading change is what I enjoy most and there’s certainly a lot of change to lead right now! Medical colleagues often look askance when I say that I look forward to going to work at the GMC, but it’s true. We deal with fascinating, varied and important issues and the breadth of our activities – spanning education, registration, standards and fitness to practise – ensures there’s rarely a dull moment.

What inspired you to go into medicine?

I was the first member of my family to go to university, so there was no professional tradition to follow. I really enjoyed science at school and I liked people. Medicine seemed like a good idea and my teachers encouraged me to go for it. Most of the London medical schools turned me down without interview. St Mary’s offered me a place (having ascertained what position I played at rugby!) but very kindly suggested I should go to Cambridge, which I did.

How can the UK do more to encourage medical students from lower income backgrounds?

I think raising the aspirations of young people well before they make career choices is key. Universities can play a part – and many medical schools have a variety of schemes to try and widen access. However, if people don’t apply to medical school they won’t get in. We’ve also got to accept that the financial landscape is very different to the one in which I chose medicine – I had a full student grant which in today’s money was around £5500 per year and paid no fees. For many young people, the prospect of accumulating a large debt is going to be a major disincentive, but medical schools in the UK in general don’t have the huge endowments enjoyed by the top institutions in, for example, the USA which can provide significant scholarships.

What are the main differences between the GMC of today and the GMC when you started your career?

I don’t think the GMC crossed my mind when I started my career! I ended up on the GMC rather randomly in 1998, when it was Nottingham’s turn to nominate a dean of a medical school to the huge Council of 104 people. I have to say that I entered a world that seemed pretty detached from the one in which I lived and worked.

We’ve undergone enormous change in the last 10 years and continue to do so. In the past, we have too often been reactive and inward looking, but we are now far more ready to take a stand on tricky issues – for example language testing for graduates from elsewhere in the EU. I think we are now a much more outward-facing organisation, but I know we have a way to go to ensure that we communicate effectively and appropriately with those who pay for us.

Interview by Jim Killgore, editor of MDDUS Summons