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Revalidation ‘worse on nine out of 12 indicators’ say GPs in official pilots

GPs involved in pilots of revalidation saw a 50% increase in hours spent on appraisals, increases in costs, and said the new system did not help them improve the care of their patients, finds an independent evaluation.

The report – described as ‘encouraging’ by health secretary Andrew Lansley – showed that GPs spent an average of 15 hours preparing for appraisals under the pilot scheme, compared with 10 hours under previous appraisal systems, and that the arrangements cost an additional £506 per appraisal.

Pulse revealed last month that GPs involved in the pilots found the process ‘unworkable’ and that GPappraisers had quit the scheme ‘en masse’.

In the official report – written by academics at Durham University and Frontline Consultants and published by the Department of Health – GPs rated the new appraisal scheme as worse than previous systems in nine out of 12 indicators, including improvements in delivery of care and identifying potential dangers to patients.

The survey showed GPs had seen improvements in the performance and objectivity of appraisers compared with the previous scheme, but mean levels of agreement with statements such as ‘my appraisal helped me understand my practice as a doctor’ and ‘I improved the way I deliver care’ fell compared with the previous appraisal scheme.

The pilots involved 3,000 doctors in total across primary, secondary and mental health care, including 923 GPs across 31 PCTs. Less than half of appraisees said they expected patient safety and the quality of care to improve because of revalidation, compared with 82% and 96% of the NHS managers involved in the pilots.

Health Secretary Andrew Lansley said: ‘It is encouraging to see that 96% cent of the pilots recognise that revalidation will improve the quality of care. It is important to ensure that the extent of the benefits of revalidation are justified in relation to the costs. These findings will allow us to identify the areas on which we need to focus in the additional year of piloting.’

‘It is essential that we work together with the medical community to have a revalidation system that is efficient, streamlined and supports high-quality care. This will provide confidence to patients, doctors and the public.’

GMC chief executive Niall Dickson, said: ‘It is really encouraging that those who took part in the pilots believe revalidation will improve patient safety. Revalidation will be built on effective clinical governance arrangements, and we know that is a prerequisite for safe, high-quality care.’

‘We have already streamlined the system following earlier feedback from the pilots, and this report will give us further insight as we prepare for roll out.’

Last month, a Pulse investigation revealed GPs involved in the pilots found the process had caused them as much as 40 hours of workload, with complaints centred around the online revalidation toolkit used in the pilots.

Notably, today’s evaluation of the pilots acknowledges ‘issues relating to the Revalidation Pilot Toolkit’ but says they will be ‘addressed separately’. It also highlights the fact that University Hospitals of Leicester NHS Trust, the only pilot site to use an in-house toolkit rather than the NHS version, found time savings.