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Furious GPC negotiator predicts revalidation 'revolt' as GPs spend more than 40 hours preparing for appraisals

The GPC has warned GPs are now routinely spending more than 40 hours preparing for appraisals, with one negotiator launching an outspoken attack on revalidation ‘overkill’ and calling for the wider BMA to ‘get some balls’ in dealing with the controversial process.

Dr Peter Holden, a veteran GPC negotiator and GP in Matlock, Derbyshire, told Pulse he could ‘see a revolt coming’ over the ‘introspective’ process, in the strongest criticism from GP leaders since revalidation got underway a year ago.

The BMA has always supported the process in principle, while expressing concern about elements of the implementation before, such as NHS England’s threat to remove funding for remediation.

Dr Holden told Pulse the BMA’s support for revalidation may need to be reviewed following reports that some doctors are spending more than 40 hours on the annual appraisal process since revalidation was introduced – five times longer than the ‘one working day’ specified in the 2004 GP contract.

He said: ‘In the 2004 contract, where we agreed to annual appraisals, it was supposed to take one day and that’s eight hours. But they keep expanding the remit, and it’s become an industry. And some of us feel that we wouldn’t mind if [the Government was] honest - it doesn’t take eight hours, it takes a week.’

Dr Holden added that his own and his colleagues’ experience of the process was a negative one. He said: ‘A quick straw poll amongst my colleagues this afternoon… we all reckoned it had taken 40 hours.’

He said revalidation now amounted to GPs being guilty until proven innocent, and said GPs were ‘sick and tired of having to prove to the authorities that we’re OK’.

‘Everybody knows you have to collect evidence in all six areas; some people would say you do it as you go along. But actually there’s an awful lot of what we do that counts towards it, and you don’t necessarily collect it as you go along, they also want you to reflect on every one.’

Dr Holden added: ‘A lot of us are getting sick of justifying every breath we take and categorising every motion we pass. This is all introspective crap, at a time when we’re under immense pressure. A lot of us feel this is becoming overkill.’

‘The BMA needs to get some balls over this - we’ve been too willing to fall over,’ he said. ‘We’ve been too willing to be blackened by the spectre of [Harold] Shipman.’

‘A lot of us resent the fact that we pay for the GMC, when in fact it is nothing more than the Government’s poodle. And I can see a revolt coming.’

The GPC itself remains in support of the concept of revalidation. But Dr Dean Marshall, the GPC’s lead on revalidation issues, said that there were mounting concerns over its implementation.

He said: ‘As lead for the UK, we get fed in lots of reports from doctors who are very unhappy with the process. Reports over 40 hours, I’ve certainly heard that. And what was once a day to prepare is now significantly eating into people’s personal time.’

‘I was having a conversation with my partners, a locum and one my sessional GPs this morning, saying exactly the same thing. That the process has taken over completely with no real evidence of any benefit to patients or doctors.’

Dr Marshall also warned against revalidation being used as a tool to performance manage GPs: ‘Unfortunately not being revalidated is frequently used as a threat, that you have to do this, or you have to do that to be revalidated. And either that’s completely wrong or really it’s a misunderstanding – accidental or deliberate – of the process.’

Dr Nigel Sparrow, the medical director for revalidation at the RCGP, and both a practicing GP and appraiser said they aimed to make the process straightforward for all GPs ‘regardless of working circumstances’.

He told Pulse: ‘We have just published version 8 of the RCGP Guide to Revalidation which has many changes to reflect the different roles and working circumstances of GPs. We have given guidance for collecting supporting information which should not be onerous particularly if collected throughout the year.

 

 

Readers' comments (78)

  • The GMC needs to hammer the more "adventurous" ATs with their managerial demands dressed up as revalidation requirements

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  • Thank you Dr Holden, that was very well said.
    I for one entirely agree and you have my vote.
    We need someone to stand up for grassroot GPs -as the article suggests, there may not be many left for too much longer, if current demands and Dr bashing continue.
    BTW it's difficult for grassroot GPs to understand -- even in the current economic conditions, no new money etc -- given the dearth of doctors entering general practice, does that not give us a stronger hand in negotiations to try and obtain a sustainable contract that will take general practice forward?
    Surely, as striking is not an option, other options should be weighed up with regard to what the profession and GPC can do to protest meaningfully, if we keep being handed unacceptable contracts by the government?

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  • Revalidation is going to leave a toxic legacy of mistrust between GPs and the GMC. It gobbles up precious resources in a time of scarcity and hurts patients whose GPs are no too busy form filling to look after them properly. There has been very little concern about the real world consequences of wasting doctors time, the patients who may not be attended to and the delay in completing more pressing tasks such as referrals for serious conditions however, I'm sure the evidence would not be hard to find. If such hare-brained schemes are the raison d'etre of the GMC one has to wonder if it's fit for purpose. It's now time for the profession to hold the architects of this disaster accountable for the time and money they are wasting.

