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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)

  • 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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