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GMC review finds revalidation 'may not improve practice'

The GMC has issued new guidance to doctors undertaking revalidation, after a three-year review found the process ‘may not necessarily improve professional practice’.

The new advice comes as official research commissioned by the GMC found that only a ‘significant minority’ of doctors had changed their practice as a result, while some doctors ‘identified potentially negative impacts’.

The GMC suggested its new guidance would help some doctors for whom the requirements of revalidation 'remain unclear'.

The GMC said its newly-updated guidance, available online, now:

  • Provides information on the balance between quality and quantity of supporting information that a doctor must collect, but explains that the GMC does not set a minimum or maximum amount.
  • Reinforces the importance for doctors who have multiple roles of gathering information that covers the whole of their practice;
  • Emphasises that appraisals and revalidation are not ‘pass or fail’ exercises, but should be developmental;
  • Provides more information on collecting feedback from colleagues.

The report concluded: 'Revalidation, through appraisal, provides a means to document practice but may not necessarily improve professional practice.'

The GMC first introduced revalidation in 2012, with doctors required to go through the process every five years and alongside an annual appraisal.

All licensed doctors are expected to collect six types of supporting information, to reflect on and discuss at their appraisals, in order to demonstrate that they are up-to-date and fit to practise.

Una Lane, the GMC’s director of registration and revalidation, said the report from the UK Medical Revalidation Collaboration (UMbRELLA) had given GMC 'an insight into the first few years and will help us as we continue to improve the process'.

She added: ‘We knew that something on the scale of revalidating tens of thousands of doctors would take time to bed in, and would need to be reviewed and refined. But these are still early days and there are positives.’

Ms Lane said: ‘Most doctors are now collecting the supporting information that revalidation requires, but for many the processes for doing so are not as simple and straightforward as they could be.

‘Employers have a major role to play to address this, and too often there remains confusion between the GMC’s requirements and those of employers or royal colleges. Our updated guidance will help doctors by making our requirements clearer, with a focus on quality rather than quantity.’

The updated guidance also includes advice aimed at responsible officers.

The GMC said last year that it intended to simplify revalidation in line with recommendations from the Pearson review, which had made a range of recommendations including on how to reduce the related workload.

This comes as GMC chief executive Charlie Massey recently claimed that the ‘bulk of doctors’ support having annual appraisals as part of the revalidation process as it leads to better patient care.

But at the same time, a Pulse survey revealed over half of GPs have stopped or changed appraisal reflections following the case of struck-off junior doctor Hadiza Bawa-Garba.

RCGP chair Professor Helen Stokes-Lampard said: 'This new GMC guidance is welcome and includes some important developments around appraisal and revalidation, particularly the increased emphasis on quality not quantity of supporting information.

'There is still work to influence the implementation of the regulatory agenda, so that it is truly proportionate and reasonable for all GPs. The college has been updating our own supporting information guidance accordingly and this will be published shortly.'

Key findings from the UK Medical Revalidation Collaboration (UMbRELLA) review

  • Revalidation, through appraisal, provides a means to document practice but may not necessarily improve professional practice.
  • A significant minority of doctors reported changing an aspect of their clinical practice, professional behaviour or learning activities as a result of their most recent appraisal.
  • However, some doctors identified potentially negative impacts on practice or for professional autonomy as a result of their appraisal.
  • Some Responsible Officers do not feel that the three options available for revalidation recommendations (revalidate; deferral; and non-engagement) adequately cover all circumstances.
  • Expectations set by employing organisations or individual appraisers can go beyond the requirements set by the GMC for revalidation.
  • Outside existing governance structures, there are peripheral groups, including but not exclusively locums, where the ability to obtain an annual appraisal has been inconsistent.

Source: Evaluating the regulatory impact of medical revalidation

Readers' comments (52)

  • So, let me get this right. We are still in an experimental stage and the tsunami of retirements, ill feeling among hard working GPs , unpaid extra work, involved, sheer uselessness of the work and the fact that it fails to pick up the 'dangerous' doctors it was set out to find, are all 'teething' factors. That with indemnity was the reason why I gave up my licence when I retired. Sheer waste of time trying to prove to a young GP why I , after all these years, should be entitled to see patients. Insulting, patronising, poorly thought out and wrong

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  • "The report concluded: 'Revalidation, through appraisal, provides a means to document practice but may not necessarily improve professional practice.'"
    As Cilla would have said Surprise Surprise!

