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Recently I cried at work. Why? Because the evening before I’d been notified that my appraisal, submitted after hours of work, had been unsubmitted by my appraiser as it was ‘not sufficient for revalidation’.
I was gutted. My mind churned with a mixture of thoughts ranging from anger to fear, through frustration and disappointment. Sleep had been impossible.
Contrary to all the reassuring emails and letters my revalidation experience is proving to be a nightmare and extremely damaging to my psyche. As a freelance locum GP I receive no remuneration for the hours of study and preparation. I would have to pay for any courses myself and am already struggling to justify the financial costs of continuing to work.
Ironically my appraisal is full of green ticks indicating appraiser comments. When opened all of them are negative and they might just as well be red crosses. What is particularly galling is that, as far as I can see, there is no facility within the toolkit for me to respond to these criticisms.
I would like to explain the limitations imposed on doctors working in practices that are not ‘their own’, how difficult it is to conduct a valid audit when one only works ten weeks of the year, how impossible it is to follow up on referrals when letters from consultants arrive long after one has left the practice.
According to my appraiser I have failed to reflect, have not ticked the boxes for the GMC domains, and have not provided evidence. Why do I have to produce evidence? If I say I have done something I have done it – I am a doctor and inherently honest. I constantly ‘reflect’ and often find myself thinking of particular problems, and solving them, away from work.
I could only record one significant event which, I admit, isn’t really significant although it offered learning point. What am I supposed to do? Make one up? I have since been informed that significant events can be positive so I should be able to add more to this section. I will, however, have to leave empty the complaints box - I haven’t had any complaints in 43 years of working.
According to my appraiser research and learning as a result of personal experience cannot be counted. Why not? Which is more likely to result in effective learning: research undertaken for a specific reason or sitting in a meeting for three hours?
At a time in my life when many doctors are fully retired, many because they can’t take the agro involved in revalidation, I had hoped to continue doing GP locums during the school holidays - as I have done in the same two practices for the past ten years.
My colleagues tell me that I just have to ‘jump through the hoops’. I am fitter than average and still enjoy racing rafts and playing tennis but at this stage in my life I don’t want to learn how to jump through hoops.
Adrienne Garner is a GP locum from Hertfordshire
Share your views and experiences of revalidation in the comments section below
Once I worked out that "reflect upon" was simply a phrase meaning "think about" and was only used by people that wanted to intimidate me with jargon the whole thing became a lot easier to understand.
I better start now. It is difficult me also as I do not follow people up. I see once and hand back to the GP to investigate. Local audit of practice will be impossible though I am involved nationally. I do not prescribe. I see difficulties ahead!
This is a train crash for locums. Eventually all the experienced doctors , nearing retirement, but doing a few locums to 'keep their hands in' so to speak, will pack it in as the appraisal /revalidation hoops disappear beyond reach. What then... a shortage of locums. To be filled ...how? Good experienced doctors all gone, only one option, EU locums, not used to our systems and cultures, here today and gone tomorrow.
What is the answer , please, Dr Nagpaul?
The processes of appraisal and revalidation are intended to be positive and constructive. When they become negative and destructive, the system fails, and fails the applicants. People will just learn how to "game the system", or worse still withdraw from it, squandering valauble resources.
Each of us should be revalidated with respect to the jobs we do, and the roles we fulfil. So an administrative doctor, who deals in policies and may do very little, if any clinical work, should be viewed from that perspective.
A locum should therefore be viewed as a locum, and assessed accordingly. Was the appraiser competent to do this? They certainly did not demonstrate many of the GMCs qualities as set out in Good Medical Practice in the way that the appraisal was communicated to the victim.
The whole appraisal and revalidation will soon become another intimidation tool to keep Doctors under control to beat them into submission and allow managers to monitor doctors performance.
It started for me as a positive experience a while ago but I can see the direction of travel and it is not what I look forward to.
Maybe there should be a national audit of doctors experiences on revalidation with findings that could advise GMC on future changes required.
I agree that the appraiser - or the appraiser's mentoring - seems to be at fault here.
It is fear of this situation that will encourage many valuably experienced GPs to discontinue registration rather than offer their intermittent service as locums.
