This week the UK regulator of doctors, the General Medical Council (GMC), has launched a consultation over the Continuing Professional Development (CPD) of qualified, practising doctors. This subject is of immense importance because the pace of medical advances is such that patients cannot expect to receive the best treatment if doctors are not up to date.
The GMC believes that individual doctors should carry primary responsibility for their own CPD and that no specific material should be mandatory. A system of annual appraisals has been in force for UK doctors since 2002, mainly to identify personal and professional development needs. These appraisals are often arranged by a doctor’s employer if he has one but they can be carried out by a number of appropriate organisations. As part of the annual appraisal process each doctor’s personal CPD arrangements are reviewed and recorded but doctors are not legally obliged to follow any advice given. A new system is scheduled to be rolled out from late 2012 onwards under which the licence of doctors to practise will require to be revalidated every five years. As part of the revalidation procedure the adequacy of each doctor’s CPD will have to be demonstrated by examining the records from past appraisals.
In general, there is much to be said for every doctor managing his own affairs with limited bureaucratic interference, regulatory burden or political pressure. However, lessons from other countries, particularly the USA, teach us that even doctors are not immune from pursuing their own self interests. Some members of the medical profession are financially or commercially motivated and do not voluntarily keep abreast of new developments as they should. Doctors can also share the same biases as one another. In such circumstances they may unwittingly fail to put the public interest first.
Most doctors are general practitioners. Their role is a very broad one to which no brief description can do justice. However, the cornerstones of general practice are diagnosis, lifestyle advice and pharmaceuticals. If action other than drug treatment or lifestyle adjustment is needed or if the diagnosis is uncertain, the patient will generally be referred to a hospital or specialist. If general practitioners are to provide the best medical care, they absolutely have to be on top of the latest drugs and diagnostic tests suitable for use in a general practice setting. The UK medical profession is one of the best in the world but there is evidence that patient outcomes in some illnesses are being compromised by poor uptake of new drugs in the UK . Part of the reason is economic or political, for example the past policies of NICE regarding the affordability and value of drugs. Another part of the reason is that doctors may have a good case for not prescribing a new drug unnecessarily until it has been around long enough for unexpected, important side effects to be ruled out. However, the third part of the reason is that many UK doctors have a bias against learning about new medicines and diagnostic techniques. To doctors it can always seem more pressing to see one more patient in the waiting room, to visit one more really ill patient or to go off duty on time rather than to be learning about new products.
The need for doctors to study drugs and for high-quality independent reviews has risen for three reasons:
- Pharmaceutical companies have been responding to mergers, difficult times in the industry and growing centralisation of prescribing decisions by cutting back on salesmen visiting doctors. These people were never very popular with many doctors but did help to generate interest in medical advances.
- The growing global trend towards increased regulation, the rising complexity of medicine and the heightened financial pressures on the pharmaceutical industry have combined to raise the demand for independent expert views and understanding.
- The way forward is not for organisations like NICE to issue rigid prescribing edicts. Such bodies have their role but tend to be slow and ponderous and to lag behind leading medical opinion. In addition, the circumstances of each patient often vary too much to make simple, inflexible guidelines appropriate.
Learning about new drugs, diagnostic tests and the latest evidence on existing drugs is too important to be left for general practitioners to take or leave as they wish. The GMC is well placed to work out the details over how to move forward. Possibilities include an explicit requirement or a strong suggestion that the matter will carry a high profile when decisions are taken over the revalidation of individual doctors’ right to practice. The consultation opened this week by the GMC invites views from all interested parties. The lay public and politicians should lobby the GMC forcefully to make sure that general practitioners really do keep up to date with the latest drugs and diagnostic tests. At the same time the public and doctors should continue to remind politicians about the importance of medical advances being available quickly to patients.