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.