GPs resent revalidation 'vacuum'

GPs feel disgruntled about working towards a half-formed revalidation system. Prisca Middlemiss reports.

Does anyone really know what is happening with revalidation? The RCGP says you should now collect evidence for your e-portfolio in the expectation that the process will start in April 2010.

But on the other hand, no one can tell you for sure when revalidation will really begin.

Last month, the GMC's UK Revalidation Programme Board admitted that 'the first doctors would not be revalidated until at least the first quarter of 2011'.

Revalidation would not even start then 'if all the necessary components' were not in place.

The DoH also expects revalidation to start at early adopter sites in early 2011.

Lack of detailed plans
As for the evidence that GPs will have to supply, no one has decided what the new (revised/enhanced/effective/strength-ened) appraisal will be called, still less what it will entail.

The DoH is expecting pilots testing the practical requirements of new appraisal to start later this year.

RCGP revalidation lead Professor Mike Pringle says the college is 'trying very hard to provide information' as revalidation develops. But definitive advice will come from the DoH and GMC, he says.

In the meantime, the RCGP says GPs only need to collect evidence 'for annual appraisal'.

The RCGP has gone furthest to tell GPs what revalidation will mean. Under its proposals, every five years GPs will have to undergo five appraisals followed by personal development plans and reviews; assess themselves on 250 learning credits; undergo two 360 degree assessments and patient surveys.

They will also have to analyse five significant events and undertake two standard audits.

Yet the detail of what supporting information will be needed, the clinical governance systems, NHS readiness, where the threshold will be set for failure and what happens after failure has still to be decided.

Small wonder that an uncertain profession feels disaffected. So disaffected, in fact, that out-sider and locum GP Dr Una Coales is currently challenging Dr Has Joshi and Dr Iona Heath in a three-way contest for the RCGP presidency (voting closes today) on an anti-revalidation ticket.

'I hope more than ever the college will shelve revalidation for now,' Dr Coales tells GP.

The GMC is aware of the profession's worries. When it consulted on introducing licences to practise, many replies came with 'comments that confirmed an appetite for further information about revalidation and, in the absence of that information, a measure of concern'.

BMA chairman Dr Hamish Meldrum has warned the programme board about 'vacuums of information' and says it is vital to 'be proactive in providing reassurance to the profession'.

Late deadline
Yet the programme board has only timetabled letting doctors know how and when revalida-tion will work and ensuring that they are preparing for it to begin at the end of 2010.

The timetable allows for three waves of pilots commissioned by the NHS Revalidation Support team to make sure the system is workable. The pilots will run until 2011.

Meanwhile, the profession remains uncertain and big questions are unanswered, such as who will pay. GPs will pay in part, Professor Pringle says, but how costs will be shared with NHS bodies is yet to be determined.

GPC member Dr Kailash Chand says: 'Support and resources must be in place if revalidation isn't just going to be a stick to beat doctors with.'

Wales has specifically raised lack of resources as a risk to revalidation. 'The information the profession needs is not there,' Dr Chand points out.

What do I need to do?

  • Make sure you have annual appraisals.
  • Make sure you are familiar with the RCGP guidance.
  • Learn to use an electronic portfolio.
  • Keep up to date with what is happening in revalidation.

Source: NHS Revalidation Support Team.

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