Guidance on supporting information for appraisal and revalidation

Your supporting information – feedback from patients or those you provide medical services to

The purpose of gathering and reflecting on this feedback

Doctors have a professional duty, set out in Good medical practice to: ‘listen to patients, take account of their views, and respond honestly to their questions.’ (Paragraph 31).

The purpose of reflecting on feedback from your patients is to help you to understand their experience of your practice. Patients have a unique perspective and their feedback can help you to identify areas of strength or opportunities for improvement. It can help you develop greater insight and self-awareness and challenge assumptions.

The GMC’s requirements

  • At least once in each revalidation cycle you must reflect on feedback from patients, collected using a formal feedback exercise.

  • If you do not have patients you should reflect on feedback from others you provide medical services to. If you can’t collect such feedback, you must agree with your responsible officer that you do not need to.

  •  Feedback you reflect on should be collected in a way that is appropriate for your patients and the context in which you work.

  • At each appraisal you should reflect on any other sources of patient feedback you can access, that give you helpful information about your practice (such as unsolicited feedback).*

  • You should reflect on patient feedback that covers your whole scope of practice across each revalidation cycle.

  • You must reflect on feedback and if appropriate, act on it in a timely manner and discuss how it has informed your practice at your appraisal. 

*We’re encouraging doctors to reflect on existing sources of patient feedback, such as letters, cards or team feedback at each appraisal to support their professional development, but this isn’t mandatory. We recognise that what doctors can reflect on will depend on their role and what they can access.

Principles for collecting and reflecting on patient feedback and how to apply them

Principle 1: You must collect and reflect on feedback from your patients (or where appropriate their family or carers) 7 and discuss your reflections at your appraisal, to help you to:

a. understand your patients’ experience of the care they receive and your work as a doctor
b. demonstrate you are taking account of your patients’ views in developing your practice
c. identify areas of strength to build on or maintain, and any changes you can make to improve your practice
d. review whether any changes you have made in response to earlier feedback have had a positive impact.

69 At least once in each revalidation cycle you must reflect on feedback from patients that has been collected using a formal feedback exercise

70 When deciding how to do this you should consider which mechanism or tool would be most appropriate for your patients, and what would give you meaningful information about your practice. A structured questionnaire (e.g. friends and family test), may be suitable, however you may take another approach if it better suits the context of your work and/or your patients’ needs. Other approaches could include: structured interviews, focus groups, formal comment cards or a remote feedback tool like an app. You can find more information in our supplementary Guidance on developing and implementing formal patient feedback tools

71 At each appraisal you should also reflect on any sources of patient feedback you can access that give you helpful information about your practice, such as unsolicited feedback (for example, cards and letters), or feedback on your team or the service you provide. 

72 Organisations where you work, or your designated body, should support you by providing or advising on mechanisms you can use to seek feedback, and by providing access to any relevant feedback collected centrally. If you are unsure how to collect patient feedback, check local appraisal guidance and discuss with your appraiser and responsible officer. If you work in settings that do not have systems in place, you may need to identify how to obtain patient feedback (for example through an independent provider).

73 Processes you use to obtain formal patient feedback should be robust, fair and help you to reflect on your practice. Responsible officers may decide to accept formal patient feedback obtained using a mechanism that doesn’t meet all the criteria outlined in our supplementary guidance, if they are satisfied it is robust enough to enable you to reflect on and discuss at appraisal.

74 Patient feedback should help you to identify what you do well and where you could make improvements. Questions that patients are asked could be based on relevant domains in Good medical practice (as appropriate for your patients and the method used), such as: Domain 3. Communication, partnership and teamwork – how well your patients felt that you listened to them.

75 Our patient feedback case studies may help you decide how best to seek feedback in roles where it can be challenging such as roles with little patient contact or where patients find it hard to respond.

Principle 2: Patient feedback

a. should be from across your whole scope of practice across your revalidation cycle

b. must be sufficient to allow you to effectively reflect on your practice.

76 You should reflect on feedback from your whole scope of practice across each revalidation cycle. Your approach should be proportionate to the nature of your work and the number of patients you see, and not unduly burdensome (for example, you do not need to obtain patient feedback using a formal exercise for each role you hold).

77 Focus on the quality of the feedback, how meaningful it is and what it tells you about your practice. A tool you use to seek feedback might recommend that you achieve a certain number of responses to get a reliable picture of your practice. However, if it’s not possible to achieve these numbers in your circumstances, the feedback can still give you valuable information to reflect on, especially free text comments. If your circumstances make it difficult to obtain the recommended number of responses, discuss this with your appraiser and responsible officer.

78 Your approach over the revalidation cycle should include reflection on both solicited feedback (that patients are asked to give), and any unsolicited feedback (unplanned and given at any time), that you receive.

79 If you do not have patients, it is still important you reflect on feedback from those you interact with on a professional basis. Depending on the nature of your practice this could include individuals, such as students, clients or those who rely on your expert opinion. Where no such feedback is available discuss and agree this with your responsible officer, suitable person or appraiser. Clearly explain any issues that may affect your ability to reflect on this type of feedback including, for example:

  • an overlap with those providing colleague feedback
  • conflicts of interest when asking certain individuals for their feedback.

Principle 3: Patients should be able to:

  1. give formal feedback in a way that meets their needs
  2. give unsolicited feedback when they have something to say.

80 Patients should be offered a way to give feedback that meets their needs, to ensure the process is accessible. For example, you might need to offer some patients support to give their feedback, or a questionnaire in an appropriate format, such as in another language or in easy read. Being able to offer patients different ways to give feedback may depend on the appraisal and revalidation policies where you work. We would expect the approach to be proportionate in terms of the time and resource required. You must make reasonable adjustments for disabled patients, as required under equality law(8)

81 If your patients cannot give feedback themselves, even with adjustments to the process, you should seek feedback from those who can give you meaningful feedback from the patient’s perspective. For example, patients’ relatives, carers or advocates. Professional judgement should be used to decide whether it is appropriate to ask patients or their representatives for feedback, for example, in a particularly sensitive situation.

82 Those who give their feedback should be broadly representative of your patient population.

Principle 4

Patients should be informed of the purpose of the feedback and what it will be used for.

83 Patients should be told; how they can give feedback, what the feedback will be used for, that the feedback will be confidential or anonymous, and that they do not have to take part.

84 It is good practice to tell patients about changes made in light of feedback from patients. This will help them understand the value of giving their feedback, and encourage them to take part. This could be done at an individual, team or service level.

Principle 5

You should reflect and, if appropriate, act on the feedback in a timely manner.

85 Reflecting on feedback close to the time when it’s given means results are more likely to remain relevant to your practice and allow you to identify actions to help your professional development. It may also allow you to identify opportunities to improve the quality of care in organisations where you work. 

86 Your reflection can be across several pieces or types of supporting information and further explored through the discussion at your appraisal, which is documented in the appraisal summary.

87 At appraisal focus on how the feedback informed your practice, whether the changes you made have helped your professional development, and if there are any further steps to take to develop your practice. 

(7) Or if you don’t have any patients, others you provide medical services to (see paragraph 79).

(8) There is a legal duty under the Equality Act 2010 (and associated requirements in Northern Ireland) to make reasonable adjustments for disabled people, to ensure they are not disadvantaged compared with non-disabled people.