I agree strongly with Alex Grieve. The Appraiser should consider the role the GP is working in, rather than adopt a one size fits all approach. Appraisal and Revalidation are about the doctor demonstrating what they are doing to remain fit for purpose.The safety first culture is creating difficulties, as doctors need certificates and letters of competence to continue doing what they have been doing for years.
Locum doctors do need to spend a not inconsiderable part of their time keeping up to date, and will need support in doing so. Sessional GP groups and Locum Chambers offer partial solutions to this.
Is it going to be possible to work in General Practice in a limited way, such as Dr Garner describes, in future? How easy will it be for GP to return to practice here, after a break or spell overseas?
I hope that common sense prevails or there will be a loss of many experienced, extremely useful doctors to general practice.
I retired from practice after 44 yrs because of the revalidation process. I retired from GP 10yrs ago and after locum work was employed part time
as Occupational Physician gaining the Diploma in Occ, Med, I had two appraisals with my employer and despite having to research and think about many unusual problems I found it impossible to complete many of the headings in this process. My appraiser seemed more concerned in being able to state he had appraised me on his appraisal and his appraiser would no doubt do likewise and so on, A self perpetuating bureaucracy !
I had to give up altogether and come off the medical register as the GMC kept asking me "who is your responsible officer?" and which organisation I worked for. As my answer to both was "I do not have one" and asked for one to be appointed. Instead they insisted I register an online GMC account, so whenever I opened this, the same message came up about the responsible officer. Despite letters to the GMC I got nowhere.
I think that the BMA should take this up. However, I wrote to the chair of the BMA retired doctors' group some months ago but have yet to receive any reply. This is despite being a member for 43 years, so I do not hold much hope for anyone else!
The whole lot is a disgrace, and represents tick box medicine at its worst. Does anyone really think this will improve patient care? The rot set in in the late 1970s with the advent of a so called management culture run by people who know nothing about medical practice and the many decisions doctors take every day, and which has become more and more powerful year by year. God help the youngsters coming up behind us.
An appraisal should be robust, but supportive. Complain to your appraisal officer, and request a repeat appraisal from someone who truly understands your circumstances.
I have recently retired from general practice, but am still doing some related clinical work. The system does not cater for those in roles that do not conform to neat clinical categories.
I will certainly not be submitting myself to further appraisals, and will let my registration lapse prior to my revalidation date.
As a GP locum I feel demoralised by the "jumping through hoops" aspect of appraisal. I find myself doing time consuming things of little value simply to be able to tick a box. whilst the true learning and reflection which all of us do every day count for nothing because of lack of "evidence". It is hard to believe that the appraisal process improves patient care in any way - surely our time could be better spent.
I'd say you need to sack your appraiser.
I've only been a doctor for 33 years so I don't quite have your length of experience but I've been around long enough to see that the whole assessment direction, both in summative assessment for trainee GPs and in the appraisal/revalidation process has been hijacked by the ivory tower types who appear to spend a lot of time navel gazing while their colleagues see the patients.
Your appraiser sounds like one of them...look for one of us - in my experience many appraisers seem to take a more sensible approach.
I suspect there are plenty of below average doctors who are good at playing the appraisal game and I daresay there are a lot of good doctors who aren't. I doubt very much if revalidation will turn out to be an effective way of telling the difference.
I hold an academic appointment, a visiting professorship, and 2 honorary non clinical appointments. I'm evaluated, appraised and reviewed five times each year, each approach being different. I happily spend weeks and weeks completing all these forms. Has my work changed or improved as a result? No. Do my appraisers/reviewers/evaluators know any more than they would have before all these administrative burdens fell in my (and their) shoulders? I don't think so. Still, keeps some people employed I suppose.
The whole system is a grotesque farce. Like others who have posted here I do not plan to go through the nonsense of revalidation. It has in fact virtually no validity. As in so many other things the so-called leaders of our profession signed up for this to ensure a quieter life and a knighthood. Medicine as a profession is still an extarordinary pleasure and a privilege. But would you advise young peopleto work in the bureaucrat infested 21st century NHS ?
Finding a competent appraiser is one matter, but the next problem will be finding a Responsible Officer to sign off your Appraisals every 5 years!