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Gold, incentives and meh

Revalidation paperwork equivalent to 390,000 days' worth of GP appointments

Exclusive GPs spend on average 55 hours a year on the revalidation process – equivalent to 1,300 full-time GPs working eight sessions a week – a Pulse survey has revealed.

The survey of 870 GPs found that more than a quarter spend more than 70 hours on revalidation, while only 15% spend less than 20 hours – which is how long it is supposed to take.

This is equivalent to 390,000 days’ worth of appointments lost to patients at a time when many are waiting at least two weeks for an appointment.

A Pulse investigation has also revealed that only 231 – or 0.4% - of all the revalidation recommendations made for GPs were serious enough for the regulator to threaten to withdraw a licence to practise. And that there is little evidence that revalidation improves patient care.

The survey, carried out last November, asked GPs how long they spend on the overall process of revalidation. A midpoint analysis revealed that they spend on average 55 hours a year. However, this is far greater that the two sessions a year cited by the RCGP for preparation and appraisal.

Dr Alan Woodall, a GP in Powys, Wales and the founder of the pressure group GP Survival, said: ‘For every hour of learning you can add another hour of recording and collating information. I spent three hours the other night going through information governance and child protection, none of which required any real learning.’

Meanwhile, the deputy chair of the BMA’s GP Committee, Dr Mark Sanford Wood, said although the union is supportive of the principle of revalidation, ‘considerable improvements’ need to be made.

He said that the 55 hours identified in Pulse’s survey was higher than the BMA’s findings, but added: ‘The time originally set aside was two sessions a year, one for preparation and one for the appraisal. But we know anecdotally that GPs are spending considerably more than that in putting together appraisal and evidence, probably in the region of four or five sessions a year which is a significant chunk of time taken away from patient contact.’

He added: ‘We need a national discussion about the evidence that’s required versus the delivery of patient care, particularly at the moment where we just don’t have enough GPs to do that job.’

But the GMC said this is bringing about positive change. A spokesperson said: ‘Revalidation has helped to strengthen the way we regulate doctors and embed a consistent approach to appraisal. Indeed, appraisal rates have risen steeply in all four countries of the UK since its introduction.

‘Doctors have said that the feedback they get from patients is particularly valuable for identifying areas for improvement. Revalidation in turn plays a vital role in assuring patients that their doctors are keeping up to date and have regular checks, maintaining confidence in the profession.’

But neither the GMC or the Department of Health were able to point to any evidence that revalidation has reduced avoidable deaths, harm caused by doctor or litigation costs, as claimed before revalidation was rolled out.

A DH spokesperson said: ‘As highlighted in the Taking Revalidation Forward review in January, the process has delivered significant benefits through its appraisal system and strengthened clinical governance procedures.’

Please note: the orginal version of this article mistakenly said it included the ’ten hours a year spent on CPD’. This was incorrect. The survey question referred to time spent on the ‘revalidation process’. We’re sorry for any confusion caused 

revalidation benefits vs costs 580x1668px

revalidation benefits vs costs 580x1668px

Readers' comments (32)

  • CENSORSHIP?

    What number took/ or are going to take early retirement because of the process?

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  • The most harmful thing about Appraisal and Revalidation is that they act as a socking great incentive to retire COMPLETELY, rather than ceasing to be a partner and doing a few sessions for the enjoyment of it. Well, that and MDU fees...

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  • Fully agree with 'Mavis' at 12.23. Appraisals have had that effect on me and at least 2 other GPs I know.
    An exacerbating factor is inconsistency in appraisal demands in some regions, mainly by their embellishment of the GMC's requirements by (presumably deliberately) conflating them with the RCGP's more onerous recommendations. Also significant differences between appraisers, some being nit-picking pseudo-academic hunts.

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  • yep - the fact that I have been told I need 50 hours cpd even though I have now reduced hours to look after relative has made me decide to surrender my license this year .
    It’s a shame as I could have carried on a few more years and practices are desperate - seems bonkers - why do we need annual mandatory appraisals after 30 years of medicine ?- we are not allowed a fallow year in case we forget 30 years of experience in 12 months!

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  • What about including the clinical hours that are lost to the appraisers? In fact how much NHS resource in terms of clinical time and £££ are spent on the whole appraisal and revalidation process every year and where is the evidence that it is improving the quality of care given to patients? Just over 40% of clinicians saying they have changed their practice as a result of appraisal/revalidation does not = improved outcomes but it does mean just under 60% haven't altered their practice despite jumping through the hoops. Value for money .....? Can we have an honest debate on this? Suggest the first step is identifying those with interests in maintaining the status quo and ensuring that their opinions are taken in context.

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  • David Banner

    Dear BMA,

    Appraisal/revalidation could easily be replaced by annual mandatory e-learning modules. This guarantees all GPs are kept up to date at the same level, dramatically reduces the impact appraisal has on appointments, and scraps the utter bonkers time wasting farce of pointless audits, meaningless questionnaires, idiotic “reflections”, infuriating uploading of evidence etc that constitutes the current sick joke we call “appraisal”.
    Oh, and if a few enthusiasts want to keep the current appraisal model, they can knock themselves out, just don’t drag the the rest of us through the whole wretched torture every flipping year, or the stampede to the exit will kill the profession in double quick time.

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  • The BMA chooses to support Revalidation rather than doctor. Hence why I for one am no longer a member.

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  • So the only recommendation that changes anything from the process is in 0.4% for non engagement? WHich means approaching retirement or didnt do xyz and has to do it later.. or maybe is abroad and it will now be more difficult for them (uk trained) to come back and work in uk than it will be for someone trained in Spain...

    that is really useful, then!


    ANd of course i change what i do s a result of revalidation.... i spend hours documenting things, and doing msf smile at folk!

    Pathetic

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  • I wrote this a year ago before I retired , reluctantly.
    I think this 55 hrs is the tip of the iceberg.

    -----------------------------------------------

    the bureaucrats and lawyers are smothering the system.
    On a local hospital management committee about 1990 I asked how many patients were seen monthly in Cas.. Nobody knew. ''It would take time for someone to count that and we have never needed to know so we spend our time more fruitfully. '' When the bandages looked low in the cupboard more were ordered. No monitoring .
    Even in those days I was surprised, but the fact is it all worked fine and was massively efficient compared to a few years later when they were paying people to stick price labels on every item of consumables , etc.. We are sometimes told the cost of the monitoring as above , but they always ignore the cost in time , distraction and stress for the front line workers of putting all this data in the notes while they work.
    And appraisals is a main reason for people retiring asap. I have to get away from sitting through yet another round of the same refresher lectures , political indoctrination much of it, writing special audits to show the appraiser (when i am one of the most audited people in the world) keeping records of everything I read and meetings attended with naval-gazing reflections about why I selected this course and who I subsequently discussed it with ; arguing with appraisers about how many points can be allotted to various activities and whether I have recorded my life in a fully auditable manner.
    It is demeaning embarrassing irritating and 90%wasted time and has driven thousands of experienced doctors to leave altogether when they might have been available for short hours.
    The retention scheme does not address this problem. If you were to work 2 sessions per week you would spend more time preparing for next year's appraisal than you would working.

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  • 50 hours? Are they having a laugh? Try over double that! And it only ever eats into the little time you get outside of work

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