Taking revalidation forwards: improving the process of relicensing for doctors
The Association of Anaesthetists of Great Britain and Ireland (AAGBI) is the professional membership organisation representing almost 11,000 anaesthetists, the largest speciality group of doctors in the NHS.
The AAGBI welcomes Sir Keith Pearson’s report on ‘Taking revalidation forward; improving the process of relicensing for doctors’(Report) and the GMC’s statement in response (GMC response). Commissioned by the GMC, Sir Keith’s report was published in January 2017 at the end of the first 5-year revalidation cycle. In Sir Keith’s view, revalidation provides tangible, individualised and regular evidence that underpins the high standard of medical practice in the UK. His overall conclusion is that ‘revalidation has settled well and is progressing as expected’.
We endorse his emphasis on the value to doctors of the appraisal process, providing a dedicated time to reflect on individual practice and develop a personal development plan that addresses the doctor’s learning needs.
We agree with his recommendations about the information needed to inform the appraisal discussion, in particular that:
- ‘the GMC should make clear how much information doctors need to collect, what is (and is not) mandatory
- organisations should make it easier for doctors to collect this by improving IT systems or investing in administrative support teams‘
We note his observation that he ‘heard little evidence … that organisations are consistently taking note of the PDP requirements emerging from appraisal and ensuring the necessary resources are being deployed to make sure plans are being delivered’.
The AAGBI would like to see stronger engagement from employing organisations in supporting individual doctors to achieve their agreed personal development plans. Sir Keith recognises that younger doctors are not as loyal to medicine and will develop “portfolio” careers. There is a need to keep revalidation alive. He questions whether the public understand the term revalidation and suggests that consideration is given to changing the name to relicensing. The AAGBI is not convinced that a change of name will have the required impact; engaging patients would be better achieved through publicity and collaborative working with public and patient groups.
We are also pleased to note Sir Keith’s comments about SAS doctors. This groups forms over 20% of the anaesthetic workforce and, in the view of the AAGBI, must be afforded the same opportunities as other team members in respect of appraisal, personal development and revalidation. Sir Keith notes that SAS doctors now feel more empowered to ask for – and more entitled to have – a high quality annual appraisal. He recommends that activity should be recorded under the SAS doctor’s name, so they are able to identify evidence of their individual practice through their employer’s IT systems.
The AAGBI shares the concerns Sir Keith expressed about the difficulties faced by locums in gathering the necessary evidence and making arrangements for appraisal. We agree with his overall conclusion that ‘There should be more support for locums with better information sharing in respect of doctors who move between designated bodies.’ Locums provide a vital service in the delivery of urgent care in anaesthesia and intensive care, often covering overnight rota gaps at very short notice.
They work in unfamiliar environments and often get very little feedback on their performance. Yet, coming into an organisation from the outside, they can see strengths and weaknesses that someone accustomed to the culture does not identify. The recommendations are sensible:
- Locum agencies must ensure that locum doctors are up to date with appraisal
- Locums should receive timely, good quality feedback that affords them the opportunity to understand how to strengthen and improve their practice, to reflect, review their performance with their appraisers and make changes and develop as clinicans
- Locum agencies need to work with hospital trusts to share information. ROs should be able to access all the information they need to make revalidation recommendations for locum doctors
Finally, we agree with Sir Keith’s recommendations about increased involvement of Hospital and Trust Boards:
- ‘the GMC should set out expectations for board-level engagement in revalidation and provide tools to support this
- Hospital and Trust Boards should be more involved, hearing regularly about the learning coming from revalidation and how this helps to improve patient safety in their organisation. They should make sure local revalidation processes are efficient, effective and fair.’
Dr Nancy Redfern
Hon Membership Secretary, AAGBI
Dr Paul Clyburn