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  • Well said Dr Holden that reflects my views entirely. Those of us in the older generation of GPs find the process demeaning and unprofessional. The BMA has been extremely weak on this and should be prepared to order all GPs not to engage with the process unless it is renegotiated satisfactorily.

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  • Don't do this work in your own time.

    We have allocated time off to prepare for appraisal and revalidation.

    It is the patients that miss out due to cancelled surgeries. A recent revalidation in our practice meant 50 appointments were lost for that doctor.

    A shame.

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  • Una Coales

    Good man Dr Peter Holden. I echo your views on the GMC and revalidation.

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  • Excellent set of comments - and pretty much what every grass roots GP is thinking.

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  • The truth is the process is more onerous than actually doing the studying. The reflection is inappropriate in alot of the process. We are so busy that you have to be part time on paper but spend a day a week doing appraisal. Alternatively GPs leave it untill nr appraisal and then spend a weeks holiday putting their plp on order.
    Ive been qualified over 39 years and its funny how i kept up to date prior to this rubbish

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  • I think it all depends on using the right tools in preparing for your appraisal. Ever since our PCO has moved to using GPTools.org, not only have they saved over £100K+ but the time we spend in recording evidence and reflecting upon it has been drastically cut. I can even send web articles I've read directly into my appraisal using the tool they provide. Actually makes revalidation ready appraisals easier than the old style ones we used to do.

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  • Revalidation was the principal reason why I retired from medical practice so I could tell the GMC that they were merely a branch of the Department of Health.

    Revalidation is not fit for purpose.

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  • I have been revalidated. I foundit immensley stressful amd lost sleep over it. It took me considerably longer than 40 hours to input the data and ten to reflect on absolutely everything. My appraiser was sympathetic and kind but had fully bought into the monstrous nonsense of a system which is not fit for purpose.
    I do nknow and acknowledge that some GPs particualrly salaried doctors find it helphul and in principle I am in accord with the need for it, but it needs serious redesign.

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  • I would say 40 hours is a low estimate.Attending courses ,travel,refection ,sat at a computer imputing it all etc I would estimate 150 hours per year.
    I have been revalidated and found it a mere tick-box exercise.

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  • Ironically the more involved you are in your work as a GP, the more evidence you have to collect and record, and the longer it takes, with no limits. If it the preparation is meant to take 8 hours only then this should be made clear and only a summary with limited examples and outlines of your work should be needed .

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  • Appraisal and revalidation seems to have been hyped up into a mini industry, with courses on how to do it etc, often run by the out-of-touch/unrealistic academic types who run the appraisals system. Some appraisers seem to expect an increasingly high totally inappropriate standard of documentation and ‘threaten’ that although borderline acceptable for appraisal, the work done would not be adequate for revalidation. Thus, due to that fear, the standard achieved tends to increase amongst the pool of GPs such that those doing the perfectly adequate minimum required, as originally intended, are regarded as having not done enough.
    The attitude of some appraisers makes me think about the Stanford Prison Experiment in the early 1970s and is a cause for concern.

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  • Appraisers? Didn't realize they still existed. They all seems to have all turned into inquisitioners where I work......

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  • Yes appraisal/revalidation has become an industry.. it will cost me £2,000..plus the time.. And new add-on are on their way, like free post envelopes for patients, multiple paying propositions for CDP..
    All that because a mad Dr (Dr Shipman) killed his patients? I have read about an pilot experimentation from the NHS (Daily Mail one month ago) that if a GP put on a special list the patients who are expected to died during the year, to avoid unnecessary not cost effective hospitalisations, they would get £50/per patient if that patient died effectively during the year!!! Is it true?? Who invent such inepties!!!
    Do you think Dr Shipman would have been revalidated???

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  • Sorry we are already almost through the first year of revalidation
    Shouldn't the GPC been saying these things about appraisal/revalidation some time ago?

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  • Appraisal is a daft game . It does not determine whether someone can do the job of a gp . Using the same principle of appraisal I could see Ian Broomfield the Leeds Utd scout say I've watched loads of football , reflected on it ad nauseam (according to the wife ) and could you please put me upfront this Saturday . I promise I'll score goals . Being a traditional soul Mr Broomfield would like to see me kick a ball about before making a commitment . This should be applied to appraisal. Get another gp to watch us doing a surgery . All done in 4 hours .

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  • I agree with Peter Holden and Jobbing Doctor. Do members of the GMC undergo revalidation by anyone?
    Disillusionment is setting in.

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  • i'veseen Ian Broomfield play up front and he was crap.He played a few games for Bristol City in the early 70's

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