Keith Pearson: “I hear and share doctors concerns about revalidation”

When the General Medical Council (GMC) commissioned me to carry out a review—Taking Revalidation Forward—I considered revalidation’s primary function was to assure patients about the quality and safety of doctors.

I still believe that, but I have also gained a greater appreciation of the benefits revalidation brings to healthcare organisations and to doctors themselves. People have told me how revalidation underpins and evidences the professional standing of a doctor.

It also has the potential to help organisations—not just individual doctors—to improve the quality and safety of the care they offer. Revalidation offers opportunities for boards to get more involved and to ask more questions.

But patients should be central to the process. Most are likely to assume their doctors are subject to regular appraisals, but very few will be aware of the process or have any understanding of the role they can play.

We need to work to increase public awareness, and to open up ways by which they can provide valuable, real-time feedback based on their experiences.

Revalidation is settling in well though, and in the four years since its introduction has helped to embed regular appraisals and to broaden doctors’ reflective practice. There is also evidence of stronger clinical governance arrangements. To have delivered such a fundamental change, without major problems, is an achievement for all concerned.

But that is not to gloss over the issues which remain. I hear and share the concerns of doctors about the administrative burden of appraisals and revalidation. I am asking healthcare providers, the GMC and system regulators to look at practical ways they can reduce the time and effort needed to prepare for appraisal.

Everyone involved has to continue to work to improve the quality of appraisal and to make sure local processes are fair, but I am not recommending any lowering of the evidence requirements or the standard of assurance that revalidation provides to patients.

The priorities now are to raise the quality and consistency of appraisals, which will help make sure doctors see appraisals, and revalidation, as a valuable experience for their own development.

In order to drive up quality, healthcare organisations should improve systems to support doctors, better share information, and do more to publicise the benefits to patients, encouraging their feedback.

At the same time the GMC has to clarify its guidance in this area, explore a broader definition of patient feedback, support local governance and identify measures to show the impact revalidation is having.
My key message for all those involved is to keep a clear focus on the benefits. It is important to work together, engage widely, share information while avoiding duplication, and to ensure a consistency of approach.

We are listening to those doctors who find revalidation more time-consuming and arduous than it should be, but we should not be deterred by the small percentage who resist regulation of any kind.

Sir Keith Pearson is chair of the GMC’s Revalidation Advisory Board, which provides the GMC with advice from external organisations, as well as insight from a range of perspectives about how revalidation is working. He is also Chair of Health Education England (HEE).

Competing interests: None further declared.