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At the heart of general practice since 1960

GPs deserve better than revalidation

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I have been appraised, I have revalidated, I have played the game since the introduction of annual appraisals ten years ago. And now I am forced to reflect.

But is forced reflection on forced learning the best we can do as a profession driven by evidence-based practice?

The system is a sham

What have I learned from my annual BLS update? Ummm, that it’s very important and I should update each year.

How has it changed my practice? Well, I know not to start another three-hour learning session in a severely decaffeinated state.

And then there is my professional development plan when I’m faced with the questions of: ’Surely you must have some learning objectives? No, two is not enough, must be three or four,’ together with ‘have you achieved last year’s? What do you mean your ideas changed? You came across something more interesting and relevant?’ with the inevitable following words: ‘Tough mate coz it don’t count.’

But as long as the hours spent on perfecting CPR in the last five years equals 15 and the hours spent learning how to recognise depression in the last five years is equivalent to 0, I get a tick and a pass. Next!

But who actually reads this guff? Obviously our poor appraisers have signed up to it, and most of course go through the same routine themselves each year and are aware of the rules of engagement (don’t start me on the whole practice manager appraisal thing) .Then presumably there are those NHS England responsible officers, medical directors and deputies who have sold their souls to the establishment, ending their careers ticking boxes and doing good on behalf of Her Majesty. I hope they derive some personal satisfaction from their role.

But other than them, most believe the system needs an overhaul. I am aware that recent RCGP guidelines are supposed to lighten the load. But have you read them? Clearly it’s a small fry, little or no impact, to keep the masses quiet.

In essence the system is a sham, it doesn’t achieve what it set out to and hasn’t since its inception. Has patient safety improved? Does anyone have figures on how many physicians have been sanctioned by the GMC as a result of the appraisal process? What is the cost benefit of this? How many physicians have left the NHS as a result of the appraisal process? Those wanting to leave general practice are told to just work one more year or do some locuming when they retire full-time practice. But no one wants to keep up with all the appraisal shenanigans that go with it.

Most of my learning is not recorded and I suspect that applies to many of us. It consists of conversations with colleagues, reading between patients, browsing journals and reading medical blogs. I learnt more in an impromptu tutorial from a cardiology colleague as I sucked his wheel on an Alpine cycle ride than I have in many highly organised meetings.

Why is it not recorded when you can use any number of apps and website trackers? Because most of us of course can’t be bothered with the banality of recording everyday events, don’t have the time or are just too busy trying to see patients and actually enjoy life rather than slide inexorably towards an overly appraised, highly reflective early retirement. We have had enough of justifying our existence behind a facade of safety and learning, falsely reassuring our paymasters and the public whom we do our best to serve.

What could make appraising better? Scrap it? Adapt it? Change happens slowly in these circles so don’t hold your breath for the next ten years.

Personally I have found my patient feedback survey has been the most interesting aspect of the whole process. The comments were revealing as a large numbers of patients said what they liked about their doctor was that ‘he listened’.

My advice would be to value doctors. Nurture them. Manage them holistically. Find a way. They are a dying breed and we won’t truly miss them and primary care until they are gone. Our doctors and patients deserve better.

Is anybody out there listening? 

Richard Cook is a GP partner in Hurstpierpoint, West Sussex

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Readers' comments (17)

  • There must be a way to collectively simply stop responding to appraisals and revalidations. What are they going to do? Strike everyone off? Hardly.

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  • The desire to look after doctors as professionals has gone. Once I used to feel valued, now that has all evaporated.
    Now we are all disposable. We are under attack. The government and others like the GMC believe that they are doing us a favour by allowing us to do our jobs.
    Well ...... to that and goodbye to medicine in the UK as the government obviously want to smash the NHS and don't give a monkeys about hard working people who have given their lives to improve others lives.
    So every doctor should only look after themselves and their own interests as no one else gives a ......

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  • "Anonymous | Sessional/Locum GP20 Jun 2016 2:44pm
    There must be a way to collectively simply stop responding to appraisals and revalidations. What are they going to do? Strike everyone off? Hardly."

    I am sorry to tell you that vast numbers of your colleagues would betray you, and would carry on doing as they are told by government. GPs will not fight for their profession - they will retire, resign, emigrate, generally run away, but they will not ever fight to preserve the profession. And that doesn't count the large number of traitorous GPs who actively take part in destroying the profession such as working for the CQC despite their union saying that CQC is one of the factors bringing general practice to its knees. So there are plenty of GPs actively working to destroy general practice.
    You have no hope of getting unified action from GPs like the JDs did.

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  • Anonymous at 2.44 has the right idea
    I enjoy studying, going to meetings and , to be honest I don't even mind the appraisal visit but the HOURS I spend collating data on the SOARS website (I live in Scotland) serves no purpose.
    And I bet it wouldn't have caught Shipman!!

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  • Modern medicine: you must no longer treat patients in a paternalistic manner... that is reserved for the treatment of doctors.

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  • Cost benefit? Good point.
    Why has nobody calculated the NNH (number needed to harm) for appraisal and revalidation?
    How many appraisals does it take to get one GP to retire early or not feel locuming is worth it post retirement?

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  • I agree with every word.

    It's a sack of nonsense. The diligent sweat blood for weeks on this stuff. The slackers knock it out in an afternoon. They all get the same ticked box. I have worked with some complete sociopaths in my career, and because they are experts in spin, driving their own agenda, and submit their own brand of "evidence", which is to my mind never checked or verified -sometimes never read- they get an easy ride. The idea that appraisal adds anything to patient safety is a joke.

    Except it's not funny. This process and the CQC have driven some of my best colleagues off to an early bath.

    And our leaders applaud from the sidelines.

    We are forsaken.

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  • The villains are our colleagues who become appraisers. We're all obliged to go through appraisal to keep our registration, but the appraisers choose to facilitate the process. These educationalist zealots and evangelists have emasculated our profession. Shame on them

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  • Well said Dr Cook! I've scanned in your article and reflected on it for my PDP. Take care though, when I replied to a GMC survey about appraisal with some negative views their response was to offer to video my next appraisal so they could watch it!

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  • I work to support doctors helping them to collate evidence for appraisal and revalidation, I have also worked within organisations and readily see the challenges appraisal and revalidation has brought. I personally find it of concern to see lack of compliance within some organisations, some appraisers making a lot of money from appraising independent doctors. Doctor's already strapped for time taking annual leave to prepare for appraisal. Over 1000 plus doctors have left the profession because of revalidation. I am told there are two distinct schools of thought, ticking boxes on one side and quality, standards and raising performance through appraisal on the other which ultimately leads to job satisfaction and patient safety.

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