Revalidation

The first two actions were swiftly carried out with the College issuing a statement calling for a flexible appraisal restart and for GPs to have access to wellbeing support independently of appraisal. This was shared with stakeholders across the UK.

The College then considered how to respond to the third ask within resource and time constraints. It was first agreed to arrange a roundtable discussion with internal and external colleagues to understand the issues, as well as the background to appraisal and revalidation, in more detail. The roundtable, held in November 2021, also considered the extent to which a new ‘streamlined’ appraisal model – Medical Appraisal 2020 – had addressed concerns previously expressed by Council.

The new appraisal model consisted of a reduction in requirements for pre-appraisal documentation and enhanced emphasis on supporting doctors’ personal and professional development. Its implementation has been largely focussed on England, but some aspects of the new model are already familiar to appraisal systems in the devolved nations.

In April of this year we asked our members throughout the UK about their recent experience of appraisal (PDF file, 270 KB). Over 1,600 responded, with three-quarters of them telling us that their most recent appraisal had followed the new streamlined Appraisal 2020 model.

In general, the results of the survey showed members were more positive about the benefits of their appraisal if it had been structured around the new model. For example, of those who had taken part in the new appraisal model:

• 77% felt it was a useful chance to confidentially discuss their work with someone who understood the challenges
• 64% agreed that it allowed them to demonstrate that they continue to meet the principles of Good Medical Practice (GMP)
• 52% believed the time taken was proportionate to the benefit.

We also looked further afield to see what the regulation of doctors looked like in other countries. We found that there are now very few European countries relying solely on the responsibility of doctors themselves to ensure they remain fit to practise, with CPD now mandatory throughout most of the EU.

Finally, we explored key areas of appraisal which had raised the most concern. We looked at the intended purpose of appraisal as an input to the revalidation process, the perception of appraisal as a ‘screening tool’, the value of the health and wellbeing discussion, the burden of supporting information, the likely time, quality and resource implications of alternative approaches, the idea that one size may not fit all when it comes to revalidation requirements, and whether appraisal was linked to retention.

The results of these investigations, together with key findings from relevant external evaluations, were shared with Council last month. Council supported the recommendation that the College should support a streamlined model of appraisal as opposed to an alternative input to revalidation, such as an examination. However, recognising that members’ experience of appraisal is not uniformly positive, Council also agreed that the College should advocate for learning from best practice, including from the UK nations, and for more consistent training and quality assurance of appraisers.

We’re getting to work on updating our existing resources to ensure they reflect a streamlined, professionally led, and supportive model of appraisal. We will also work with stakeholders to encourage changes that will make sure all GPs receive supportive, high-quality appraisals.