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Shaping the future of medical revalidation – interim report (January 2016)

Published: April 2016

What were the key findings?

The report presents emerging findings from the UMbRELLA (UK Medical Revalidation Evaluation Collaboration) study into the regulatory impacts of revalidation. The study is due to conclude in 2018.

Key findings from the licensed doctor survey include:

  • The vast majority of doctors licensed to practise by the GMC are engaged in annual appraisal processes. 90.3% of respondents said they’d had a medical appraisal at some point in their career. 95.4% of those respondents said they’d had an appraisal within the 12 months before the survey.
  • Responding doctors who had had an appraisal within the 12 months before the survey were positive overall about that individual appraisal experience. But less than half of respondents agreed that appraisal is an effective way to help improve clinical practice.
  • Responding doctors were divided in their opinions about the impact of revalidation on appraisal, with less than a third believing that revalidation has had a somewhat or very positive impact on appraisal.
  • The majority of responding doctors (57.6%) said they had not made any changes to their clinical practice, professional behaviour or learning activities as a result of their most recent appraisal, compared to 42.4% who said they had made such changes.
  • There was scepticism amongst doctors about whether revalidation has led to improved patient safety, and about whether the process will identify doctors in difficulty at an earlier stage. Responding doctors had mixed views about whether revalidation will improve standards of practice.
  • A majority of responding doctors (74.3%) used guidance documents about supporting information, appraisal and revalidation produced by the GMC and reported finding them useful. But nearly a quarter (22.7%) said that although they were aware of such guidance produced by the GMC, they had not used it.
  • Rates of submission varied for different types of supporting information, as might be expected, as they are needed at different intervals within a revalidation cycle.
  • There were also variations in submission rates between subgroups – for instance, respondents in pathology and public health had lower rates of patient feedback submission. Respondents in anaesthetics were more likely to report some degree of difficulty in collecting patient feedback.
  • Where patients submitted feedback, a majority of responding doctors found it to be the most helpful type of supporting information to help them reflect on their practice.
  • A tenth of appraiser respondents (10.4%) had formally escalated a concern about at least one of their appraisees. Nearly a quarter of responding appraisers (22.5%) identified concerns about at least one of their appraisees that they did not formally escalate. A majority of these appraisers (86.0%) were able to deal with all such concerns within the appraisal process itself. The most frequently cited reason for concerns was a lack of appraisee reflective practice.

Key findings from the Responsible Officer survey include:

  • A majority of responding Responsible Officers (62.7%) felt that the number of concerns being raised about doctors had not increased since the introduction of revalidation.
  • The majority of responding Responsible Officers work with and value the GMC’s Employment Liaison Service.
  • Less than a third of the Responsible Officers (32.4%) who responded to the survey said they tell doctors what their revalidation recommendation is before they send it to the GMC.

Key findings from the patient and public involvement survey include:

  • Two thirds (11 out of 17) of patient and public involvement representatives felt that patients were unaware of revalidation or did not understand its aims and purpose.
  • Patient and public involvement representatives raised issues of time, anonymity, and perceived negative repercussions as barriers to patient feedback.

Why did we commission this research?

We want to understand the impact revalidation is having since we introduced it in 2012, learn from the experiences of those directly involved and understand whether we can make any improvements.

What did the research involve?

The UMbRELLA study consists of seven work packages, organised by research methods, designed to collect and analyse quantitative and qualitative data covering revalidation’s component activities.

The interim report primarily contains findings from three surveys conducted in 2015:

  • a survey of doctors licensed to practise (excluding doctors in training)
  • a survey of Responsible Officers from across the UK
  • a survey of patient and public representatives.

26,171 doctors of 156,610 invitees completed the survey of doctors licensed to practise, giving a response rate of 16.7%. 374 of 595 Responsible Officers provided completed surveys, giving a response rate of 63%. 41 patient and public representatives from national, regional and local organisations and employers responded to the patient and public involvement survey.

Full report and further analysis

Shaping the future of medical revalidation interim report (pdf)

UMbRELLA Interim Report Preparatory Work (pdf)