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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)

  • Appriasals would be Ok if they were every two or three years. Once a year is pointless.

    The lastet blurb from GMC really stuffs it up for doctors who want to work overseas (that includes British overseas territories), with loss of license even if you keep up appraisals. Loss of license means loss of place on perfomers' list and getting back on that might be very costly.

    I am not sure why GMC have made subtle changes to the wording giving such a devastating effect; seeking to discourge GPs to work abroad and gain experience, or work most of the year abroad and in then UK, and also discouraging GPs in Australia New Zealand and Canada to come back. Very odd.

    The new wording would also seem to prevent superspecialists such as those coming over from for a few days (say from USA)

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  • I seem to remember being told on day 1 at medical school that first we must do no harm?? Perhaps they missed that talk

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  • Who pays me for spending 50 hours updating myself &,the hours spent writing it up on clarity toolkit & 2 hrs spent with the appraiser to tick boxes

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  • Took Early Retirement

    Happy- "It's all in your global sum"- as I remember being told when urging people to vote "no" to the con-trick of c 14 years ago now. 80% of GPs disagreed with me.

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  • Some stupid idiots in this system need to do 'RESEARCH' for a couple of years after making crucial decisions that adversely affect the Health Community only to find what was evident from the outset to the ordinary health professionals. And that is why they are in the chairs where they are:) Forgive them o Lord for they do not know what they thought they know:)

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  • Appraisers esp retirees who see this as being an easy way of making some money on the side without having to deal with patients should also do some soul searching - never too late and can be done at any age. Some certainly believe that this is beneficial and do it in good faith, I am sure, but then would like to reconsider the sense in this exercise now that GMC mentions it is a waste of time.

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  • That’s really making me feel so much better....not. After the worry and anxiety that appraisals caused me which paled into insignificance compared to revalidation (which incidentally I got through without any criticism)they now tell me that it didn’t reflect my professional competition!
    I finally jumped ship a few months ago as the oldest working GP in my region at age 65 but with my head held low. As a result all those years seem wasted in a profession that has lost direction even if it was enforced.

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  • Oops I meant professional competence!

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  • Come along children, you are not playing nicely.

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  • I never believed in appraisals. I Just do it with my foot and not my heart or my head.
    About time it is abolished and let GMC be appraised instead.

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