This site is intended for health professionals only

At the heart of general practice since 1960

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)

  • I will begin by confessing that I'm no longer a Proper Doctor. I left General Practice 14 years ago and have worked part time in Occupational health since. I now derive a modest income by working from home examining motorsport competitors and doing DVLA drivers medicals. I have just been informed by the GMC that I will need a licence to practice to continue. Revalidation for me will be in July 2014. I do not have a Responsible Officer and it will be impossible for me to comply with the requirements of revalidation. I am facing unemployment with the possibility of having to sell my house. The concept of a limited licence to allow me to continue does not seem to have occurred to the GMC. It seems a little bit unfair that I will not be able to continue with examinations which I have carried out thoroughly and conscientiously for many years.

    Unsuitable or offensive? Report this comment

  • Abdul QADRI

    Dr Holden is 100% spot on about the feelings of the gross root GPs up and down the country.
    Last year I had to work weekends to prepare the documents for the Appraisal. I suddenly was exhausted and unable to have good nights sleep. I ended up seeing psychiatrist who suggested escitalopram but needed first cardiac check up, ended up having angiogram that showed 30% narrowing of the LAD artery without any symptoms.All the Appraisal data is the in tool kit & I decided to call it a day on 31.03.2013. Having worked as a successful GP since April 1982 , it felt humiliated to prove myself after all this experience. You are absolutely right , so called Shipman factor has consumed BMA and they never realise that those incidents happen once every 50 years or so. Besides if Shipman wasn't a Doctor , his personality disorder would have made him to do the same by using different strategy. Appraisal or revaluation has become commercialised and people promote their business by targeting Doctors. If you want to up-to date yourself in any field of General Practice, there is price tag attached. So called learning CPD in BMJ or Pulse Magazines have started putting a price tag too on their hourly topics. GP are already struggling with the time restrains in the surgeries as they have to enter all the unnecessary rubbish in the computer for the sake of achieving targets. Take the example of finding new patients of dementia or depression or angina in the preceding 12 months. If you don't have any, you score Zero points. What is poor GP supposed to do , make people demented to get points. In my last 2 years of the practice, my patients who have been with me for decades, always commented that Doctor - you have changed as you are always glued to the computer screen and don't have time anymore to talk to us like before. The whole system has been ruined by outsiders who don't have a clue about the Golden Concept of Family Doctors as it used to be called. Now it is like a Doctor -client relationship.180 or 360 degree tool revaluation test doesn't have any benefit whatsoever to Doctors or patients. Recently they are now focussing on lifestyle changes incentive programme and nurses have to go for training to be able to organise it for the Doctor. What a waste of nurses time as if she doesn't know how to address the issue of lifestyle changes. Come on , this is basic thing we have been doing as soon patients registers or if he or she is on chronic disease register template. There is a big section waiting : Smoking history , exercise history , BMI history etc & one has deal with this according to the answer given by the patient. What is so dramatic now to waste every bodies time on so called special training which will be repetition of what we already know. GP should have been approached in a most time friendly practicable manner for yearly Appraisals. Majority of us are good Doctors. Yes if somebody had been reported with significant genuine complaints, then that individual should have been informed according and offered necessary help by involving fellow practitioners. This way that under performing Doctor wouldn't have felt threatened.
    One can go on writing but in summery , I feel that whole procedure of Appraisal & revaluation is in a mess and BMA as a representative body needs to take a closer look again and listen to the comments of the gross root GPs , otherwise there is a danger that GP jobs may not be the top option for fresh medical Doctors in the future.

    Unsuitable or offensive? Report this comment

  • Well said Abdul

    Unsuitable or offensive? Report this comment

  • Thanks Dr Holden for standing up to real GPs. We full timers are often being told by doctors that only do 1 to 2 sessions what to do as they know best. There should be a rule that anyone less than 6 clinical sessions should not be making any rules as it does not affect them significantly. The primary job of a doctor is to treat patients not wasting time producing lots of paper work for managers to keep their jobs. Doctors has lost trust in the GMC that is deprofessionalising us. Lets change things or move abroad.

    Unsuitable or offensive? Report this comment

  • Recently got revalidated after being informed few months ago that I was on the line for revalidation. That after putting hours of scanning and attaching ,not to mention reading guidance which changed according to any authors fancy every 2 months.. Of course I had a lot of time for that as full time partner and of course patient care and safety has improved (what a joke) as the policy makers would like the public to believe. After this looking to move on from UK as this is no longer worth it.

    Unsuitable or offensive? Report this comment

  • Why do GPs not simply request a straightforward knowledge test for re-accreditation? Taking maybe three hours (cf the MRCGP AKT), this will correlate pretty well with actual competence, and precipitate a few failing individuals into proper assessments. Most GPs I know would prefer this, and it would surely re-assure patients far more than appraisals.

    Unsuitable or offensive? Report this comment

  • This comment has been deleted by the moderator

    Unsuitable or offensive? Report this comment


    Unsuitable or offensive? Report this comment

  • I so agree..and as for 360 colleague feedback..when I said I didn't have 20 colleagues I was told I could use my friends! Of course they aren't biased..what a waste of time for everyone..never mind the cost of administering such nonsense

    Unsuitable or offensive? Report this comment

  • Come the revolution appraisers will be first against the wall. Traitors to their own profession .

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say