Working with doctors Working for patients

Taking revalidation forward in 2017

13 January 2017

We want every doctor to have a positive experience of appraisal and revalidation. And we want revalidation to support the care you offer to patients.

Today, an independent review sets out how we can work with the wider healthcare sector to improve revalidation and the processes that contribute to it.

Sir Keith Pearson carried out this important review of revalidation. He has been involved in revalidation since its inception, enabling him to gather practical feedback from a wide range of individuals and organisations involved in the process, as well as being able to analyse the findings of recent research. Find out more about what he found and his recommendations for improvement:

We welcome and strongly support the recommendations in this report. The findings suggest that revalidation is becoming embedded locally and starting to encourage more doctors to reflect on their practice. But revalidation is still a relatively new process and we recognise the difficulties and challenges Sir Keith has identified.

We know that doctors are under increasing amounts of pressure. So it is vital that we all focus on making revalidation and the processes that contribute to it as efficient as possible, while maximising its impact.

Five priorities to improve revalidation – for us and others

We are determined to take forward Sir Keith’s recommendations and we want other organisations to make the same commitment. Many of the areas for improvement, including those that will most benefit doctors, need action at a local level or by organisations other than us. We want to help make this happen, by working collaboratively, offering support and sharing information with all those involved.

These are our five key priorities to improve revalidation:

Reduce unnecessary burdens and bureaucracy for doctors, so there is better balance between reflection, development and compliance with revalidation requirements

This includes:

  • improving how doctors access the information they need for their appraisal. Sir Keith recommends that healthcare organisations should explore ways to make it easier for their doctors to pull together and reflect upon supporting information for their appraisal. Doctors should have access to good data and good IT in the organisations in which they work, and we will urge boards and independent sector providers to make sure these are in place
  • distinguishing local employment requirements from revalidation requirements. Sir Keith heard concerns about doctors being asked to carry out activities that go beyond our requirements, to be revalidated. We agree with Sir Keith’s recommendation that reviewing our guidance on supporting information is a key way to minimise any confusion – we have started working on this and will update the guidance by the end of this year. We also expect royal colleges to make sure their guidance is clear, and employers to clarify their mandatory training requirements and when this is not part of revalidation.

Make revalidation more accessible to patients and the public

This includes:

  • looking at how a real-time approach to patient feedback could give doctors a better-quality picture of their practice. Sir Keith recommends that patient feedback mechanisms should be improved and this is a priority for us – we know that doctors find patient feedback valuable when reflecting on their practice, so they can see this through the eyes of those they care for.

Increase oversight of, and support for, doctors in short-term locum positions

We’ll do this by:

  • working with responsible officers, to make sure doctors in these roles have the information they need to support their appraisal following every placement and that any concerns are raised directly with the doctor’s responsible officer. This follows Sir Keith’s recommendation that we need to work with others to address weaknesses in information sharing, particularly for locum doctors.

Extend the responsible officer model to all doctors who need a UK licence to practise

We’ll do this by:

  • pressing for legislative change with the four health departments across the UK. Sir Keith recommends that all doctors who need a licence to practise in the UK should have a responsible officer and we agree that every doctor should have the same level of support.

Measure and evaluate the impact of revalidation

We’ll do this by:

  • working with others to identify a range of measures that will track the impact of revalidation. We agree with Sir Keith’s advice that it is important to develop quantifiable impact measures for revalidation, to demonstrate how revalidation is improving patient care and safety.

We have started working on some of the improvements that we can deliver and will focus immediately on other priority areas. You can find more details on how we’ll achieve this, including actions we’ll take and what we expect of others, in our response to Sir Keith Pearson’s review of revalidation (pdf).

Comments

56 comments

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Jeremy Bland (8 months ago)

I have practiced my own form of reflection and review for 28 years, ever since being appointed a consultant, each year compiling a summary of activity and clinical outcome measures, mostly of my own devising since the IT support for this kind of exercise was non-existent when I started. I have found this immensely useful and informative and it has led directly to an active research programme trying to address some of the questions thrown up by the process. In contrast, the formal appraisal and revalidation system adds nothing of any value to either myself or my employing trust to this process. The resources currently devoted to appraisal/revalidation would be far better invested in the systematic collection of clinical outcome measures and the investigation of outliers found in that data.

