Review Criticises Appraisal and Revalidation Process for GPs

A review conducted by the GMC regulator has found that appraisal and revalidation impose burdens on doctors that are too severe.

It is common for healthcare professionals to be asked to complete activities which are above and beyond the requirements of the GMC, the review concluded.

And clarity around the process for locums is equally problematical, with local organisations needing to be more proactive on the subject.

The report also raised concerns that GPs in particular face duplication of work because information they must collect for appraisal and revalidation is required in a different form by the Care Quality Commission.

But despite concerns, the review led by Sir Keith Pearson to mark the end of the first three-year cycle of revalidation found that the process “has already delivered significant benefits”.

The introduction of revalidation had tackled the long-standing issue that unless a serious concern was raised about a doctor, they could “practise from registration to retirement without any check on their performance or competency”, the report stated.

There was also evidence collated by the report that the appraisal process has strengthened clinical governance within the NHS.

And it is encouraging that 90% of doctors have undergone appraisal and that 95% of these had done so in the past year.

“Despite appraisal being a contractual requirement in the NHS for many years, annual appraisal rates in England in 2010 were just 36% for SAS doctors, 64% for consultants and 73% for GPs,” the report notes.

Pearson suggested that “throughout the course of my review I have repeatedly heard that revalidation has been the catalyst for increases in appraisal rates across all settings.”

Pearson cited evidence from the BMA that structured annual appraisal “prevents a doctor’s skills becoming so out of date that they become subject to formal competency procedures without being given the opportunity to put things right”.

Nonetheless, 40% of doctors say revalidation has had a positive impact on their clinical practice, despite the negative experiences of some.

But Pearson was keen to acknowledge those with concerns.

“I hear and share doctors’ concerns about the cost and administrative demands of the appraisal and revalidation process. I am asking healthcare organisations, the GMC and system regulators to look at practical ways they can reduce the time and effort needed to prepare for appraisal.”

Commenting on the issue, BMA chair Dr Mark Porter questioned how the report’s recommendations would be put into practice.

“The vast majority of doctors are good doctors – they have the skills, experience and expertise to deliver first-class care. While many of the recommendations will be broadly welcomed by doctors, it not yet clear how this how these will be turned into a reality. The BMA will continue to press the GMC and other bodies about the actions needed to relieve the unnecessary burden that revalidation can sometimes place on doctors, in order to ensure the process delivers for patients, doctors and the NHS.”


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