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  • With Dr Bawa Garba still sidelined, another good reason to get rid of this organisation.
    In all its pious perversity it is probably more of a threat to the nation's health than a hundred Dr Shipmans. The irony.

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  • Oh, interestingly, the GMC found revalidation does not work but they continue this non-sense programme for What?

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  • So no research feedback can make them step back and reflect that the negatives outweigh the positives and the whole thing should be binned?
    And since when was Revalidation not pass/ fail?

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  • The DoH should take over from GMC as a regulation body and health professionals to run this body not others.

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  • The only persons who benefit from this are those who collect the money for overseeing it.

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  • How much money and my time has been wasted on this exercise

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  • Entirely predictable: Bloody appraisals carried out by doctors still wet behind the ears ( better than seeing patients!!) were what caused me to give up.

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  • A little advice for Ms Upa Lane (GMCs director for this disastrous activity). Most medics saw where this was going, years ago, so many bailed out. It speaks volumes when a regulatory agency misunderstands (possibly purposely) the concept of 'public accountability' and replaces it with 'self serving / own interests'.
    Where too now, seeing the current has served?

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  • What a surprise the amount of time and stress we have all spent. No one needs a study to tell us. Basically if we mess up, the patient will sue us, and that plus our professionalism keeps us on our toes. There is no need for this useless exercise so they can up our fees again. Scrap the GMC and the CQC. The ambulance lawyers are more than sufficient.

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  • Totally predictable.
    If this was a new treatment or a new care pathway, this would constitute the worst sort of negligence and carelessness. And yet, we’re watching powerless, as the CQC, GMC, NHSE triad destroys our profession with impunity.

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  • This is what happens when politics and power are allowed to govern medicine. It's pretty obvious revalidation has done significant harm to UK patients in terms of doctors lost, working hours lost, the collapse in confidence around regulation and the problems with recruitment. Usually in medicine when something does harm we stop doing it but when this much money is at stake the thing will be kept going whatever cost. What really needs to happen is an investigation into the probity of the architects of it and possibly even a criminal investigation into how much resource has been squandered and who profited from it.

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  • If it makes no difference then why persist.It detracts from valuable clinical/family time

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  • This is quite a shame given the whole industry that has been created around appraisal and revalidation. however if you create a façade just to placate the vocal over Shipman what can you expect?

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  • The only comparison I can find to GMC Revalidation is where Negan in the 'The Walking Dead' beats people to death with his baseball bat for the sole purpose of ensuring Rick and his group realise who is really in charge. It is an exercise in ensuring subservience, flushing out those who can't endure kneeling to their overlords and masters!

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  • And yet GPs I know like being appraisers. Perhaps they believe in the value of the process? And I have been told you don't even have to be doctor to be an appraiser of GPs. You can apparently be a retired GP no longer licenced to practice or you can be an educationalist or something.
    Please someone tell me I wrong wrong about this...

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  • Is it possible the GMC may be engineering a retreat from this position to try and stop an angry membership from baying for their blood and head to roll or am I being an old cynic.The Dr BG case being the catalyst,the straw that breaks the camels back.

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  • Time to get rid of the GMC. We should we still pay for all of this.

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  • When appraisal first came out, I was invited to be an appraiser. Might as well, I thought. Me or someone else, and I'm pretty easy going. It was the easiest work I have ever done, the fees paid for may car (only a Corsa, but, hey...). Don't get me wrong, I did it sincerely, but as time went by I came to see what a waste of time and money it all was. I went public on the waste-loads of GPs agreed with me, but my manager didn't and I had to resign. That was years ago, and now it has got much worse with revalidation.

    I always said, if revalidation was a drug, we ought to have asked

    1) what condition are we treating?
    2) is this the best way to treat it?
    3) does the drug work?
    4) is it safe?
    5) is it cost effective?

    But none of these questions were ever asked. We had mass medication on a hunch. It was a case of 'something must be done-this is something-therefore this must be done.'

    But as a filthy rugby song I sadly remember says,'now we come to the tragic bit, there was no way of stopping it.'

    The main side effects of this drug has been disillusionment leading to early retirement of good doctors who had another few years work in them. How many good GPs have quit early because of this, we shall never know.