Dr Anonymous (8 months ago)

Appraisal is a total waste of time and effort. I've done 10 over the last 8 years (had to do 2 a year at one point). Learnt nothing. A process designed entirely to keep GP/Public/Government happy. Serves no purpose for the doctor other than wasting their time

Lindsay (8 months ago)

The whole appraisal process is just a way of life for new GP's as we have not known any different. However I see huge flaws in the process - not least the discrimination towards women. I am still required to provide the same number of CPD points for revalidation over a 5 year period as my colleagues despite having 12 months off for maternity leave. Another gaping whole in the process. It infuriates me that my revalidation cannot be put back a year to give me the same advantage as those who have not had time out, instead I have been forced to do 2 appraisals in one year to make up for the 50 points I didn't get whilst I was giving birth and looking after my baby.
This issue alone has made me lose respect for the GMC and Royal college for it's total lack of support for women who take time out for maternity leave.

GMC feedback (8 months ago)

Hi Lindsay - thanks for raising this & sorry for our delayed response.

We'd expect doctors taking maternity leave or having a career break to discuss their circumstances with their appraiser/Responsible Officer. Together, they can then plan the most appropriate & proportionate way to meet the requirements for revalidation and minimise the issues you have raised.

The Royal College of GPs has some helpful advice on this in their ‘myth-buster’ guidance (section 6.11) - http://www.rcgp.org.uk/training-exams/revalidation/new-revalidation-guidance-for-gps.aspx

Doctors don't need to complete a set number of training hours or CPD points to show they've met revalidation requirements. Doctors should discuss with their appraiser what is appropriate to keep up-to-date.

We know we need to make sure everyone is clear on what is a requirement for revalidation. We’re improving our own guidance & will be working with Royal Colleges, ROs & employers to make sure they're clear on this too.

Dr P Gill (8 months ago)

At my last appraisal I was short of the required number of CPD points (50) by about 15. This year I have managed to spend £700 attending a course for 12 CPD points. The trust I work for has a blanket ban on study leave budget, as like many hospitals North Bristol Trust is also bankrupt. So I had to pay for course out of my own pocket, all for the sake of getting bits of paper for an appraisal outcome. Will the GMC and the "great and the good", committees people, pen pushers and desk men/women who came up with all this guff now refund me? The whole process is a bureaucratic wonder, which is interesting considering who came up with this great scheme. People who haven't got a clue about the real world of work in the NHS. It's simply driving REAL doctors in hospital and general practice to early retirement, and you know this to be true but you refuse to accept your failure. You are loosing the very people you need most.

GMC feedback (8 months ago)

Hello Dr Gill,

Thank you for comment - apologies for our delayed response.

Doctors don't need to complete a set number of training hours/CPD points. They should, in discussion with their appraiser, discuss what is most appropriate to keep up-to-date across their whole scope of work.

We recognise from Sir Keith's review that we need to make sure everyone is clear on what is a requirement of revalidation. That's why we're improving our guidance for doctors and will be working with Royal Colleges, Responsible Officers and employers to make sure they're clear on this too.

Dr Rab Khan (8 months ago)

Well...here it is in black and white...a resounding thumbs down for this ludicrous exercise of revalidation and annual licensing. I agree with the sentiments of others here. Is it not time fot this GMC, this organisation that WE pay for, to start listening to US ?? Why doesn't the GMC stop harassing us in this way and actual ask us what WE think? If the comments so far are anything to go by, then the answer is clear...they do not want to hear the truth, because, to purloin a great line, they can't handle the truth. It is burdensome, fruitless, frustrating and nothing more than a monumental waste of time. According to the GMC there are 193,532 licensed doctors with full registration. Let us suppose each one of them spends 30 hours on reflective writing and information gathering (a gross underestimate I know) - then that makes a total of 5,805,960 hours wasted. We don't have a shortage of doctors in the UK - we just don't have enough time to do the work that we dedicated our lives to !

