Focus on Revalidation

Recently, we have been focusing on revalidation as part of a wider programme of work on ensuring that all of our processes are fair for all doctors.

Over the past few months Council members and senior staff at the GMC have been meeting with groups of Black Minority and Ethnic (BME) doctors around the country. In addition to our own Fairness Conference in September 2012, our Chief Executive, Niall Dickson, attended the British Association of Physicians of Indian Origin (BAPIO) annual conference and our Director of Registration and Revalidation, Una Lane, met with members of the BME Doctors Forum in October 2012.

GMC was well represented at the Fair Route to Revalidation Conference and the launch of the Toolkit at the Reebok Staduim in Bolton in November 2012, where Ben Whur, Assistant Director, Registration & Revalidation, was a keynote speaker and Iqbal Singh and Rajan Madhok chaired the plenary session.

Other GMC staff have attended a number of regional events with BME audiences. Most recently, we have been focusing on revalidation as part of a wider programme of work on ensuring that all of our processes are fair for all doctors.

What is Revalidation?

The process of revalidation is underpinned by a number of core concepts: it is a legal process, supported by clear guidance, built to be flexible, and designed through extensive consultation.

As a legal process, there are duties and requirements imposed on the GMC and employers, as well as on doctors. All designated bodies (employers and other organisations that contract with doctors) must provide their doctors with access to an annual appraisal process and an opportunity to reflect on their practice. The responsible officer in each designated body is responsible for making sure this happens.

The imminent introduction of revalidation and the appointment of responsible officers, has led to a significant increase in the number of doctors who are having appraisals. This is particularly true of those doctors who told us that that there were difficulties in accessing appraisals in their organisations, such as doctors at Staff and Associated Specialist grade. More information on the role and responsibilities of responsible officers can be found on the Department of Health website (for England, Scotland and Wales), and the website of the Department of Health Social Services and Public Safety (for Northern Ireland).

A flexible process

We have developed revalidation so that it is sufficiently flexible to cover all licensed doctors, regardless of the nature of their practice. Our requirements on supporting information are not prescriptive and the information can be collected over a reasonably lengthy period of time. More detail can be found in our guidance on ‘Supporting information for appraisal and revalidation’ (pdf).

The process is also sufficiently flexible to take account of those doctors who take career breaks or maternity leave. In these cases the revalidation date can be deferred for up to twelve months, or even longer if the circumstances require it. A revalidation date can also be deferred to allow a doctor to receive any support that they might need in managing their practice effectively.

Some doctors have expressed anxiety about seeking patient and colleague feedback, especially about potential bias. We are very clear that:

• the purpose of the exercise is to provide doctors with information about their practice through the eyes of those they work with and treat.
• it is intended to help inform further development.
• it is not intended to be used as a judgemental tool or to involve a high stakes test of some kind.
• this kind of feedback as simply another piece of supporting information that should support the doctor in his or her professional development.
• any conclusions about a doctor’s practice should take into account all of the supporting information they bring to appraisal and the wider practice context.
• no single piece of supporting information should be considered in isolation.

Guidance on the ‘administration of the GMC colleague and patient questionnaires’ (pdf) is available on our website. 

There is also flexibility for doctors who work outside of mainstream practice and are not currently linked to a responsible officer. A supplementary online tool has been developed to provide information and advice to doctors in this situation. For these doctors the GMC is able to recognise a ‘suitable person’ who will act like a responsible officer and make recommendations to support their revalidation.

The way forward

All the guidance that supports revalidation is published and available on our website. This includes guidance we have developed to support responsible officers in making their recommendations, the ‘responsible officer protocol’. We have also introduced the Employer Liaison Service to support and advise responsible officers on making revalidation recommendations about doctors where there are concerns about their practice. This should help to ensure consistency in the recommendations that responsible officers will make.

The process of revalidation has developed significantly over the last few years as a result of our consultation and engagement with all parties. We have engaged with a wide variety of doctors and will continue to do that. The views of doctors, patients and employers continues to be key to ensuring that the process is fair as we undertake our longer term review.

As part of our wider commitment to ensuring revalidation is working effectively and remains fair, we will collect, analyse and publish data on recommendations made by responsible officers. This will enable us to identify outliers and ensure that no group of doctors is unfairly disadvantaged by the process.