Reaccreditation: the why, what and how questions

Currently, reaccreditation is the subject of debate within general practice in the United Kingdom, largely in terms of medico-political expediency. In an attempt to broaden the basis of the debate, this paper explores reaccreditation in relation to its purpose in shaping the future of general practice (the why question); the qualities it might appropriately seek to assess (what?); and, whether such qualities can be measured (how?). It is argued that reaccreditation has far-reaching educational and service implications for general practice in the UK and should only be adopted after careful consideration of the issues involved for the profession, for patients and for the National Health Service. Providing that these issues can be resolved satisfactorily, it is proposed that the ability of general practitioners to learn from experience, rather than competence or performance, represents an appropriate and feasible yardstick for reaccreditation. Both general criteria and specific characteristics of assessment methods suitable for measuring experiential learning are identified. The feasibility and acceptability of applying such methods to the reaccreditation of general practitioners are considered. It is concluded that once such methods have been successfully refined and field-tested the way would be open for the profession's negotiators to offer the implementation of reaccreditation in return for certain safeguards designed to protect the future role of the generalist doctor in the community.