‘Don’t allow consumerism and bureaucracy to corrupt professional development’

There are lessons for those shaping social work’s professional learning framework from the medical profession, writes Michael Fitzpatrick

The government has suspended the introduction of a scheme to revalidate doctors’ registration with the General Medical Council pending further pilots. The scheme had been scheduled for launch next year.

Health secretary Andrew Lansley’s decision came days after the British Medical Association urged the GMC to “go back to the drawing board” with its plans for a system that would “do little to weed out under-performing doctors” while adding “yet another layer of bureaucracy to doctors’ role”.

Social workers, who face similar schemes, should welcome any retreat from what Harry Ferguson, professor of social work at Nottingham University, recently called the culture of “obsessive audit, inspection and micromanagement of practice” that dominates the caring professions.

In principle, the GMC’s proposals seem entirely reasonable. The fact that doctors have been able to emerge from medical school and practise for decades without so much as opening a book, reading a journal article or satisfying any external assessment is a long-running scandal. Now doctors will be required to show that they are up to date with contemporary standards and fit-to-practise. It seems reasonable too that social workers, particularly at a time when their standards are under intense public scrutiny, should be required periodically to produce evidence of professional development.

Consumerist pressures

The difficulty lies in the detail of constructing a process of revalidation that effectively measures fitness-to-practise without being excessively bureaucratic or authoritarian. Another problem is the pressure to subordinate professional standards to the pressures of consumerism. This trend was encouraged by the last government which announced an official NHS website on which patients could “post messages about their experiences of GPs” and rate their professional standards, as people rate books on Amazon.

For its revalidation process the GMC favours a model closer to that followed by Strictly Come Dancing, in which contestants are judged by a combination of studio experts and public voting (notwithstanding the fact that this system is notorious for producing confusing results). This approach may provide good entertainment, but it seems unlikely to improve the quality of care.

Multisource feedback

For example, in one method approved by the GMC doctors seeking revalidation would be required to provide “multi-source feedback” from patients and colleagues. It is ironic that the doctor whose name is most closely associated with the drive to introduce new processes of revalidation – the late Harold Shipman – would have had little difficulty in demonstrating his high levels of performance in any such test. Any GP would have been proud to include the Shipman inquiry’s comments on his professional standards in their personal development portfolio (if not in a frame on the waiting room wall):

“Shipman had the reputation in Hyde of being a good and caring doctor. He was held in very high regard by the overwhelming majority of his patients. He was also respected by fellow professionals. His patients appear to have regarded him as the best doctor in Hyde.”

Patients may be more likely to suffer harm from an incompetent GP than they are to become victims of another GP serial killer. They are more likely still to suffer the adverse consequences of the destruction of the autonomy of the medical profession and the corruption of doctor-patient relationships that results from the incursion of state and commercial forces.

Michael Fitzpatrick (pictured) is a GP in Hackney and author of Defeating Autism: A Damaging Delusion, published by Routledge

Appeared in 17 June 2010 Community Care under heading Let’s not introduce a culture of ‘rate your social worker’