GP leaders reject claim that revalidation is building doctors' confidence

GP leaders have disputed GMC claims that revalidation is boosting doctors' confidence, arguing that findings from an analysis of post-appraisal feedback are not representative of the profession's views.

GP appraisal (Photo: iStock)
GP appraisal (Photo: iStock)

Results from an independent report last month showed that more than two fifths of GPs changed their practice, behaviour or learning activities after their most recent appraisal.

The GMC said the report, part of a long-term assessment by the UMbRELLA group, which compiled feedback data from doctors, showed that revalidation was having a ‘positive impact’.

In response to warnings from GPs that revalidation was driving doctors to practise defensive medicine and make changes to appease appraisers, the GMC pointed to analysis in the report on how doctors had changed their practice.

UMbRELLA analysed responses from a 10% sample of the 26,000 doctors – including 7,000 GPs – who provided feedback for the survey to assess how they had changed their practice following appraisal.

It suggested around a third (32%) of doctors reported that their last appraisal had helped boost their confidence. One in five (21%) said it had improved their clinical knowledge or practice, while 14% said it had improved their organisation.

Effects of revalidation

But GPC deputy chairman Dr Richard Vautrey said he did not think revalidation ‘had anything to do’ with raising doctors’ confidence.

‘I think they're pleased that it’s a hoop that they've manage to jump through,’ he said. ‘But it’s the engaging in continuous learning that helps GPs to improve what they're doing – and that's really got nothing to do with revalidation.

‘Revalidation demonstrates to the wider public that doctors are keeping up-to-date, but it in itself doesn’t do that. I think it’s the clinical professionalism of doctors that leads to them wanting to improve their skills and continue to learn and develop.’

The UMbRELLA report acknowledges some ‘scepticism’ among doctors as to the benefits of revalidation.

The majority of GPs (59%) reported that they had made no changes following their most recent appraisal.

After once again analysing a 10% sample of this group, the researchers found that 55% said this was because nothing had been identified as requiring change. One in eight (16%) said they automatically reflect and make changes anyway.

Changing practice

Dr Vautrey said: ‘We should be very cautious about interpreting any information that comes out of the post-appraisal questionnaires.

‘A lot of people are far more supportive when providing feedback as part of the appraisal process than they otherwise would be because they don’t want to undermine their appraiser and they want to maintain a good relationship with them.’

He added that it was ‘certainly quite possible’ that doctors were being driven to make defensive changes to avoid being sued rather than positive ones.

‘Many doctors who have been through a difficult complaint or even faced the risk of being referred to the GMC are aware of the rising number of complaints which has led to increased indemnity costs. So the risk is that you get much more defensive medicine, which ultimately isn’t good for patients and it costs the NHS more in the long run.’

The report also found that 43% of doctors do not believe revalidation has led to improved patient safety, compared to 20% who do. Half (46%) said they thought the system would fail to pick up failing doctors.

A similar survey by GPonline in January found that 77% of GPs did not believe revalidation made the profession safer.

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