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  • When appraisal first came out, I was invited to be an appraiser. Might as well, I thought. Me or someone else, and I'm pretty easy going. It was the easiest work I have ever done, the fees paid for may car (only a Corsa, but, hey...). Don't get me wrong, I did it sincerely, but as time went by I came to see what a waste of time and money it all was. I went public on the waste-loads of GPs agreed with me, but my manager didn't and I had to resign. That was years ago, and now it has got much worse with revalidation.

    I always said, if revalidation was a drug, we ought to have asked

    1) what condition are we treating?
    2) is this the best way to treat it?
    3) does the drug work?
    4) is it safe?
    5) is it cost effective?

    But none of these questions were ever asked. We had mass medication on a hunch. It was a case of 'something must be done-this is something-therefore this must be done.'

    But as a filthy rugby song I sadly remember says,'now we come to the tragic bit, there was no way of stopping it.'

    The main side effects of this drug has been disillusionment leading to early retirement of good doctors who had another few years work in them. How many good GPs have quit early because of this, we shall never know.

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  • ...just counting the number of revalidations to retirement. And seeing if I can cut it by at least one.
    Tragic really, when not so long ago we couldn’t get GPs to retire, they enjoyed the job so much.

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  • Nhsfatcat

    And in other news GMC surprised at finding ursine faeces in copse.

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  • Oh! my favourite topic - is it too late to join in say - Who'd have thunk it

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  • stop whining you bunch of losers.
    you must do this even if the evidence is that it is useless
    and my master 'lord Hunt almighty' will make you all prescribe homeopathy

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  • Took Early Retirement

    I revalidated once- just to show that I could. Then I took early retirement so I would not have to waste my time on it again. I also hated and still hate the GMC.

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  • David Banner

    “Insanity is doing the same thing over and over again, and expecting a different result”
    I’m no Einstein, but even I can figure out that the annual colonoscopy of appraisal has achieved nothing other than angry, frustrated and despairing GPs queuing for the exit.

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  • I retired in 2016 on my 60th birthday, withdrew my name from the GMC register, and haven’t treated a patient since. I had been an appraiser/appraisee for many years. I believed (and still believe) that I could have worked effectively to age 70 or so. I stopped appraising as soon as the process started to become “quality-assured”, seeing the writing on the wall for formative appraisal. As my fears became realised, and as medical indemnity became ever more expensive (in spite of all the quality assurance, odd that!), I decided that I would survive on my pension. So I haven’t used my stethoscope in anger since then. Do I miss it? Yes, I suppose; but not as much as I feared.

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  • Vinci Ho

    If getting a successful revalidation every 5 years was like winning a military medal , this is what the general told his ‘successful’ soldier,

    'Son , the medal isn't for what you did , it's for living with it....'
    Madame Secretary season 2

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  • Vinci Ho

    Wow , I just got revalidated for another five years . Thank you GMC , thank you . I want to thank you my family and my wife.Without their support , I would not make such an achievement . And specifically, I want to thank you all the appraisers who put up with me last five years because I could be bit of a b*st**d sometimes. God bless (tears in my eyes).

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  • Just Your Average Joe

    If the GMC is an organisation for doctors to self regulate, how does one sack the management including CM who are running it into the ground?

    Appraisal should be reserved for those doctors where significant concerns have been raised so they can demonstrate they are reflecting and getting appropriate training in areas where they were lacking.

    So DR BW instead of erasure should have been advised to have a 5yr revalidation cycle (Some would see that as a harsher punishment!), and left to continue the profession, where she could continue to help many thousands of patients.

    Everyone else should be left to see patients and get rest in between.

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  • Remember Mr Hunts ‘penance’ comment? Ta Daaaa appraisal and revaluation 😃

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  • An opportunity here for the GMC to win some much needed support of doctors if they can see it.

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  • David at 9:52
    Re the “annual colonoscopy” of appraisal: spot on. And at least there is a proven benefit to a colonoscopy, and figures for NNH, cost benefit etc. With A&R, whilst we have mounting evidence that the number needed to harm is appalling, the GMC pursues unabashed and unbridled. How many GP-Years have we lost as a nation on the altar of Shipman-gate sacrifice?
    But nobody really notices, nobody really cares and nobody actually does anything.
    Ironically, the appraisal process was once of significant value - before it was linked to revalidation and before it fell prey to the same level of over-regulation as general practice itself. I was an appraiser, and thoroughly enjoyed it, before the professional over-regulators got stuck in - and quality-assured it out of shape. I found myself not wanting to be associated with a process so obviously and so closely linked to the decay of our profession.

