Designing revalidation processes using lay expertise: Nottingham University Hospitals MARAG

How are lay people involved in local revalidation processes?

Nottingham University Hospitals Trust (NUHT) has had a lay member on its Medical Appraisal and Revalidation Advisory Group (MARAG) since it began in 2012.

MARAG maintains and develops the trust’s medical appraisal and revalidation policies and processes. It is directly accountable to the responsible officer.

Using a job description (see sample below) and person specification, the lay member role was advertised in the trust’s ebulletin, which reaches over 7,000 member of the public.

The role of the lay member is not to represent any particular group of patients. It is a three-year fixed term position, and is unpaid except for expenses. They have two main aspects to their role:

  • membership of MARAG: making sure that NUHT medical appraisal and revalidation processes are informed by the perspectives of patients and public, and are focused on improving the quality and safety of care and increasing public trust
  • membership of interview panels appointing new specialty lead appraisers when needed.

Alongside the lay representative, MARAG’s membership includes specialty lead appraisers, clinical academics, heads of service, SAS doctors and a representative of the Local Negotiating Committee.

What are the benefits?

Dr Carol Roberts, Community Paediatrician at the Trust and Chair of MARAG
Because revalidation is about raising public confidence in doctors, it seemed appropriate to include a lay member in designing and reviewing our systems from the start.
Our current lay member has very useful expertise in areas like appraisal, performance management and multi-source feedback. He brings a completely different perspective and keeps us focused on outcomes.
In particular, he reminds us not to get bogged down in processes and to make sure we try to answer the ‘so what?’ question – in other words, what are doctors and patients getting from appraisal and revalidation?
Malcom Ginever, lay member
Despite having a longstanding interest and involvement in healthcare, I didn’t know anything about medical revalidation before taking this role.
The process is quite complex. I was tentative at first but am now treated as an equal by the other group members. I enjoy the meetings and get a lot out of them. I also talk about and promote revalidation in other environments, including the local voluntary sector roles I hold.
I act as a kind of ‘conscience’ for the group. I can ask questions that may seem naïve but actually open up a useful debate and reveal things that might not otherwise have come to light.
I recognise it may be too early to know what has been the impact of revalidation but it is not too soon to ask how we would go about measuring this.

Making it work at your organisation

  • Use a formal recruitment process to get a lay member who brings expertise and insight, and can represent the perspective of patients.
  • Protect confidential discussions by holding meetings in two parts. At MARAG, the first part of the meeting involves the lay member and considers policy and evaluation, quality assurance of appraisal summaries, and reviews policy compliance. Confidential matters involving individual doctors are discussed in the second part, which is not attended by the lay member. 

Sample job description