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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)

  • 1) It needn't take 40 hours. What use is a casual straw poll?
    2) It's all very well playing to the gallery but what exactly does he think he will achieve with this rant?
    3) There are much bigger problems for GPs to face than revalidation: loss of income, new contract changes, loss of seniority, pension contributions hike, loss of experienced partners to retirement or foreign lands.

    I predict Peter will seek publicity this time next year when it is too late to complain about these either.

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  • Anonymous | 28 November 2013 5:14pm

    1) 'It needn't take 40 hours.' agree but it depends how organized you are. I'm not so it takes me 4-5 days!

    What use is a casual straw poll? agree - but it will have to do until someone is willing to fund a proper poll.

    2) 'It's all very well playing to the gallery but what exactly does he think he will achieve with this rant?'

    I think he should be supported as it isn't often that someone with some say takes on a major bugbear for the grassroots.

    3) There are much bigger problems for GPs to face than revalidation: loss of income, new contract changes, loss of seniority, pension contributions hike, loss of experienced partners to retirement or foreign lands. agree and there are many more things to add to that list.

    in the long term we are better out of the NHS - we can then focus our time on the patient and opt out of all this bureaucratic rubbish that politicians and pen pushers have lumbered us with!

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  • All the problems above can be summed up as CONTSTRUCTIVE ( DESTRUCTIVE ? ) DISMISSAL >

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  • I think the effects of revalidation have been quite corrosive to general practice and the GMC have a lot to answer for. You can argue over the exact number of hours it takes but the reality is that unless you work part time, it is more or less impossible to do it 'as you go along' unless you compromise patient safety. Our days are just too packed now to take out this much work time and spending loads our precious spare time 'reflecting' is ultimately demoralizing as you end up having no life outside of the job, just form filling. When you put this into the context of one in five GPs aged over 55, demographic changes, dwindling funds, a recruitment crisis and all the other reforms we have been handed, one can only draw the conclusion that UK general practice is perilously close to failing if this is allowed to continue much longer.

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  • Crikey 6 pages of comments and NOT A SINGLE ONE THAT DEFENDS REVALIDATION. There is one that has a dig at Peter Holden personally but it is amazing how united we are on this, yet nothing happens to change it.

    I had quite a bust up with my appraiser this year because I refused to button my lip, preferring instead to share with him my "reflections" on what I had "learned" from the process. It was enormous fun.

    When somebody stands to lead the BMA on a ticket of explicitly aiming to undo revalidation, they will win by a landslide.

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  • The problem is that to convince the GMC to drop revalidation, we would actually have to put together some evidence that this box-ticking is harming patients. Whilst this should be self evident if you tally up the cost of doctoring hours lost to medicine and consider key recommendations of the Francis report, this will not be enough. Possible suggestions could include comparing GMC referral rates of those revalidated vs those not (I seriously doubt there will be a difference), auditing variation in admissions and mortality of patients on GP lists in the 2 months prior to revalidation or commissioning a paper on the financial consequences of this reform.

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  • How about auditing the year of retirement with the proximity of the next revalidation date. I think you will see that doctors are beginning to think of their retirement date in terms of avoiding the next revalidation.

    You could be losing doctors up to 5 years earlier than you would have done.

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  • 15.59 Great idea though I've no idea how to get this data? I'm sure there is something in it and given the deficit of 2-10, 000 GPs whom we can ill afford to loose (unless the eastern Europeans come to the rescue) this would have to be acted on.

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  • substitute plan:- 1) Doctor goes to Out of Hours Base . Does 4 hours observed face to face consultations . 2 ) Job done . - Added bonus gets paid for doing shift at £ 100 / hr .

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  • Anon 5.34 Good plan - no buggering about with collecting evidence -seems simple enough - Why can't we do this ?

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