GMC feedback (8 months ago)

Thanks for posting, Dr Khan. Sorry for the delay in getting back to you.

We are conscious of the pressures in the NHS at the moment. However, reflection and appraisal are part of being a professional. Appraisals have been a requirement in the NHS for over 10 years, and revalidation builds on that. It means appraisals follow a consistent structures on a regular basis.

Revalidation is still relatively new, but it is starting to encourage more doctors to reflect on their practice - see p. 26 of Sir Keith's report for evidence of this.

Recent findings from the long-term evaluation of revalidation we commissioned (by UMbRELLA) show that 63% of doctors said they spent the same amount (43%) or less time (20%) preparing for their appraisal since revalidation.

Sir Keith highlights ways this process can be improved and we're committed to working with others to take these forward and make revalidation as efficient as possible.

W Fahrenheit (8 months ago)

Revalidation / Appraisal is a total and utter waste of time. Having gone through a process that is a massive paper chase that takes up hours of valuable time I’ve got nothing at all good to say about it. Pointless outcomes, pointless process. I have spent entire weekends and evenings putting together documents for appraisal because SPA simply doesn't exist due to work pressures. I have also seen appraisal used by appraisers to avoid service work, appraisal and revalidation used as a tool by managers to bully and threaten colleagues preventing them from moving on in their careers. This is a joke the system needs to be scrapped. So well done GMC you have definitely made me want to retire ASAP, my career cut short by 10 years.
No crisis in the NHS, as long as the pointless appraisals get done.

Dr Peter Hilton (8 months ago)

Well ..... nearly 50 negative comments. Since the GMC is so good at sending us emails I openly challenge them to seek the views about revalidation from ALL registered doctors. It would be very easy . Go on .... DO IT !.

GMC feedback (8 months ago)

Dear Dr Hilton,

We agree that it's important to ask doctors about their experiences of revalidation. That's why we asked 150,000 doctors for their views in summer 2015, as part of the long-term evaluation of revalidation we commissioned (by a UK-wide consortium called UMbRELLA).

Emerging findings from the survey were published in an interim report in April 2016 (http://www.gmc-uk.org/news/28650.asp).

In his report, Sir Keith confirms he reviewed the findings of this survey of the profession to develop his recommendations for improvement.

Once the final report is available, UMbRELLA's research will give us independent findings, so we can identify any further changes to make revalidation as efficient as possible.

R Smith (8 months ago)

Can we really justify the 50 million pound expenditure on this ridiculous charade of GP appraisal which every GP I speak to hates with a passion (barring the appraisal team in the Deanery and the appraisers of course)
Why not have a 'light touch' approach to those who do not wish to waste their time waffling with a colleague after spending hours throughout the previous year chasing paper and counting hours. The metrics available now can produce detailed data on prescribing rates, referral rates,complaint rates, and even death rates per Dr in the Practice.
If a doctor is within the 95 percent confident limits on the bell curve for each parameter then he is likely to be doing a safe job and could be excused a face to face appraisal unless he requested one. Those outside the limits would have to have an appraisal in detail. I am approaching my last appraisal prior to early retirement beacause I can stand it no more.

David Mackereth (8 months ago)

We need to get to the heart of the matter.

Either we accept reflective writing and support all that the GMC is trying to do, or we do not. If we do not support reflective writing, which appears to be the one non-negotiable thing in revalidation, we have to aim our fire there.

What is the underlying philosophy of reflective writing? In my opinion it bears a remarkable resemblance to Marxist dialectic.

Dialectic has a process of thesis + antithesis leads to synthesis. For example I see a patient and the patient complains that is the thesis and antithesis. The synthesis is my relfective writing.

Under this system Sir Keith's report is the synthesis. All this very negative refective writing on this page is the antithesis and as someone has pointed out that this may lead to a new organisation that is the synthesis. Perhaps we are all being played? perhaps it does not matter what gets said here as long as it is reflective writing?

I am not a Marxist and I reject dialectic.

