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GPs go forth

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)

  • Hurray Dr Holden, well said, the whole process has become demeaning,after 36 years wonder how we kept up. Being treated like school children will make us behave like schoolchildren. This is is not for professionals. A good idea but completely flawed both in implementation and width.

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  • I propose scrapping Revalidation all together and getting everyone to sit the CSA exams in its current form - every year ; )

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  • I propose scrapping the college, the GMC and the CQC and letting us get on with the job in hand...

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  • Perhaps it would be worth taking the legality of revalidation to a judicial review? We would need to prove evidence of harm to patients and also name those who used their powers to instigate it so that they would be held to proper legal account. Judicial review generally cannot be used to challenge law but I believe it can be if a law found to be incompatible with ECHR (human rights) legislation.

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  • I am a kind appraiser and have no wish to be power crazed. My own appraiser is of a similar nature. I take as easy going a view to appraisals as I possibly can. I have been revalidated & it probably took me 12 hours for my last year's appraisal + say 3-4 hours extra to organise my MSF & my PSQ. I am surprised by many of these comments. I would be dissapointed not to do my appraisal in a maximum of 12-15 hours (and I agree this is too long). Part of the secret is to write up each CPD asap after any learning event. It usually takes me 10 minutes. I also record my notes at meetings on an iPad. This can be emailed to oneself in seconds, downloaded onto Word & attached to ones CPD in a minute. Never leave your appraisal to the last minute or it will become overwhelming. Brief reflections are all that is required for CPD events.

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  • dear kind appraiser 7:31, there are some appraisers who are not like you . If you are allocated a strict appraiser then the appraisal can become a hellish experience. this might make you realise why so many people are upset about the whole thing. Also what do you do if your appraiser is treating u unfairly? who supervises them??????

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  • I am an appraiser for another specialty and also have recently been revalidated, I used a lean quality rather than quantity approach. It took me about 30 hours to collect the evidence and write the reflective notes where required. The process is good in parts but the one size fits all is not appropriate to my specialty. A single appraisal from the appraisers point of view can take up yo 6 hours depending on the volume of material. It is a blunt tool and I am not sure it is even fit for purpose in identifying poor or dangerous doctors or instilling a culture of quality improvement.

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  • Appraiser 7.31, you also miss the point (as do all appraisers it seems to me) that we do not want to do ANY unnecessary paperwork. We want to learn, attend meetings, go on courses etc, but some of us have no desire to write it up so that people we don't know can judge us on it. Learning and developing used to be called a professional responsibility and we were trusted to do it and most GPs DID do it and did it properly. Appraisal is just more admin and form-filling and most GPs are sick of it. I have had many appraisals and I have never found it a positive experience. I find it very stressful, my patients and my appraiser's patients lose GP time, it costs the taxpayer money - so for whom exactly am I doing it?

    The fact that you do not find it onerous does not mean that the rest of us are unjustified in finding it a frustrating and unpleasant experience. I think it should be optional, for those who feel they need a mentor.

    Thanks for popping your head over the parapet though.

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  • Totally agree with every word, well said Dr Holden. I have many friends who are vets, lawyers, accountants etc, who are aghast at what we are up against. It's needlessly time-consuming for Principles and disproportionately onerous for sessional/part-time GPs trying to balance family commitments and desperately trying to stay up to date. I'd far rather use the time actually reading the literature/attending meetings than endlessly documenting/introspecting on the small amount of actual learning I've managed to fit in!

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  • I respect Dr. Holden. But he knows as long as the BMA stands for the NHS and not the doctors, we are cooked. There is nothing we can or will do.

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