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Putting the validation back into revalidation


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I have to declare a conflict of disinterest in writing a column about appraisal/revalidation, which is that I think the whole process stinks worse than a squashed and decomposing roadkill skunk, and is likely to hold my attention for about as long. Still, making that disclosure at least gives me something to put in the ‘probity’ section.

I realise that raging against the appraisal/revalidation machine is a tired – and, let’s face it, lost – argument by now, but I don’t care. Articulating it reminds me that, despite the regulators’ best efforts, I remain a breathing and sentient being.

So: I update my knowledge every single day in an ongoing and automatic process of self- improvement because, like all the other GPs I know, I’m a professional with some self-respect, and that carries with it the desire to do the best job I possibly can, even given the current constraints of what is still laughably known as our vocation.

Whereas, having to be seen to do this via time and energy-sapping reflective and box-ticking exercises is not only insulting, depressing and demoralising, it actually undermines motivation for the very job the process is designed to ensure the quality of.

Spending £97m per year for the sake of identifying the 0.4% of bad apples is, of course, a compelling and durable argument

But you knew all that. So what’s new? Well, let’s just suppose that revalidation is here to stay, because it is. After all, spending £97m per year for the sake of identifying the 0.4% of GP bad apples is, of course, a compelling and durable argument.

So what if there was a way to revalidate that minimised the grief for the vast majority of us who desperately want to throw off the dead weight of bureaucracy and get on with our jobs? Something that caused us a very transient and minimal arse-ache rather than the full-blown chronic, intractable proctalgia of the current system? Would you be at all tempted to delete those tedious eportfolios for a new light-touch system? I know I would.

What I would accept, in fact, would be a five-yearly mandatory MCQ to assess whether I’m fit for purpose. Bear with me. Yes, I know, this can’t test all the touchier-feelier areas that are fundamental to practice. But frankly I don’t care, because it would be quicker, cleaner and cheaper – and I’ll bet you all of my current year’s credits that an aberrantly low score would act as a valid proxy marker for an aberrant GP.

I’d suggest the top 97.5% are re-licensed for another five years, with no other requirements imposed on us, while the bottom 2.5% are subjected to the current full-on revalidation/appraisal torture. If you’re having trouble getting your head around this, think risk tools. Instead of using QRISK2 to statinise patients most at risk of cardiovascular disease, we’re using GPRISK2 to sanitise the tiny minority of GPs most at risk of harming patients.

No, I don’t like exams, but I’d take a five-yearly one-hour MCQ over the revalidation/appraisal edifice any day. Imagine it: most of us would be done and dusted in an hour.

You know it makes sense. I’ll even volunteer to write the questions.

Dr Tony Copperfield is a GP in Essex



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Readers' comments (13)

  • Big problem with MCQs: Let's assume answers are based on a published guideline, we know only 15% of which are based on strong evidence [citation exists but not on my desk right now], and may be several years old. What if you've read a critical appraisal of a recent large systematic review of RCTs which makes it clear the opinionated-expert based guideline is wrong? Answer 13 is now e - none of the above instead of a,b and d. At least you get the tortuous appraisal to explain yourself.

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  • LetsCutTheCrap

    Dr Copperfield is insightful, pithy and I for one am in complete agreement. I wish to add that this revalidation juggernaut runs rampant outside the NHS as well. There are a number of Non-NHS Designated Bodies that have gained favour with the GMC (how???). Independent doctors have to apply to "connect" with these in order to obtain revalidation via these Hallowed Bodies.
    For this process to succeed, one has to appease a tiny (but extremely wealthy) clique of Independent Responsible Officers. These Non-NHS RO's each have created several limited companies. Employees or contracted doctors with these companies can connect with the relevant Designated body. Independent RO's thus receive generous offerings via appraisal and revalidation fees from mere mortals like us who have no option but to seek their blessing.

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  • Sounds sensible. Much better than the present system

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  • How about a monthly (you only have to return quarterly)MCQ that includes all facets of clinically current thought e.g Conditions , treatment , prescribing , NB interactions, NB NICE guidelines and so forth.
    You return it to an automated process that scores you and returns the form with referenced answers and allows you to complete again if you failed.
    This would be practical and educative.

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  • It would be all very well if our 97m£ actually detected the bad apples. It failed to detect a GP defrauding the HMRC because he ticked the box to say he was 100% honest.

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  • An exam would be a disaster. After a few years, some bright spark would say the pass rate is too high. We'd then face pressure to 'fail' more doctors and those that didn't pass would probably end up subject to investigation or thrown on the scrap heap. How would you explain to patients that the GP they trusted had just failed his exams? Would patients then demand compensation for having a failing GP? Good partnerships would be torn appart. Not only this but the content of such a test would end up polluted by whatever rubbish NICE dreamt up last week or stuff we never ever see that bears no relevance to the job. Anyone who has ever done an e-learning for health module will understand what a dispiriting experience this is. Oh and did I mention the cost of this would no doubt rise? It's simply not appropriate to make people sit exams into their 40s and 50s. At some point we have to accept we are grown ups and trust one-another to get on with it.

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  • Revalidation as it currently is arranged... stinks.
    It does not serve the purpose that it was designed to serve.
    We all despise the very word ‘reflection’ to the point that we no longer look into mirrors as we pass by.
    Appraisal itself is bad enough, and pointless too, let alone time-consuming.
    I would like to see the figures, that show, as I fully expect, that a disproportionate number of experienced mature GPs choose to hang up their stethoscopes and quit in that fifth year of the revalidation cycle, rather than go through the additional navel-gazing and self-flagellation of the revalidation year.

    Has anyone got the data?

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  • I am so Pleased that Tony Copperfield put the argument about the perils of Revalidation programme. In my honest opinion this one particular thing is costing a huge amount of time and money to NHS and individual GPs and is utterly stupid waste of time and resources.The revalidation is costing me almost 3 weeks of my clinical time every year ,and still I can describe myself as a super star. I know at least 30 of my GP colleagues given up doing locus or retired early just because of the unnesasary burden of Appraisals. It is imperative that revalidation and appraisal should be once in 5 years an should be by a written competency and aptitude test .Hats of To Tony for highlighting this issue
    The other 4 things that should go immediately to improve morale of GPs and make more available appointments for patients are
    1..Abolish QOF
    2.Abolish CQC inspections of GP practices
    3.Abolish Referral Management
    4.Abolish Local prescribing advisors/advisory groups and replace them by National Guidelines only

    I am writing this with a long career As a GP and as a member of vast number of Medical committees in the past

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  • revalidation and appraisals are de-motivational tools .I’d like to quote the medical intellectual giant Dr Theodore Dalrymple at this point: ‘In obeying directives not because they are right but because they are directives, doctors lose their self-respect, their probity and their intellectual honesty. Gogolian absurdity can result – with a hint of Kafkaesque menace and Orwellian linguistic dishonesty
    I would rather sit a5-yearly board exam ( like in the US ) , rather than this touchy-feely - dishonest nonsense. And remember folks : appraisal /revalidation data is accessible vis freedom of information acts -- has been done already by lawyers to find dirt on doctors

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  • Whenever I went to college gatherings, they would always start with some children's party exhortation to "put your hand in your neighbour's shoulder" or "stand on a chair"

    Touchy feely BS is in GP DNA

    It's why everyone laughs at / craps on us

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