Abstract
In 2012, medical regulation in the United Kingdom was fundamentally changed by the introduction of revalidation – a process by which all licensed doctors are required to regularly demonstrate that they are up to date and fit to practice in their chosen field and are able to provide a good level of care. This paper examines the implications of revalidation on the structure, governance, and performance management of the medical profession, as well as how it has changed the relationships between the regulator, employer organizations, and the profession. We conducted semi‐structured interviews with clinical and non‐clinical staff from a range of healthcare organizations. Our research suggests that organizations have become intermediaries in the relationship between the General Medical Council and doctors, enacting regulatory processes on its behalf and extending regulatory surveillance and oversight at local level. Doctors’ autonomy has been reduced as they have become more accountable to and reliant on the organizations that employ them.
Highlights
The organization and management of medical work has long attracted considerable attention among academics and healthcare policymakers alike
Medical regulation in the United Kingdom (UK) was fundamentally changed in 2012 with the introduction of revalidation – a continued competency process by which “all licensed doctors are required to demonstrate on a regular basis that they are up to date and fit to practice in their chosen field and able to provide a good level of care” (General Medical Council [GMC] 2013)
In this paper we have explored how the implementation of revalidation has impacted on the regulatory relationships between the GMC, healthcare organizations, and doctors
Summary
The organization and management of medical work has long attracted considerable attention among academics and healthcare policymakers alike. The purposes of revalidation have been much contested, with some regarding it as an important mechanism to protect patients and improve the quality of care and others regarding it as an unwelcome and bureaucratic system to exert greater control over doctors with few real benefits (Archer et al 2015; Tazzyman et al 2017) This move brings the work of regulation into the organizational sphere, a situation in which complex relational and governance issues already exist. The GMC traces its history back to the 1858 Medical Act (21 & 22 Vict c 90) This direct relationship between individual professionals and a professional regulatory body was established long before the creation of the National Health Service (NHS) in the UK, and was founded on a model of medicine that saw doctors practising autonomously – both in general practice and in hospital medicine. Such autonomy was seen as a defining characteristic of professional work (Durkheim 1957; Freidson 2001)
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