Proposals for the revalidation of doctors in the United Kingdom were released in June in a consultation document from the General Medical Council (GMC). Elsewhere, notably in Canada and the United States, it is routine for doctors to undergo re-certification at regular intervals to show that they are maintaining their skills and are competent. The purpose of revalidation is to reassure the public that their doctors are competent and abide by high ethical standards. Revalidation will be the culmination of an ongoing review of professional performance that should aid doctors in developing their skills while at the same time identifying at an early stage those who are performing poorly.

All doctors in the United Kingdom will undergo revalidation whether they work within or outside the NHS, are in training, or are in temporary employment. The stakeholders in revalidation include the individual doctor, the NHS, other healthcare providers and purchasers, the medical royal colleges, and, most importantly, the public. The challenge for doctors over the next year or so will be to reconcile the needs of all parties while at the same time ensuring that a robust and fair system of revalidation ensues.

The stages of revalidation will include collecting evidence of competence and performance, performing regular review of this evidence, and having a group of medical and lay people make recommendations for revalidation or recommending that the doctor’s registration should be reviewed by the GMC. The precise details about who should take responsibility for each stage (especially who makes the recommendation to revalidate) is to be agreed.

All the medical royal colleges in the United Kingdom have set up continuing professional development schemes and have jointly produced a generic folder that provides the means for individual doctors to show that they have participated in professional development and personal development planning. The royal colleges and specialist societies will provide guidance on what type of evidence is needed for revalidation in their specialty and will elaborate the principles of revalidation set out in Good Medical Practice, a code of practice developed by the GMC.

Urinary tract infection is common in childhood. Because of practical difficulties with collecting urine, samples are often not obtained. Most samples are collected by parents, yet nobody has sought parents’ views on available methods. 

Parents of children aged 1-18 months volunteered to collect urine at home by pads, bags, and clean catch in a randomised order, on one day. Demonstrations and instruction sheets were given. Parents washed their hands before each procedure and the child’s perineum before each collection. Pads (Newcastle sterile urine collection packs, Ontex UK, Corby) were placed inside the nappy and checked every 10 minutes until wet (but not solid), then urine aspirated with a syringe. Bags (Hollister U-Bag, Hollister, Libertyville, IL) were applied and inspected every 10 minutes and removed to decant the urine.

For clean catch samples, infants were nursed with a sterile bottle ready. Samples were immediately instilled on to dipslides with sterile swabsticks and returned with forms recording parents’ collection times, comments, and rankings. Equipment costs were: pads 40 pence for 10 (or 59p for a pack containing syringe, bottle, and two pads); bag 89p; sterile bottle 7p; dipslide and swabstick 59p.

This is the first study of parents’ views of infant urine collection methods. Pad, bag, and clean catch samples were equally effective at excluding an infection; variations in contamination rates balanced collection failures. Most parents disliked clean catch collections; their views should be heeded. Most preferred pads to bags, and they are cheaper. They also 

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Clinical governance (CG) is needed to address variations in care, well documented during recent decades, and to prevent inappropriate care.

The Health Authority (HA) has set up effective working arrangements and leadership in co-operation with the Local Health Groups (LHGs) and NHS trusts. Baseline assessments of capacity and capability have been performed by the Health Authority, LHGs and NHS trusts.

A recent BMJ looked at the attributes of clinical practice guidelines which influenced their use of guidelines in decision making in clinical practice. This was an observational study relating the use of 47 different recommendations from 10 national clinical guidelines to 12 different attributes of clinical guidelines – for example, evidence based, controversial etc.

The study was carried out in the Netherlands and included 61 general practitioners who made 12 880 decisions in their contacts with patients. Controversial recommendations were followed in 35% of decisions and non-controversial recommendations in 68% of decisions. Vague and non-specific recommendations were followed in 36% of decisions and clear recommendations in 67%.

Recommendations that demanded a change in existing practice routines were followed in 44% of decisions and those that did not in 67% of decisions. Evidence based recommendations were used more than recommendations for practice that were not based on research evidence.

People and organisations setting evidence based clinical practice guidelines should take into account the blocks to them being implemented, especially that guidelines need to be clear and based on good evidence..

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