Patrick Wilson (8 months ago)

I am a retired GP. I retired almost three years ago when I turned sixty, and yes, I do miss many aspects of General Practice. As I became older, more experienced and maybe a little wiser, I became more empathetic and patient. Heart sinks became patients with problems to be helped, if a patient was rude or demanding then that may have been because the patient was scared.

I was probably a reasonable GP, and, if the number of letters I received when I retired is anything to go by, probably popular. Patients I meet in Sainsbury's still tell me they miss me!

Although my appraisers were all competent and as helpful as the system allowed, I developed an increasing and probably irrational loathing of the appraisal process. It hugely increased my anxiety level. I felt that to sail through appraisals one had to be good at appraisals, I was a doctor for patients and I left the profession because I did not want to face the ordeal of another appraisal and revalidation.

Dr Peter Hilton (8 months ago)

The musical ‘La La Land’ is set to do well at the Oscars. It describes well the situation in my hospital and at the GMC concerning revalidation.

Not one single senior or trainee doctor at my busy regional hospital had anything positive to say about it when I conducted a small survey last year.

It is a massive distraction from delivering patient care in an increasingly chaotic environment. We are now producing Consultants who are vastly less experienced and capable than they used to be. THIS should be the major cause of concern …. not tick boxing those of us who have safely delivered a high standard of care for many, many years. I seriously wonder whether it weeds out problem doctors anyway. Harold Shipman would have flown through the process.

Saleem Althaf (9 months ago)

Having reviewed the GMC response to my original comment (first comment on this topic), my response is poppycock!

The list of people met by Kenneth Pearson is stated in the appendix and just four (4) allegedly independent doctors are named, one (1) of whom is a repeat already named as representing another organisation, Dr Finlay is a peer, Daniel Redfern is appraisal lead and Dean Marshall is GPC revalidation lead.

The word "whistleblowing" does not appear once in the report.

N martin (9 months ago)

I agree with all before. This is a time consuming, costly and unhelpful process that has doen nothing to help patient safety. The majority of doctors think so and have responded as such to this consultation and this report simply whitewashes over this. It is just one more odious and oppressive thing for doctors to do on top of escalalting workloads and huge amount of professional stress. Wake up GMC the biggets risk to patient safety in the UK just now is an incompetent SoS for Health and a Government that refuses to properly fund health and social care. Stop attacking the doctors...the system is falling to pieces.

GMC feedback (8 months ago)

Thank you for your feedback.

On page 8 of Sir Keith's report, he says he reviewed the website comments made on the UMbRELLA interim report on revalidation as part of his review (http://www.gmc-uk.org/publications/29146.asp). His analysis of this feedback is discussed on pages 27-29.

Sir Keith also says he took into account analysis and recommendations in earlier research on revalidation and all the feedback we've received from doctors, including through complaints.

One of our key priorities is to reduce unnecessary bureaucracy for doctors by, for example, making our requirements for revalidation more clear and working with others to improve how doctors access the information they need for their appraisal.

You can find more detail on how we will take action to improve revalidation in our response to Sir Keith's report: http://www.gmc-uk.org/GMC_response_to_Sir_Keith_Pearson_Report.pdf_68909630.pdf

Liaquat Ali (9 months ago)

Appraisal is one of the worst bureaucratic impositions on the medical profession during my 25 years working as a GP. It is one of the reasons that will make me leave the profession much earlier than I planned to. It is nothing more than a paper exercise which takes in excess of 50 PDP hours to complete and another 25-50hrs to write up. Yet the GMC has the aloofness to say that they do not insist on doctors completing 50hrs of PDP as part of the appraisal process (Times Sat 14.1.2017) in response to the BMA defending the doctors opening hours. While the surgery is closed on an afternoon we continue to call the patient’s back who could not get an appointment and do the home visits right up to 6:30pm because we just cannot cope with the influx of patients and workload.
The GMC is out of touch with reality and no longer fit for purpose. The sooner the appraisal system is abolished along with the CQC the better.