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  • 'Cwm scienta caritas'--- as a 'scientist' I could'nt see how writing everything down that you did,could be expected to make one a better or safer doctor.It felt wrong,so like many others I left at 55.
    When I look at what my London medical school contemporaries who became GP's did,I find a broadly similar picture.
    Compare this to the antipodes(a similar health care environment to ours) and you see doctors maintaining Registration into there 'late 60's'.Perhaps the GMC should make this comparison?They won't of course because we all know they are Not Scientists but they do show the qualities of many other words that also start with S---.

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  • If we had a Union that represented our interest, rather than the useless BMA apologists, the Appraisal and Revalidation farce would have been killed-off long ago.

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  • Since when does the government act onevidence? Only when it confirms there position. Otherwise shelve it or do it again.

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  • Why is it everything I advise or prescribe has to be evidence based. Yet the GMC still makes me waste my time on something which has been proven to not achieve it was set out to do?

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  • It is an insult to our professionalism when they feel we are racing to the bottom for updates.
    All doctors are the top students in their schools who want to be the best they can.
    I doubt Mr Massey has the same no. of As we have for A levels and he is telling us what to do.

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  • AlanAlmond

    GMC review finds revalidation 'may not improve practice'

    ..I especially like the ‘may not’ bit. Nicely non committal, and less embarrassing than simply fessing up, coming out with it and saying ‘does not’. Following this earth shattering discovery, at least we can take comfort that in around 10 years time, after several expensive ‘pilots’ we can look forward to the system being changed - to something just as crap. Thank god.

    Call me a cynic - I am.

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  • Appriasals would be Ok if they were every two or three years. Once a year is pointless.

    The lastet blurb from GMC really stuffs it up for doctors who want to work overseas (that includes British overseas territories), with loss of license even if you keep up appraisals. Loss of license means loss of place on perfomers' list and getting back on that might be very costly.

    I am not sure why GMC have made subtle changes to the wording giving such a devastating effect; seeking to discourge GPs to work abroad and gain experience, or work most of the year abroad and in then UK, and also discouraging GPs in Australia New Zealand and Canada to come back. Very odd. https://gerardbulger.com.au/revalidation.html

    The new wording would also seem to prevent superspecialists such as those coming over from for a few days (say from USA)

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  • I seem to remember being told on day 1 at medical school that first we must do no harm?? Perhaps they missed that talk

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  • Who pays me for spending 50 hours updating myself &,the hours spent writing it up on clarity toolkit & 2 hrs spent with the appraiser to tick boxes

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  • Took Early Retirement

    Happy- "It's all in your global sum"- as I remember being told when urging people to vote "no" to the con-trick of c 14 years ago now. 80% of GPs disagreed with me.

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  • Some stupid idiots in this system need to do 'RESEARCH' for a couple of years after making crucial decisions that adversely affect the Health Community only to find what was evident from the outset to the ordinary health professionals. And that is why they are in the chairs where they are:) Forgive them o Lord for they do not know what they thought they know:)

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  • Appraisers esp retirees who see this as being an easy way of making some money on the side without having to deal with patients should also do some soul searching - never too late and can be done at any age. Some certainly believe that this is beneficial and do it in good faith, I am sure, but then would like to reconsider the sense in this exercise now that GMC mentions it is a waste of time.

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  • That’s really making me feel so much better....not. After the worry and anxiety that appraisals caused me which paled into insignificance compared to revalidation (which incidentally I got through without any criticism)they now tell me that it didn’t reflect my professional competition!
    I finally jumped ship a few months ago as the oldest working GP in my region at age 65 but with my head held low. As a result all those years seem wasted in a profession that has lost direction even if it was enforced.

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  • Oops I meant professional competence!

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  • Come along children, you are not playing nicely.

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  • I never believed in appraisals. I Just do it with my foot and not my heart or my head.
    About time it is abolished and let GMC be appraised instead.

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