Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb 11;17(1):33.
doi: 10.1186/s12916-019-1270-4.

Does regulation increase the rate at which doctors leave practice? Analysis of routine hospital data in the English NHS following the introduction of medical revalidation

Nils Gutacker  1 , Karen Bloor  2 , Chris Bojke  3 , Julian Archer  4 , Kieran Walshe  5
Affiliations

Does regulation increase the rate at which doctors leave practice? Analysis of routine hospital data in the English NHS following the introduction of medical revalidation

Nils Gutacker et al. BMC Med. .

Abstract

Background: In 2012, the UK introduced medical revalidation, whereby to retain their licence all doctors are required to show periodically that they are up to date and fit to practise medicine. Early reports suggested that some doctors found the process overly onerous and chose to leave practice. This study investigates the effect of medical revalidation on the rate at which consultants (senior hospital doctors) leave NHS practice, and assesses any differences between the performance of consultants who left or remained in practice before and after the introduction of revalidation.

Methods: We used a retrospective cohort of administrative data from the Hospital Episode Statistics database on all consultants who were working in English NHS hospitals between April 2008 and March 2009 (n = 19,334), followed to March 2015. Proportional hazard models were used to identify the effect of medical revalidation on the time to exit from the NHS workforce, as implied by ceasing NHS clinical activity. The main exposure variable was consultants' time-varying revalidation status, which differentiates between periods when consultants were (a) not subject to revalidation-before the policy was introduced, (b) awaiting a revalidation recommendation and (c) had received a positive recommendation to be revalidated. Difference-in-differences analysis was used to compare the performance of those who left practice with those who remained in practice before and after the introduction of revalidation, as proxied by case-mix-adjusted 30-day mortality rates.

Results: After 2012, consultants who had not yet revalidated were at an increased hazard of ceasing NHS clinical practice (HR 2.33, 95% CI 2.12 to 2.57) compared with pre-policy levels. This higher risk remained after a positive recommendation (HR 1.85, 95% CI 1.65 to 2.06) but was statistically significantly reduced (p < 0.001). We found no statistically significant differences in mortality rates between those consultants who ceased practice and those who remained, after adjustment for multiple testing.

Conclusion: Revalidation appears to have led to greater numbers of doctors ceasing clinical practice, over and above other contemporaneous influences. Those ceasing clinical practice do not appear to have provided lower quality care, as approximated by mortality rates, when compared with those remaining in practice.

Keywords: Medical revalidation; Medical workforce; Policy evaluation; Regulation; Retention.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval is not normally required for secondary analysis of anonymised administrative data. Nevertheless, ethical approval for this study was awarded by the University of Manchester ethics committee (REC 15227) on the 29th May 2015.

Consent for publication

Not applicable.

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: all authors had financial support from the Department of Health Policy Research Programme for the submitted work; JA and KW have received research grant funding from the General Medical Council for a related research project. JA is a practising NHS consultant subject to revalidation. We have no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Revalidation states and transition pathways
Fig. 2
Fig. 2
Kaplan-Meier survival function and hazard function, with 95% confidence intervals
Fig. 3
Fig. 3
Number of consultants ceasing activity; observed vs. predicted based on retirement at age 65
Fig. 4
Fig. 4
Thirty-day mortality rates (95% CI) of stayers and leavers, 2008 to 2014
See this image and copyright information in PMC

References

    1. IPSOS MORI. Veracity Index 2017 [Available from: https://www.ipsos.com/sites/default/files/ct/news/documents/2017-11/trus.... Accessed 28 Jan 2019.
    1. Mechanic D. Changing medical organization and the Erosion of trust. Milbank Q. 1996;74(2):171–189. doi: 10.2307/3350245. - DOI - PubMed
    1. O'Neill O. Reith Lectures 2002. 2002.
    1. Kennedy I. Learning from Bristol - the report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984–1995. 2001. - PubMed
    1. Smith J. Shipman: the final report. 2005.

Publication types