Introduction

Chapter One highlighted that two ideas have long defined the contractual nature of the relationship between the medical profession and the public under the legislative terms of the principle of self-regulation. First is the idea that, as they do an occupation which possesses specialist expertise and a strong ethical ‘service orientation’, doctors can be left alone to manage their affairs, including the training, monitoring and disciplining of group members. Second is the related idea that, once qualified, a doctor can be left alone to practise until they retire. It also outlined how the shift towards risk-based regulation has led to these two interrelated ideas being challenged, with contemporary reforms to the GMC introducing greater transparency and accountability in the regulation of doctors and how their fitness to practise is ensured. Chapter Two focuses on one of these reforms – medical revalidation. It traces its historical development and implementation as well as critically examining recent research into its application. In doing so, the chapter highlights areas for critical consideration in relation to future policy and practice.

Challenging medicine: the rise of hospital management and the patient revolt

It is often argued that, although it was initially proposed in the 1970s, revalidation began in 2000, when the GMC published a consultation document: Revalidating Doctors: Ensuring Standards, Securing the Future (GMC 2000). This document came into being as a result of high-profile medical error and malpractice cases, such as the case of Harold Shipman, who murdered over two hundred of his patients. Yet it is important to note, if only for the sake of holistic clarity, that there was increasing state intervention in the field of medical regulation from the early 1970s onwards, particularly in relation to the operation of the NHS.