jose photo.jpegFollowing Sir Keith Pearson’s review of revalidation, we’ve been working with others to explore ways to increase the awareness and involvement of patients in revalidation. Dr Jose Mathew, Deputy Medical Director and Responsible Officer at North West Boroughs Healthcare NHS Foundation Trust, tells us how they involve patients in revalidation.

We know how valuable involving patients in revalidation can be. Greater public and patient participation ensures greater transparency, engagement and helps to build trust. Patient feedback can help us to improve our practice and become a more caring doctor.

When I first did 360° multisource feedback for my revalidation, I was surprised to find that patients were very keen to provide feedback and they were generally positive about being involved. Hearing from my patients has been very worthwhile, and a really constructive experience for me.

But one of the challenges of involving patients in revalidation is that many don’t even know that it exists. Or if they have heard about it, they don’t really know what it is. Some patients only ever hear the word when they’re asked to complete a questionnaire about their doctor. If appraisal and revalidation is a means of ensuring safer, high quality care for patients, what good is it kept hidden away from the people it’s meant to reassure?

We can all take steps to raise awareness of revalidation and involve patients and the public more in annual appraisal and revalidation processes. The GMC along with healthcare organisations should work together on a meaningful and focused campaign to promote this. And some of this work has already started.

How do we involve patients in revalidation?

At our Trust we firmly believe that involving service users and carers to improve our services is the way forward. We value the knowledge and skills they can bring, drawing on their own experiences to tell us how we can improve quality and patient care.

Earlier this year we published a video about annual appraisal and revalidation. We asked lay people and experienced service users from our involvement scheme to talk to our doctors about their revalidation experiences, and reflect on what revalidation and appraisal means for them. The feedback I got from patients was that it was very informative and a useful session for them. The doctors who took part felt more empowered to involve patients in their work.

We have also identified other ways to engage the public in revalidation including:

  • presenting the annual appraisal and revalidation report at the public section of the Trust board meeting
  • delivering a session on appraisal and revalidation at the service user and carer forums
  • dedicating a section on our website for revalidation
  • publishing the Annual Organisational Audit.

Addressing some of the challenges

Digital solutions can help to reduce burdens

Using simple online portfolios and feedback tools help us to have standardised patient feedback. Our organisation uses the ‘Allocate’ e-portfolio for appraisal with 360° multisource feedback built in. I have found it to be very user friendly and it provides useful benchmarked data.

I firmly believe having better digital solutions in the future will simplify the process and make it less burdensome on patients and doctors. It will help to capture live, real-time feedback. The solutions have to be focused on the patients in question. For example a young person may find using an app on their mobile device more appealing than a detailed questionnaire. For some of us in England, the NHS digital exemplar and fast follower programme, which aim to develop the information management platforms of organisations, will allow us to produce better performance metrics for doctors. And they will help to triangulate service level feedback with individual feedback. This will produce live, meaningful data for doctors and enable them to improve their practice and patient interactions.

Supporting patients to give feedback

Patients can sometimes find it difficult to provide negative feedback about their doctor. They may be worried that negative comments would upset their doctor or affect the care they get. It’s therefore important that we let our patients and their carers know how valuable their honest feedback is. We must reassure them that feedback is confidential and that by telling us what we can do better will help us to improve our practice.

Some patients find it challenging to complete a written questionnaire because of the nature of their health issues. I work with patients who experience cognitive impairment and they can find it difficult to give me detailed written responses. It was really important that I simplified the process and actively involved their carers so I could get the most meaningful and valuable feedback. The GMC have a number of case studies to help you think about how you can adapt your approach to getting feedback from your patients.

We must aim to make appraisal and revalidation not just a doctors concern but a public concern. And I believe this will help strengthen trust in the profession and allow us to provide better care to our patients.

Dr Jose Mathew
Deputy Medical Director and Responsible Officer

Guidance to help you promote patient and public involvement in revalidation

We have recently published a simplified explanation about revalidation that organisations can use in their own materials created for patients and members of the public. The explanation was developed with focus groups to make sure it is easy to understand and has the information that patients want and need to know. There is also a leaflet that can be given to patients when they’re asked to give feedback about a doctor for their revalidation.

We have also published two case studies showing how organisations involve patients in revalidation.

Milton Keynes University Hospital Trust has two lay members on their Revalidation committee, who help to provide quality assurance from a lay perspective. Along with other members, they review individual appraisal portfolios, prepare recommendations for the responsible officer, and provide ratings and feedback to appraisers.

Read: Quality assurance from a lay perspective: Milton Keynes University Hospital Revalidation Committee

Nottingham University Hospitals Trust has a lay member on its Medical Appraisal and Revalidation Advisory Group. They make sure that appraisal and revalidation processes are informed by the perspective of patients and the public.

Read: Designing revalidation processes using lay expertise: Nottingham University Hospitals MARAG

In his Taking Revalidation Forward report Sir Keith Pearson made some practical suggestions about how organisations can involve patients. They include inviting patient groups to look at how revalidation works locally, asking patient groups to provide an assurance statement annually, and involving lay representatives in the appointment of appraisers. You can read more about this in chapter three of the report.

If you have examples in your own organisation that you’d like to share, please speak to your employer liaison adviser.