Revalidation: a guide for doctors

Authors: Kathy Oxtoby 

Publication date:  28 Nov 2012

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Kathy Oxtoby outlines the basics of revalidation in the first of our series of practical guides to the process

It’s been a long time coming, but this month revalidation for doctors will begin, more than a decade after the idea was first aired by the General Medical Council (GMC) in response to concerns about some doctors’ ability to treat patients. Over the years, high profile cases, such as that of GP and convicted serial killer Harold Shipman, have fuelled a desire from both professional bodies and the public to check up on doctors more regularly. Now clinicians will need to provide proof that they are up to date and fit to practise.

What is revalidation?

Revalidation is the process by which doctors will have to show the GMC that they are up to date and complying with the relevant professional standards. All licensed doctors are now legally required to be revalidated every five years to continue practising in the United Kingdom.

The rationale behind revalidation is that the process will give patients greater confidence that doctors are abreast of the latest developments in the area of medicine in which they practise, and it will help clinicians to reflect regularly on how they can improve their practice, says the GMC.

The process requires that doctors complete annual appraisals based on the GMC’s core guidance, Good Medical Practice,[1] and once every five years the evidence from these appraisals will be used to make a recommendation to the GMC on whether the doctor should be revalidated.

Revalidation is not designed to be a “pass” or “fail” process but rather a formative developmental process that will assure a doctor’s fitness to practise and help them to identify areas for improvement. Doctors whose practice is not up to standard should be identified by the annual appraisal process and offered remediation and support through a personal development plan.

Senior clinicians across the UK will be the first to go through the process between December 2012 and March 2013. The aim is for the majority of licensed doctors to have been revalidated by the end of March 2016 (box 1).

Completing appraisals

Revalidation will be based on “a local evaluation of doctors’ performance through appraisal,” according to the NHS Revalidation Support Team, which is working with the Department of Health (England), the GMC, strategic health authority clusters, and other partners to design and support the implementation of medical revalidation in England.

During their appraisal, doctors will be expected to show that they have collected evidence for and reflected on the areas of practice outlined in the GMC’s Good Medical Practice Framework for Appraisal and Revalidation.[2] The framework consists of four domains—knowledge, skills, and performance; safety and quality; communication, partnership, and teamwork; and maintaining trust—each of which is described by three attributes.

To show that they meet the attributes in the framework, doctors will have to compile a portfolio of supporting information that they should bring to their appraisal as a basis for discussion (box 2).[3] The GMC requires that doctors bring evidence of six types of activity at least once in each five year revalidation cycle:

• Continuing professional development

• Quality improvement activity

• Significant events

• Feedback from colleagues

• Feedback from patients

• Review of complaints and compliments.

Doctors’ appraisals must cover the whole of their practice, so if they are working for more than one organisation they will need to collect supporting information that covers their practice in all those places, the GMC advises.

The GMC says it is important for doctors to provide information about their work through the eyes of those they work with and treat, because it will help them to “develop and improve their practice.”

Doctors will need to consider how they can gather feedback from patients and colleagues. The GMC suggests doctors’ employers or organisations supporting them should provide access to relevant information, although any feedback from patients and colleagues must have been collected “no earlier” than five years before the doctor is due to be revalidated and should “be relevant to the doctor’s current scope of practice,” the GMC says.

The GMC has developed questionnaires that doctors can use to help them to collect feedback from colleagues and patients,[4] which will be evaluated by their appraiser. There are many other organisations that provide feedback services, such as Patient Opinion (www.patientopinion.org.uk) and I Want Great Care (www.iwantgreatcare.org); however, the GMC does not endorse any particular companies. It is up to an individual doctor or his or her employing organisation to determine which is the most suitable for their particular circumstances, bearing in mind GMC guidance on developing and administering questionnaires, the GMC says.

Revalidation recommendation

To have their revalidation recommendation made, doctors must have completed at least one appraisal within the five year revalidation cycle, signed off by them and their appraiser. This will then need to be approved by a responsible officer. The responsible officer will come from the designated body, the organisation that is supporting the individual doctor with their appraisal and revalidation.

All doctors should identify their designated body and their responsible officer. The GMC knows the designated bodies for most licensed doctors on the medical register. The name of a doctor’s designated body will be displayed in their GMC online account.

The responsible officer at this designated body will then make a recommendation to the GMC about whether a doctor should be revalidated. The officer can make one of three recommendations. They can:

• Make a positive recommendation that the doctor is up to date, fit to practise, and should be revalidated

• Request a deferral because they need more information to make a recommendation about the doctor. This might happen if the doctor has taken a break from practice

• Notify the GMC that the doctor has failed to engage with any of the local systems or processes (such as appraisal) that support revalidation.

Doctors who do not engage with appraisal and revalidation may have their licence to practise revoked.

Different roles, different needs

All UK licensed doctors will revalidate in the same way, regardless of how or where they practise. However, doctors should consider their individual needs; those working in a particular specialty may have their own specific queries about revalidation. The medical royal colleges and faculties have provided guidance to help doctors in all the main specialties to meet the requirements for appraisal and revalidation, which can be found on the website of the Academy of Medical Royal Colleges.[5]

Recognising that some doctors do not see patients or cannot collect feedback from them through typical routes, the GMC recommends that doctors should think “broadly” about who can give them this feedback, “which may include carers, students, or even suppliers or customers.”

The NHS revalidation support team has issued a briefing to advise locum doctors about the revalidation process. The briefing advises that, as with all doctors, it is important for locums to identify their designated body and responsible officer and to inform the GMC through their GMC online account (www.gmc-uk.org/doctors/information_for_doctors/gmc_online.asp).

As with all doctors, locums will need to collect supporting information. The revalidation support team says that a locum’s place of work should assist by providing “good information about the quality of the service, and access to information systems during the period of the locum appointment.” Given that locums may practise in many organisations, the support team says that they should focus on collecting information relating to the types of role they undertake, rather than from every place of work.

Doctors in training

Doctors in foundation or specialty training will revalidate in a similar way to other licensed doctors. The date of their first revalidation will depend on either their date of full registration or their expected certificate of completion of training date, the GMC says.

The trainee’s responsible officer will make a revalidation recommendation to the GMC periodically. In England, a trainee’s responsible officer is their postgraduate dean, in Scotland the medical director for NHS Education for Scotland, in Wales the postgraduate dean of the Wales Deanery, and in Northern Ireland the postgraduate dean of the Northern Ireland Medical and Dental Training Agency.

Responsible officers will base a trainee’s revalidation recommendation on the trainee’s participation in the annual review of competence progression process or its equivalent, the record of in-training assessment. This means trainees “need to be engaged in and meeting the assessments and curriculum requirements” of their training programme, the GMC says.

Trainees should already be in regular discussion about their progress and outstanding learning needs with their supervisors. As long as they are doing this, “there is nothing extra” they need to do to be ready for revalidation, the GMC says.

Be prepared

According to the GMC, many doctors are already collecting supporting information and taking part in annual appraisals, so they should be adequately prepared for revalidation. However, the GMC knows that some organisations, and therefore some doctors, are “more ready than others.” It says, “Doctors won’t be put forward for revalidation until they’re ready, provided they’re doing all they can to prepare.”

Competing interests: None declared.

Kathy Oxtoby freelance journalist London, UK

 kathyoxtoby@blueyonder.co.uk