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Lessons from the pilots

Keep the GMC’s requirements in mind

Dr Stephen Scott is a GP in Dorchester, Dorset, and an appraisal lead. He took part in the original pathfinder pilots
Bear in mind that the GMC bar is what you will be revalidated against, and that bar is much lower than the one set by the RCGP. The college’s bar is what you might wish to aim for, but the GMC requirements are ones that most GPs should be able to demonstrate.
For example, the college expects you to do 50 hours of CPD in a year and two significant event analyses, whereas the GMC refers to CPD appropriate to your work, and quality and improvement activity every year. This quality and improvement activity could be case-based discussion about what you are doing.

Don’t worry about the IT and workload
I was involved in the pathfinder pilot of revalidation in Dorset in 2010, and it was appalling, because the IT requirements weren’t right. But the pilot did what it was meant to do and enabled change, and what is happening now is much better. To prepare for your appraisal shouldn’t take more than one session – that is, three to four hours.
If you are a locum, you don’t have to take a week off to update – it has to be proportionate to your work.

Try not to think of appraisal as a hurdle
Make appraisal useful – use it as time to stop and think. It is not about ticking a box, but about talking things through, and that should be helpful. In my area, appraisal has helped to retain GPs who were considering leaving. It can also prompt people to retire or reduce their working hours because they are burning out. It is not a huge hurdle and you can’t fail. The appraiser is simply there to appraise you and make a recommendation to the responsible officer. The appraiser is not judge, jury and executioner – that role belongs to the GMC, as it always has.

Focus on the positive

Dr Seema Jani is a GP in Denham, Buckinghamshire. She was involved with the pilot of the Medical Appraisal Guide last year
Appraisal can be seen as a chore and there can be a lot of negativity about it. However there are benefits, in improving care and improving your confidence. It’s definitely helped me, and I think it will improve the standing of the profession and public confidence in us.

Keep a regular learning log
I have got into the habit of keeping a learning log, just in a notebook, but you could keep one on a computer. This has helped me address PUNs and DENs – patients’ unmet needs and doctors’ educational needs. I don’t put in any patient-identifiable information, just a note about the condition and the outcome and what action I took. It can be difficult to keep those interesting cases in your head, so if you jot them down, you won’t forget. This shows you are reflecting on cases and changing your practice, and is the type of thing that the appraiser will want to see.

Get advice locally
Look for local educational meetings and ask your appraiser about, for example, methods of conducting 360-degree feedback. Make contact early so you have time to get started. Speak to colleagues – it is important for doctors to get together.

Don’t panic
Appraisal for revalidation is not as difficult as you think and the appraisers are there for you. It’s not an exam!

Make time to think about your learning needs
The stressful part for me was being so busy and having to focus my mind on gathering evidence. However, it makes you think about your learning needs and when you have a deadline, you go out to educational meetings and it is good to do so. It’s just about making time and prioritising.

Constantly look for gaps in your knowledge

Dr Graham Edlin is a GP locum in London, and took part in a revalidation pilot last year
For revalidation, you need to review your education, look for gaps in your knowledge and fill them. This is not a one-off exercise; over the whole year you have to be focusing your mind on it. This does represent a change in the way we work, from how it used to be 10 years ago.  We have to do this consciously – and have to be seen to do it.

Be up-front about complaints and mistakes
We all make mistakes and we have got to be honest about it. It’s a whole process, asking whether we are practising in a way that is helpful to patients, in our attitude and practice.
You need to put mistakes and complaints into the evidence you present and say what you are doing about them.

Get feedback from your patients
Feedback from patients is a key part of revalidation. Even if you are a locum, there are ways to get patient feedback. I have used the American Medical Association’s tool for allowing the patient to rate you. If you just do one session at a practice it could be more difficult, but I might do a run for a period of time and can collect feedback.

Use an audit appropriate to the way you practise
As a locum you can do a small-scale audit of your work. Practices will help as they will see the logic in it. I have audited my referrals, going back to the practice and asking for the outcome of referrals to see if I am working in a sensible way. You don’t refer unless you can’t deal with the problem or don’t know what it is, so you get a bit of education. It is a learning experience.

Remember, dramatic consequences are unlikely
Revalidation is nothing really terrifying. If the appraisal is done to standard, any concerns should have come up with the responsible officer before revalidation and revalidation is the final stop. I think practice has changed because revalidation is taking place. If you start looking at something, you change it. There are already structures in place for remediation, such as being mentored – I have mentored an individual to help ensure that their practice was up to standard. Remediation is there on paper but whether it will work in practice is another matter.
I don’t think we have anything new coming in, we have had a steady build-up that has put these checks in place. It won’t be a dramatic result because everyone has moved in anticipation.

Don’t worry about your appraisal…

Dr Funmi Chirnside is a GP and principal medical officer at Northwood HQ in Hertfordshire. She took part in a revalidation pilot last year
Before the pilot I was really worried; you can read and read about something but still you don’t know what it is going to be like. Having done it, I now think ‘Wow, how easy was that?’
It is nothing to be frightened of at all. Most doctors are good doctors and try to improve their practice, because they want to do the best for their patients. The appraisal process just proves that you have done it.

… But don’t leave it till the last minute
You will have to bring along evidence to your appraisal, such as certificates of attendance for courses. The key thing to it is keep collecting evidence all year long. Don’t leave it all to the last minute.
Put everything into your file as you go and you will have more than enough evidence.

Keep everything in the right order
Keep all your documentation in date order. Otherwise you can spend 10 minutes trying to find things during your appraisal. So, if you went to a meeting, file your notes under the right month. You need some sort of system for knowing where everything is. Put key documents that the appraiser will want to see where you can easily get them. 

Don’t overload your PDP – and consider putting in something fun!
When I started having appraisals I would put too many things in my personal development plan and my appraiser pointed out that it might be better to focus on just a few. I’ve also been recommended to put in a fun thing – we all have lives outside work.

Get the most out of it
Overall I did not find that this was a tick-box exercise, I have had valuable advice from my appraisers and have learnt from the appraisals I’ve given to colleagues.

What are your expectations of the revalidation process? If you’ve been through a pilot, what advice would you offer colleagues?