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Independents' Day

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)

  • 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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