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The waiting game

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)

  • Scapegoating appraisers for revalidation is like scapegoating Trainers for the onerous nature of the MRCGP eportfolio ( trust me, it's ten times worse!)

    I'm slightly confused about what most GPs have been doing for the last 5 - 10 years. I have been preparing for an annual appraisal for at least 8 years, which was the requirement of the PCT to stay on the performance register.

    I don't think it is a viable position to expect all clinicians to be self motivated learners and remain up to date without some kind of periodic assessment of performance.

    That said, I would be in favour of an AKT style test which would be more valid to ensure people are keeping up to date and take a fraction of preparation time. Apparently......we declined this!

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  • I could not agree more I find it unprofessional Appraisers seem to be box ticking control freaks I dont wish to spend my life doing Navel gazing reflections. The audit section alone takes hours.

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  • GPs always used to be self-motivated learners Shaba Nabi. It was called professional pride. We are now mere administrators and the pride has gone.

    Some things cannot be measured. Being good at forms and being a good GP are not necessarily the same thing.

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  • Kind appraiser again (see 7.31 on page 7). An AKT may test ones' medical knowledge, but it does not see how one inter-relates to ones' patients & staff. It does not test whether you are a caring & proactive doctor. Academic ability does not mean good doctor necessarilly, though it helps. It certainly would not weed out a Shipman, mind you, most appraisers are not sure an appraisal would either! One cannot fault the various tasks provided they are appied equally across the board. I would be in favour of a significant reduction in the tasks. The best policy is KISS. Reams of notes or reflections are not required- just an overview & it certainly helps massively to write up at the time or shortly afterwards. I still maintain a maximum of 15 hours should be possible except when PSQ & MST are required for your revalidation.

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  • I meant to write MSF not MST & KISS stands for Keep it simple "silly"

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  • The medical profession needs to wake up and realize that Revalidation is actually part of the plot against the NHS. What could be more perfect but to keep the doctors so busy worrying about keeping their jobs that they wouldn't have the time or energy to resist the Health and Social Care Act 2012? Revalidation was a Trojan horse to stifle dissent amongst the ranks and stymie resistance to the backdoor sale of NHS resources. As a profession we have lost a huge amount of power being hamstrung by this pointless waste of time and in effect shrugged off our responsibilities to stand up for the needs of patients as apposed to the rapidly expanding medical regulation industry. We should be ashamed of this but everyone is now so locked up in their own little world of online forms that they are now too apathetic to care.

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  • As a GP who fell foul of revalidation in June this year and had his revalidation deferred due to no fault of his own, I can only say that this entire process has left me hurt and wounded by a process that is intrinsically unfair and doctor unfriendly, instead of being a formative and supportive process, I found this episode to be deeply destructive and nearly destroyed my career as a GP, I will be earnestly trying in my various capacities as GP and GP educator to help modify this deeply flawed process. The profession is in grave danger of being demoralised and brow beaten by a process that seems to be unwieldy and deeply unfair,

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