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Revalidation pilots must trigger rethink

The IT bugs and excessive paperwork that plagued the revalidation pilots must be fixed, argues Dr Shelagh McCormick

The recently completed piloting of Strengthened Medical Appraisal (SMA) as a potential signpost for revalidation was a disappointing failure – at best.

Cornwall and the Isles of Scilly LMC was consulted in the early days, when the PCT put in a bid to be a pilot site. The idea we signed up to was that it would be a useful exercise for GPs and our secondary care colleagues, as it would not only count as that year's appraisal but might also contribute towards revalidation.

Appraisers were initially willing to be persuaded that this was a good thing – but it rapidly became apparent that the toolkit was not up to the demands placed on it.

First, the toolkit only went live several months into the pilot, wasting time when appraisers could have been familiarising themselves with the site. There were unfortunate delays in recruiting local administrative support.

Once the toolkit was accessible, it proved almost unworkable – one enthusiastic appraiser for the local trust reported spending more than 20 hours mapping his educational activities against the GMC's required attributes.

There were avoidable errors that wasted hours of time, such as pages failing to save automatically and having to be repopulated.

The early adopters and enthusiastic appraisers found the process increased their preparation time by up to 50%, leading to a dispiriting situation where those appraisees who presented minimal evidence were easier to appraise, because more time could be spent on the actual appraisal itself rather than the appraisee and appraiser getting mired in a version of Twister.

Turning back to paper

Before SMA, appraisers had been working hard to persuade GPs to use the NHS Appraisal Toolkit. But following the confusion caused by the pilot, many of those persuaded have reverted to the use of paper, since the NHS Appraisal Toolkit is no longer funded unless by individual PCTs. Concerns still exist about confidentiality of online appraisal toolkits, but in any case the pilot toolkit was subsequently shut down and all information loaded onto it was lost, despite the LMC's request that doctors should be able to transfer their evidence to another version.

Once the pilot was running, there was some funding available to encourage GPs to attend a session on how to use the toolkit. But the sessions were mostly centrally located in the county, and required significant time out of the practice, with inadequate levels of funding meaning those GP principals who attended a session part-funded the backfill themselves.

The amount of paperwork associated with the pilot seemed excessive, with everyone – appraisees, appraisers and nominated responsible officers – having to complete several forms each during the process.

Of greater concern was the mounting pressure on GPs via the PCT and appraisers to sign up to SMA – there seemed little understanding, despite the presence of GPs on the Revalidation Steering Team who were running the pilot, that this engagement relied on the goodwill of GPs and their willingness to be part of the development of revalidation, nor that all that is required of GPs currently is that an appraisal be undertaken.

This was, of course, a pilot, and the aim was to investigate pitfalls as well as strengths and weaknesses. However, the end result has been a lack of confidence by GPs in the evolution of revalidation and where appraisal fits in. There is even more uncertainty among GPs about what will be expected than there had been before.

In my view, revalidation is inevitable and desirable. But the pathway must be flexible, sensitive to circumstances and responsive. It must not be a one-size-fits-all blunt instrument.

Dr Shelagh McCormick is chair of Cornwall and Isles of Scilly LMC and a GP in Gunnislake, Cornwall