Features: On revalidation: implementation and pilots
29 March 2010
As part of our revalidation special, we hear from doctors in practice on what revalidation means to them and their experiences so far.
- Dr Hamish Meldrum, Chairman of Council, BMA
- Dr Anne Kilgallen, Medical Director, Western Health and Social Care Trust
- Dr Andy Theobald, Buckinghamshire PCT
- Professor Rajan Madhok, Chairman BAPIO, GMC Council Member and Medical Director, Manchester
- PCTComment: Jeremy Taylor, Chief Executive, National Voices
- Dr Sarada Kodali, Locum Consultant Psychiatrist
Dr Hamish Meldrum, Chairman of Council, BMA
Revalidation will impact on every single licensed doctor, regardless of their branch of practice or stage in career. Progress is being made in firming up how revalidation may work in practice, and the GMC’s consultation, and the opportunity for stakeholders and members of the profession to feed into this process is an important milestone.
Challenges abound in trying to construct a system of revalidation that is fair, transparent, and avoids excessive bureaucracy, and many questions remain to be answered. One thing that is clear to me, however, is that the confidence of the profession is crucial to the success of any system that is introduced. The GMC’s consultation is your opportunity to help to shape what the new system will look like and how it is implemented.
Revalidation will have to contend with the everyday pressures of the working lives of doctors, and so I urge you to read the consultation document and feed in your views in order to help us achieve a system that is fair, practical and achievable.
Dr Anne Kilgallen, Medical Director, Western Health and Social Care Trust
As a group, the Medical Directors in Northern Ireland tested the standards that need to be incorporated into appraisal. I acted as liaison for the GMC within the Western Trust and my role was to ensure clinicians were aware of the testing phase. We had two teams of doctors taking part ensuring quite a diverse range of feedback and with geographical spread across the organisation.
The main concern was whether we have adequate routine information sources and that is what the pilot was designed to test. I think it is a very rational framework. It does not require us to develop new information sources apart from the introduction of a validated multi-source feedback tool.
We recognise we will need to improve the administrative infrastructure to support our doctors more proactively. It is not a large leap although some development work needs to be done.
If revalidation is to be of benefit then it must provide a means by which doctors can record evidence that they are maintaining high professional standards. I believe the pilots have demonstrated that we are better prepared than we anticipated.
Dr Andy Theobald, Buckinghamshire PCT
Our recent pilot project sought to understand the quantity and quality of information that GPs currently bring to their appraisals and how this could be improved. As a group of GPs who are appraisers we were keen to introduce more rigour into the quality assurance of the appraisals we undertake.
What makes the appraisals work for us is the fact that they are peer led. As appraisers, we understand the job we are appraising. It is also important that revalidation will be based on taking five years as a whole rather than just a one-off assessment. That’s why a five-year revalidation process is good for patients and good for doctors.
For all but a minute proportion of doctors the new system should be nothing to worry about. And if a problem is identified by the process, hopefully it should be dealt with at an early stage.
Professor Rajan Madhok, Chairman BAPIO, GMC Council Member and Medical Director, Manchester PCT
One of my central concerns as Chairman of the British Association of Physicians of Indian Origin is to ensure that there is no discrimination against Indian (and all international) doctors within the NHS. From the outset therefore it is essential that the principles of equality are built into the process of revalidation. I believe that black and minority ethnic doctors have everything to gain and nothing to lose through the successful implementation of revalidation, as it should act as the catalyst to resolve some of the long-standing problems faced by BME doctors.
But this will only happen if we take the opportunity to help shape the process. That means responding to the GMC’s consultation and pressing for local systems of appraisal and clinical governance that are not only free from discrimination but also support doctors when they face difficulties. If we achieve that, revalidation will not be something to fear but a long-overdue opportunity for change and improvement.
Jeremy Taylor, Chief Executive, National Voices
From a patient perspective, revalidation is good news. It will strengthen the assurance that doctors are safe, effective and up to date in their practice. Patient feedback will be central to the process and we need to find ways of ensuring that people can praise what is good as well as voice concerns so that a balanced picture emerges.
Revalidation needs to reinforce standards of good practice that are meaningful to patients. Doctors need to be excellent technicians, but also ‘people’ people and team workers. They need to be able to share information, and involve people fully in medical decisions, particularly the growing number of people with long-term conditions, who account for the largest part of NHS spending.
Overall, there are high levels of satisfaction with doctors. The extra public accountability may feel scary for some, but there is no reason for the profession to be defensive. In other walks of life, regular appraisal of performance is routine. Besides, the NHS needs to get better at learning from patient experience and opinion, not only to stamp out poor practice but to reward, recognise and spread good practice. Revalidation could prove to be an exemplar in how this is done.
Dr Sarada Kodali, Locum Consultant Psychiatrist
My involvement in revalidation has been to take part in a pilot held in Sheffield to assist NHS Professionals in preparing its doctors for revalidation. We also wanted to develop an appraisal system for locum doctors.
Our focus was on the appraisee and how revalidation would work for locum doctors, looking at what time, training, supervision, support and guidance would be needed. We looked at the timescales involved and the practicalities of both parties – appraisee and appraiser – within the same specialty getting together for the appraisal.
The pilot showed that it will be crucial to build in flexibility for locum doctors and that patience, understanding and communication will be key to making it a success. I would advise that if you are not clear about anything to seek advice and make sure you know what information you need to collect or acquire for your annual appraisal.