Andrew (9 months ago)

I agree with David 2's comment. The appraisal process as it stands reminds me of Philip Zimbardo's 1971 Stanford Prison experiment. Our appraiser colleagues are 'only doing their job' in signing up to take on their role of the guards, but can't really see that inmates are sick of the experiment and are making the decision to escape from the prison...

Karen Trewinnard (9 months ago)

Yes extending the provision of Responsible Officer and making requirements for all doctors the same is essential. For many independent doctors like myself delivering training within GP as a non GP, not working for locum agency and not on the performers list getting a suitable person proved elusive. The direct route for me was impossible as the only appropriate exam (MFRSH) I could take is prohibited for me as an MSFRH examiner. (I am An FSRH Trainer, examiner and work as independent provider of CSRH in GP)

GMC feedback (8 months ago)

Thanks for your feedback on this. We are committed to working with others to take action in response to Sir Keith's report as swiftly as possible. We want to make sure the process if more efficient for all doctors.

J W Sebastian Kraemer (9 months ago)

There is a terrible irony in all this; even tragic in that the most dangerous doctors will probably tick all the boxes. I'd urge the GMC seriously to explore methods of peer review, which could be the least worst way of identifying practitioners at risk. Of course it needs protecting from the witch-hunt/lynch mob mentality that some awkward but competent doctors evince in others, but it should be possible to pilot confidential group discussions across trusts (so not everyone knows each other) in which each doctor has to present vignettes of their clinical (or teaching) work and listen to commentary on it, without getting into inquisitiorial discussion. This is a modification of Balint group discussions, where the presenter withdraws and listen to what colleagues have to say. Consult the people (outside the NHS) who have been working with group process for 70 years: the Tavistock Institute of Human Relations

GMC feedback (8 months ago)

Thank you for your suggestions, Dr Kraemer.

Doctors can take part in case review discussions with a peer, another specialist or within a multi-disciplinary team as part of their quality improvement activity for revalidation (see p. 7 of our 'supporting information for appraisal and revalidation' - http://www.gmc-uk.org/doctors/revalidation/revalidation_information.asp).

Sir Keith's report touches on the effectiveness of existing approaches to colleague feedback (paras 154-156) and suggests this feedback sometimes lacks objectivity. We welcome his suggestion - and yours - that we could learn from other sectors and we will explore this as we develop our plans to improve revalidation.

thomas (9 months ago)

I think the appraisal process and set up for revalidation is a time consuming, complicated, odious process which has more holes in it than net stockings. I echo the comments of others that it is the single greatest thing driving me towards the exit door in terms of early retirement (i'm in my 50's), It is a major source of stress for me and blights my year. the process is neither meaningful nor manageable. i've had several appraisals now and not one of them has been of any use to me. They're tick box exercises and i feel none of the appraisers i've had so far have been able to help me manage my cynicism and negative feelings about the process. i agree that my attitude is not a good one but i feel the processes have been foisted on me and with little help or support to make it work for me. i think these processes have been very badly sold to the profession. Why is it that so many doctors have such antipathy to this. i don't believe the public can be reassured as things stand.

GMC feedback (8 months ago)

Thanks for you feedback, Thomas. We are committed to taking action in response to Sir Keith's report, which includes reducing unnecessary bureaucracy and better supporting doctors.

As part of this effort, we will make our revalidation requirements more clear and work with others to improve the systems doctors use to access the information they need for their appraisal. There's more detail on how we'll take action in our response to Sir Keith's review: http://www.gmc-uk.org/GMC_response_to_Sir_Keith_Pearson_Report.pdf_68909630.pdf

We want to make sure that revalidation and the processes that contribute to it are as efficient as possible.

R Battersby (9 months ago)

I can appreciate the mainly negative and angry comments, particularly from those in part time posts and nearing retirement. I retired early along with several other senior and experienced Consultants and don't regret leaving the NHS, which sadly has continued it's decline in many aspects. My former colleagues are counting the days. How sad to see this change. The GMC must recognize that to maintain morale doctors must be better supported. I continue with revalidation and appraisal knowing that it is a "paper" exercise with no appreciable benefit to myself or patients.

