Guidance on supporting information for revalidation

Patient feedback (or feedback from those you provide medical services to)

The purpose of gathering and reflecting on this feedback

  • As a doctor, AA or PA you have a professional duty to listen to patients, recognising their knowledge and experience of their health, and acknowledging their concerns12
  • Reflecting on feedback from your patients, or those you provide medical services to, will 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.

Our requirements

  1. At least once in each revalidation cycle you must collect and reflect on feedback from patients, collected using a formal solicited13 feedback exercise. 
  2. You should also reflect on any other relevant, available, informal and/or unsolicited14 patient feedback at each annual appraisal.
  3. 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, suitable person or AA/PA recommender that you do not need to.
  4. Feedback you reflect on should be collected in a way that is appropriate for your patients and the context in which you work.
  5. You should reflect on patient feedback that covers your whole scope of practice across each revalidation cycle. In your appraisal discussion, consider the context of your work and whether this is likely to have influenced the content of feedback you received.  
  6. 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. Reflecting on the information close to the time it’s collected means that it’s more likely to remain relevant to your practice and allow you to identify actions to help your professional development.

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

Principle 1:  You should consider which mechanism or tool for collecting formal feedback once a cycle would be most appropriate for your patients, and your scope of practice.

  1. A structured questionnaire, may be a suitable formal feedback mechanism. Other approaches could include: structured interviews, focus groups, formal comment cards or a digital feedback tool like an app.
  2. You should be supported in collecting patient feedback by the organisations where you work, or your designated body. They should provide, or advise you on, mechanisms you can use to seek feedback, and provide access to any relevant feedback collected centrally. You may want to consider using a specialty-specific questionnaire to gather feedback. If you are unsure how to collect formal patient feedback, check local appraisal guidance and discuss with your appraiser and responsible officer, suitable person or AA/PA recommender.
  3. If you work in settings that do not have systems in place, or you do not work in any one setting on a regular basis, you should not collect or collate responses yourself, or ask your responsible officer, suitable person, AA/PA recommender or appraiser to do this.  To obtain patient feedback you should:
    • use an independent provider to process your feedback and give you an anonymised report of your results
    • minimise bias in the selection of patients asked to take part. For example, by asking a colleague to approach a number of consecutive patients, or a random sample.
    • consider whether there are any settings where you have a more established working relationship, where support staff might be willing to help.
  4. Processes you use to obtain formal patient feedback should be robust, fair and help you to reflect on your practice. Your responsible officer, suitable person, or AA/PA recommender must be satisfied that any process you have used to obtain formal patient feedback meets the requirements and principles of this guidance, and that it is sufficient to enable you to reflect on and discuss it at appraisal.
  5. Questions could be based on relevant duties and principles in Good medical practice such as those under Domain 2. Patients, partnership and communication. The questions should help you to identify what you do well and where you could make improvements.

Principle 2: Patient feedback should be from your whole scope of practice across your revalidation cycle, and must be sufficient to allow you to effectively reflect on your practice.

  1. Your approach should be proportionate to the nature of your work and the number of patients you see, and not unduly burdensome. You do not need to obtain patient feedback using a formal exercise for each role you hold. In planning when you will collect patient feedback, you should consider the time it will take for you to reflect on and discuss your patient feedback at appraisal. This will help to ensure that you can meet the requirement to collect and reflect on formal patient feedback once a cycle.
  2. Focus on the quality of the feedback, how meaningful it is and what it tells you about your practice. A feedback tool might recommend that you achieve a certain number of responses to get a reliable picture of your practice. You might need to adapt the way you collect feedback to get a good number of responses from a representative sample of patients. For example, by considering the most appropriate time to ask for their feedback, and/or by collecting feedback at a number of different settings if your work is varied. 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. 
  3. Unsolicited feedback might include cards and letters, digital patient feedback, or feedback on your team or the service you provide. What doctors, AAs and PAs can reflect on will depend on their role and what they can access.
  4. If you do not have patients, or where it would be inappropriate to collect patient feedback for a particular role, or aspect of a role, that you undertake, 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, customers or clients, suppliers, those who rely on your expert opinion, or others that you provide services to as a doctor, AA or PA.   
  5. Where it is difficult to obtain the recommended number of responses, where you are considering alternatives to patient feedback, or where no such feedback is available, you should discuss and agree this with your responsible officer, suitable person, AA/PA recommender 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 give formal feedback in a way that meets their needs, and to give unsolicited feedback when they have something to say.

  1. Patients should be offered a way to give feedback that meets their needs, to ensure the process is accessible. You might need to offer support, or a questionnaire in an appropriate and accessible format, for example where patients have a learning disability, or are children. You can also adapt your approach, if needed, so that you get responses from patients who you only see once.
  2. 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 law15
  3. If your patients cannot give feedback themselves, even with adjustments to the process, you should seek it 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. If patients (or their families or carers) are too distressed to be asked for feedback, use your judgement to decide whether you could ask later and consider when would be the most appropriate time.
  4. 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.

  1. 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.
  2. It is good practice to tell patients about changes made based on 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.

12 Gmp 2024 para 23(b)
13 Feedback that patients are asked to give.
14 Feedback that is unplanned and given at any time.
15 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.