In the aftermath of the Shipman Inquiry's fifth report,1 the Chief Medical Officer for England, Sir Liam Donaldson, had an unenviable task in producing a report2 on patient safety, revalidation and the functions and structure of the General Medical Council (GMC) that would engage a general public exercised by the circumstances it reviewed, a bemused government and a UK medical profession showing a loss of confidence. His 44 recommendations deserve careful consideration but, alongside those that will be generally welcomed, others bear more careful scrutiny during the 4-month period of consultation.
Our patients should welcome the emphasis on increased public safety and the Royal College of General Practitioners will recognise many of its responses to Donaldson's Call for Ideas3 in his final recommendations, and will welcome the pivotal role for it that he proposes in their delivery. Even with a rigorous approach, there will always be variation of standards within a range and the public must accept that even if that variation is narrowed, by definition, the performance of 50% of all ‘good’ doctors will be ‘below average’. Donaldson proposes examining a number of domains of performance, but any test of a reasonable level of knowledge must take into account not only that range of normal achievement, but also the different ways that doctors at different stages of their careers codify their knowledge. The young doctor can produce long lists of differential diagnoses, whereas older doctors, relying on long experience, not only know what they do not know, but know where to find the answer. The trick will be to bridge both variables with a method capable of withstanding legal challenge.
A ‘rigorous approach’ may possibly ignore any debate over revalidation's core purpose. Some believe that a recertification process is one that should summatively guarantee quality practice. …
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