But there are more important questions than revalidation for the GMC to urgently address:

Why do medical schools persist in admitting those who may not be temperamentally suited to medicine as evidenced by the very high attrition rates?

What steps are being taken to retain experienced doctors as in other countries? They probably make more effective and cheaper management decisions than those with less expe

D Thapar (9 months ago)

Every colleague that I have spoken to has expressed negative comments about the revaluation process, as reflected here. Unfortunately, without any clear evidence, GMC will continue to practice an ever increasing scrutiny on us in addition to the government's extreme negative attitude towards our profession! We are spending more time and money in this exercise on top of increasing workload and salary reduction.

GMC feedback (8 months ago)

Thanks for your comments, Dr Thapar. As we say in our response to Sir Keith's report, we agree there needs to be clear evidence of the impact of revalidation. That's why we commissioned an independent long-term study of it, which included a survey of 150,000 doctors in summer 2015 (by research group UMbRELLA).

We are conscious of the pressures in the NHS, as shown by our recent publications, which have pointed to a 'state of unease' among doctors and stressed the importance of giving doctors in training the time and space to learn (see http://www.gmc-uk.org/news/27482.asp and http://www.gmc-uk.org/news/29298.asp).

However, reflection and appraisal are part of being a professional. Appraisals have been a requirement in the NHS for over 10 years - revalidation builds on that.

We're committed to working with others to learn from Sir Keith's report and the UMbRELLA study to make revalidation - and related processes - as efficient as possible.

D Thapar (9 months ago)

Every colleague I have spoken to has expressed very negative views about the revalidation process and this is reflected in all the comments made here. Unfortunately, without evidence, the ever increasing scrutiny from GMC is going to continue!

Isaac Koffman (9 months ago)

I have not met a single colleague with anything positive to say about revalidation.

Revalidation has had ZERO effect on improving clinical standards. Plenty of deficienct doctors sail right through it.

The UK medical workforce is in a state of crisis and low morale due to many different factors and the GMC is guilty of being the cause of one(revalidation).

How is this man independent? He was "involved in revalidation from its inception" and has a huge interest in portraying it in a positive light, I'm sure he foolishly reported it to be a great idea at its inception too.

Lastly, the GMC needs to remember that oppressive behaviour gives birth to revolutions and it is not too outlandish to envisage a new regulatory body being setup by the membership and the achievement of legislation to give it licensing powers.

Jason Heath (9 months ago)

As a GP with 20 years experience including as trainer, med school tutor & full time principal, I resigned last year from appraising. I went into appraising when it began because I thought it would be supportive formative encouraging & 'praising' of our hard working frequently under appreciated & under valued workforce. As revalidation took over I became increasing disillusioned, and one too many finger wagging sessions at the (unpaid) appraisers learning sets about how to tick the revalidation boxes right convinced me it was no longer really what we had hoped it could be.
It is interesting and telling now that little use is made of the appraisal word in the report summary indicating to me that the original inception of appraisal has really been corrupted into a largely tick box revaludation tool. With so many of us disillusioned & eying early retirement there has never been a greater need for the true core values of appraisal as it started. We have had enough 'resilience' training.

Sheena (SP yesterday) (9 months ago)

Have now read the full report and watched Hospital on catchup tv. Do you not realise these senior difficult doctors "we all know who they are" who are choosing to relinquish their licence rather than revalidate, are not the risk to patient safety implied by Sir Keith, but the guardians of patient safety- the whistleblowers- who have given up because being liked by your colleagues is now more important than standing up for patient safety by speaking out when things are going pearshaped?

Dan Williams MSc FRCS (9 months ago)

Five priorities are good; move quickly by making use of existing data / companies. Real time patient feedback available through www.iwantgreatcare.org and links well to personal website e.g. www.danhwilliams.com. Please continue to iterate the revalidation programme.

GMC feedback (8 months ago)

Thanks for your comments, Dan. We will work with others to take action in response to Sir Keith's report as quickly as possible. We're keen to make sure revalidation is a more efficient process for all doctors.

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