Jonathan Sleath: Why revalidation for older doctors needs to change

In January 2017, Keith Pearson, chair of the GMC’s own Revalidation Advisory Board, delivered a review into the future of revalidation. For many of us, anxious for some crumbs of reassurance that this burdensome ritual would be reformed, this was a deeply depressing document. There are over 50 responses on the GMC website, almost unanimous in their view that this is a futile and bureaucratic process that is having a negative impact on patient care. In fact, apart from those employed by the appraisal and revalidation industry, it is very difficult to find a doctor who will claim that this is a worthwhile activity.

Nowhere is this felt more than amongst my own generation: doctors in their 50s who have submitted to the yoke of many years of appraisal and who have already undergone one revalidation. Every year the endless ritual of classifying, documenting, and submitting reflective documentation about the way we keep up to date seems to become increasingly tiresome. Many of us are growing weary of the process, and looking forward to the day when we no longer have to record our efforts at self-improvement. None of my patients has ever shown the slightest interest in the appraisal process.

In the BMA quarterly survey Q4 2015, nearly 50% of doctors were considering early retirement, with GPs being the most likely. In a study in 2016, over a quarter of such doctors gave appraisal and revalidation as an important factor in their decision. In the face of a GP workforce crisis, a report by the parliamentary Public Accounts Committee in 2016 urged NHS England to set out how they plan to reduce the number of GPs leaving the profession early. Yet nobody seems to be listening.

None of the GMC’s responses to the comments left on their website answer the concerns. When I wrote a letter in The BMJ about this matter. I had many replies in support, often describing battles with the GMC who seemed completely unsympathetic. I wrote to the minister for primary care suggesting that GP retention could be improved if the appraisal and revalidation requirements for older doctors could be relaxed, but merely had a response directing me back to the GMC.

The GMC’s regulations state that to hold a licence to practice all doctors are required to be revalidated every five years. The annual appraisal requirements are set by the RCGP. Currently there is no mechanism to relax the appraisal process for experienced doctors wishing to continue to practice part time after retiring from full time work. This is just the time when it becomes more difficult to collect all the evidence required because of the reduced clinical contact.

It could be claimed that the GMC has a duty to protect the public by ensuring that all practising doctors meet the same high standards, no matter how little they are working. I think that the chance of anyone posing a danger to patients who has already successfully completed a revalidation cycle is negligible. I would argue that both the GMC and the RCGP have a duty to protect the public by doing what they can to maintain an adequate clinical workforce. This includes ensuring that by their actions they do not encourage the loss of capable and skilled doctors. They are manifestly failing in this duty, and together with NHS England and Health Education England need to come up with a solution quickly to avoid a continued ebbing away of experienced older doctors from clinical activity.

Jonathan Sleath is a general practitioner at Kingstone, Herefordshire, and is a member of the RCGP overdiagnosis group. 

Competing interest: I intend to retire shortly from partnership but wish to continue to work part time.