The Royal College of Physicians and Surgeons (RCPS) of Glasgow enjoys a unique and privileged position among its sister colleges in the UK in that both physicians and surgeons (including dentists) make up its Membership and Fellowship. The College, founded in 1599, has since then being setting and maintaining standards for all levels of the professions. These involve both basic professional and specialty training in all disciplines.

Dr A R Lorimer, president, RCPS Glasgow, accompanied was in India to participate in the XIV Annual continuing medical education programme (CME) of Delhi chapter of the Association of Physicians of India recently.

In an exclusive interview with Joe C Mathew of Pharmabiz.com, Dr Lorimer spoke on the general trends in medical profession in UK, the CME programmes organized by RCPS and his piece of advice for his fellow physicians and surgeons in India. Excerpts:

How important are CMEs for a medical practitioner in the United Kingdom? What role does RCPS, Glasgow play in helping the physicians update their knowledge on a periodic basis?

All doctors are required to keep themselves abreast of developments in their particular fields. The College helps them by providing opportunities for physicians, surgeons and dentists - both senior and junior - to update their skills and knowledge. Trainees wishing to specialise in surgery and experienced surgeons can develop and hone their manual skills in the Clinical Skills Laboratory. They can learn about new surgical techniques using simulation equipment, at no risk to patients. State-of-the-art video-conferencing facilities allow interactive links from the College to hospital operating theatres and other centres around Scotland.

The advent in the United Kingdom of revalidation at all levels will bring new challenges in our quest to improve quality and standards. The College supports these developments and is committed to their implementation.

The RCPS is also taking active role in the The Scottish Intercollegiate Guidelines Network (SIGN) which aims at improving the quality of health care for patients in Scotland by reducing variation in practice and outcome, through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence.

Could you tell more about the revalidation system that is being made mandatory in the UK?

The General Medical Council (GMC) of UK has announced its plans to introduce revalidation system for all practicing doctors by 2005. The GMC is changing the system for the registration of doctors. At present, the Medical Register shows who is properly qualified to practise medicine in the UK. This principle will continue, but in future the Register will be strengthened by a new system based on a licence to practise, supported by periodic revalidation.

The purpose of the changes is to modernise the model of regulation led by the profession, in partnership with the public. Beginning from next year, the registered doctors in the UK will have to follow the principles of Good Medical Practice (GMP) set up by competent professional bodies on various medical specialties. They will also have to prove themselves that they have done so, if they need a fresh license to practice. The GMP components are: good clinical care, maintaining good medical practice, teaching and training, relationships with patients, working with colleagues, probity and one's own health. Every hospital will thus have Clinical Standards Board where the performance of the doctor will be peer viewed and approved every year. While the approval is an internal exercise, external experts will carry out the revalidation.

What is SIGN? How can it improve the quality of patient care?

The Scottish Intercollegiate Guidelines Network (SIGN) was formed in 1993 and is supported by an executive based at the Royal College of Physicians of Edinburgh. Its membership is drawn from all the medical specialties, nursing, pharmacy, dentistry, professions allied to medicine, patients, health service managers, social services, and researchers. The SIGN guideline development programme is funded by the Quality Improvement Scotland. SIGN has a programme of 76 evidence-based clinical guidelines - published, in development, or under review - covering a wide range of topics. Many of the SIGN guidelines relate to the NHS priority areas of cancer, cardiovascular disease, and mental health.

Clinical guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Guidelines provide recommendations for effective practice in the management of clinical conditions where variations in practice are known to occur and where effective care may not be delivered uniformly throughout Scotland.

There are many guidelines available, but most are based on a consensus of 'expert opinion' or a non-systematic review of the scientific literature. The evidence-based guidelines developed by SIGN are derived from a systematic review of the scientific evidence, and are therefore less susceptible to bias in their conclusions and recommendations. The guidelines are revised every two years.

How does it work? Are the guidelines also to be mandatory?

SIGN guidelines are part of a range of complementary activities to translate research into practice, set and monitor standards, and promote clinical excellence in the National Health Service in Scotland. Guidelines can achieve better treatment outcomes for patients, but local ownership of the implementation process is crucial to success in changing practice. For this reason, SIGN is responsible for the development of national guidelines, but not for their implementation into practice. This is a responsibility of each individual NHS Trust, and is now reinforced by the twin 'levers' of clinical governance and the Clinical Standards Board for Scotland (CSBS). SIGN guidelines provide the evidence base for many of the standards developed by CSBS, and SIGN also works closely with the Health Technology Board for Scotland (HTBS).

Do you think a similar system can be thought of in India?

CMEs are essential everywhere. A patient focused approach also leads to good relationship with the doctor and the patient. Clinical guidelines that are framed with the participation of all stakeholders can ensure delivery of quality healthcare. However, there is no need to copy SIGN guidelines. On the other hand, SIGN guidelines can be considered as signposts to be adopted locally.

On the guideline front, India is in the process of developing a consensus among all the stakeholders in healthcare delivery for improving the standards of medical practice. A national Accreditation Council is in the offing. The Medical Council of India has come out with a code of ethics. What would be your advice to Indian friends at this juncture?
Any move towards accreditation should be seen as a great start. The government has the responsibility to let the doctors provide best services to the patients. Any such move from the part of clinicians should be promoted. However, the standards should be set by an independent agency.