Older Mind Matters

Portfolio doctors – designated as different

Appraisal and revalidation (introduced in 2012) are serious worries for people like me who are portfolio doctors. (See this link for the General Medical Council’s resources on appraisal and revalidation.) The theory is that doctors should be required to demonstrate that they are up to date, fit to practise, and providing quality care – I have no problem with those aims, but the system has caused me anguish and sleepless nights. So I was interested to read two recent reports. One looks at organisational changes and impacts related to revalidation. The other is an interim report from UMbRELLA led by Plymouth University, part of a 3 year study on the impact of revalidation.

The interim report gives details of a survey of licensed doctors that resulted in these findings:
· 16.7% response rate (approx. 26,000).
· Fewer than half the respondents (41.8%) agreed that appraisal is an effective way to improve practice.
· Fewer than a third (32.3%) believed that revalidation has had a somewhat or very positive impact on appraisal.
· Most (57.6%) had not made changes to practice, professional behaviour or learning in response to their most recent appraisal.
· Reported scepticism as to whether revalidation led to improved patient safety.
· Most Responsible Officers felt that the number of concerns about doctors had not increased since revalidation was introduced.
Not an enthusiastic endorsement of the system to put it mildly!

I have a portfolio of work encompassing clinical work, therapy, research, teaching and training, consultancy, and work I class broadly as safeguarding-related activity. I aspire to high standards and invest time, money and effort in my continuing education and development (despite having retired from my NHS consultant post). Most of us are our own most stringent critics, imposing high standards on ourselves. For me, retirement from the NHS brought the opportunity to redesign my working life. Yet the GMC’s assumption appears to be that I am suspect, maybe even “rogue”. The tone of their correspondence feels, when you’re on the receiving end, to be threatening and critical.

I have struggled to find a designated body to belong to. I managed one appraisal whilst in a locum post, but I didn't redesign my life to do locum posts. Now I’ve joined the Independent Doctors Federation, which has a quality assured appraisal system, and I’m about to have my first appraisal with them. It’s a relief for me to find somewhere to belong, and I appreciate the careful detailed processes they have developed, but it involves me in considerable expense and I would question the benefit in terms of my practice – though I still think it’s worth it for my peace of mind.

In all this evaluation of appraisal and revalidation, who is looking at the doctors who give up medicine because the revalidation system has become too difficult and because they feel the GMC’s communications are intimidating and imply that we who are different have done something wrong? Who is looking at the impact on individuals?

Explanatory notes:

  • Designated Body – generally an organisation that employs doctors.
  • Responsible Officer – the person in the organisation responsible for implementing revalidation processes/ systems.


2 comments (Add your own)

1. Emyr wrote:
I've interacted with the GMC over a number of matters because of my role in medical student examinations and student fitness to practice matters, and I find their way of doing things very reminiscent of government departments I interacted with about 15 years ago in respect of organ retention matters (I'm a histopathologist, and at that point, I was in charge of a large autopsy service in a teaching hospital). Put very simply, the approach was that they, be it the Ministry of Justice, Department of Health or the GMC, made the rules, and we had to make them work, no matter how ridiculous they were.

Now, I'm not suggesting that the fact that the GMC is funded almost exclusively by doctors should change the standards of practice they ask us to follow, or that it should allow us the right to bend the rules. However, I think it should have some responsibility towards facilitating our attempts to maintain and validate those high standards.

With power should come responsibility. Or is that now a naive thought?

Wed, June 15, 2016 @ 8:30 AM

2. Dave Jolley wrote:
Revalidation and Portfolio Doctors
Yes – it is as you say a frustrating situation. I am sure that there should be an in-house (GMC) system for the appraisal and revalidation of doctors who chose to work as you do. Many, like you, provide extraordinary skills and experience which complement and enrich the clinical services provided within the mainstream of NHS appointments. Indeed having an independent cohort is a healthy balance to the risk associated with inbreeding and slavish accountability to management-led rules amongst NHS employees.
It seems to me that the values which inform appraisals are often questionable – highly qualified, obviously motivated and able doctors being required to spend their time away from productive clinical or academic work simply to attend days of ‘training’ in how to sit or walk or write their names on a paper
The process could be led and conducted by clinicians and the content restricted and tailored to the needs of individuals.
I would think the research you quote should be decommissioned as useless – such a low response rate means that any ‘findings’ will be dismissed as unrepresentative. It is interesting though, that even in this flawed exercise there is so little credibility being given to the current expensive and potentially damaging procedures. It would indeed be informative to discover more about the loss of doctors from clinical practice which has followed the introduction of the scheme – and the morbidity associated with the process even for those who survive it.
I would not say that my eventual retirement from clinical work was attributable to stress from these processes – there were other considerations and I am happy to continue to use my experience and knowledge in other forums.
Also to say that the fierceness you describe from the GMC in this matter contrasts with my experience of them when I acted for a short time as a psychiatrist asked to assess and support doctors whose fitness to practice had been questioned. I encountered rouges and incompetents who had been supported by others in my role over several years. My view was that most should be taken off the register for their own and everyone else’s peace of mind – and that this should have been done years ago

Mon, June 20, 2016 @ 11:47 AM

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