Medical revalidation may be exacerbating the GP workforce crisis by reinforcing dispirited doctors’ intentions to leave the profession, analysis of 1,200 GP survey responses suggested.
The GP researchers have called for an urgent review of revalidation processes to ensure they are manageable and fair in light of the findings – which could include tailoring the process more closely to the stage doctors have reached in their career.
They warned that revalidation is often the ‘final straw’, pushing GPs nearing retirement out of the profession against a backdrop of declining morale and soaring workload pressures.
The survey, carried out last year, found as many as two fifths (42%) of GPs intended to leave general practice within the next five years. The researchers looked again at these results in the current study, published in BioMed Central, analysing free-text responses from respondents on reasons for wanting to leave or retire from the profession.
They found that three quarters (72%) of the GPs making complaints and expressing concerns about revalidation and appraisal were over the age of 50, compared to 46% of the sample overall.
These GPs were also almost twice as likely to have had at least 20 years of experience in general practice.
Three quarters (72%) of the GPs who made comments about revalidation indicated they wanted to leave the profession over the next five years.
In response to a direct question, a third (29%) stated that appraisal and revalidation was ‘very important’ or ‘important’ in their decision to leave.
One respondent, in their 40s, described the processes as ‘one of the most depressing parts of general practice’, while another in the same age group said it ‘hugely negatively impacts on my time and morale’.
A GP in their 50s said they felt subjected to ‘invasive scrutiny’ from the process, which was described as ‘stressful and devoid of much real meaning’ by a freelance GP over 70.
The authors said: ‘Through its impact on GP morale and burnout, the current appraisal and revalidation system in England appears to be contributing to the workforce crisis.
'The findings indicate that the appraisal system may be in urgent need of re-design to increase its relevance to individual GPs’ experience and seniority, clinical activities being undertaken and professional development needs.’
They added that it is ‘particularly an issue’ for GPs aged 50 and over and those working part time. ‘The findings suggest that appraisal and revalidation is currently viewed by such individuals as inflexible, laborious and lacking relevance.
‘There appears to be a need to tailor appraisal more closely to the stage of career that the GP has reached, as well as the varied activities undertaken by GPs with portfolio careers, locums, part time doctors and others who may find it harder to produce the currently required evidence.’
GMC chief executive Niall Dickson said: ‘Annual appraisal was a contractual requirement for GPs long before revalidation was introduced – we are keen to make sure it contributes effectively to revalidation and does what it is meant to do as part of that process, which is enable GPs and other doctors to reflect on their practice and provide assurance that they are competent and up to date.
‘We have commissioned research into the impact of revalidation as well as an independent review led by Sir Keith Pearson. These are early days but we can see that it is starting to make a difference in appraisal rates, bringing doctors who were not part of a governed system into the process and helping to highlight problems at an earlier stage.'