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.

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