Clare Barton, Assistant Director of Revalidation at the General Medical Council (GMC), talks about the progress made since revalidation was launched five years ago.
It barely seems possible that five years have passed since revalidation began for UK doctors. I remember that day well – I was part of the team that had spent years planning this new way for doctors to assure patients they are up to date and fit to practise.
Where did revalidation start?
It’s easy to forget how challenging it was to get revalidation started. Back then many doctors never had an appraisal, and for those who did they weren’t always as thorough as they should have been.
I remember the concerns people had about how revalidation would work – indeed whether it would work.
I remember speaking to doctors and seeing a row of blank faces when I mentioned the terms ‘responsible officers’, ‘designated bodies’ and ‘prescribed connections’.
I remember colleagues hearing patients say they assumed these checks were already happening.
Yes, it’s true to say much has changed in the past five years. And in the case of patients perhaps we have finally caught up with their expectations of how things should be.
Five years on – where are we?
The most significant impact revalidation has had is on doctors’ annual appraisals. Appraisals linked to our professional standards are at the heart of revalidation and 90% of licensed doctors now have them. They really have become embedded into the way doctors work.
However, while revalidation is now in place and working, we still have a challenge with the general quality of appraisals.
Some doctors have told us they find their appraisals beneficial but we know this view isn’t universal. For some doctors the experience feels more like a ‘tick-box’ exercise. Now this may provide some level of assurance to their employer, but any doctor in this position would quite rightly feel like this was a missed opportunity to have a genuine, constructive conversation about the quality of their practice.
If the first five years of revalidation were about getting the nuts and bolts of the process in place, then the next five years has to be about getting the quality of appraisals right for doctors. A challenge that we’ll need every appraiser’s help to solve.
Collecting feedback from colleagues and patients is another revalidation requirement that some doctors can find hard. It was new to many doctors when revalidation began. It has to be gathered at least once in the five year revalidation cycle, so that doctors can reflect on how their work and professional behaviour affect others.
We know some doctors, particularly those who have both clinical and non-clinical roles, have found collecting feedback a challenge. But doctors are thinking broadly about who to approach for feedback and we have some real-life scenarios on our website to help.
We know more can be done locally to support doctors with their appraisals and revalidation, and we are making it a priority to encourage and enable this.
At five years old, revalidation is still a relatively young process – one which I’m sure everyone would agree needs to mature. We know revalidation is not perfect but we have made improvements (with the help of independent reports from Sir Keith Pearson [PDF] and UMbRELLA) and we’ll continue to take revalidation forward to give doctors and patients greater confidence that it is working as intended.