Introduction
Appraisals started as a formative process for GPs. They are now well established and are undertaken to a level of quality that can exceed many other specialities within the NHS.
Revalidation was introduced in December 2012 and is designed to reassure patients and the public that all doctors keep up to date and are fit to practice. The GMC has set out the requirements for revalidation for all GPs.
Your appraisal is an annual opportunity to reflect with a trained appraiser. (See also GP Support Health and Wellbeing – Wessex LMCs)
Whether you are starting to spot the warning signs of burn-out or are aware of issues that you want to sort out, helpful discussions may well start at your annual appraisal
This guide is to help answer any questions that might arise. The Medical Directors are also available to answer queries.
Confidentiality in Appraisal and Revalidation
NHS England Responsible Officers (ROs) are individually responsible for signing off the revalidation of several thousand doctors and are therefore reliant on the support of IT systems. It is only practicable for ROs to discharge their responsibilities through the teams who work for them. The use of the national Revalidation Management System to provide a revalidation dashboard for the Responsible Officer; the requirement to upload appraisal documents to it plus the requirements for quality assurance of appraisal outputs and the need for revalidation checks now means that individuals within the RO’s team may have need to view appraisal information without seeking additional consent from the GP. The appraiser should inform a GP that the next appraiser, the RO and their delegated proxy (usually the appraisal lead and/ or a senior appraiser) may view appraisal outputs and occasionally the full portfolio on a “need to know” basis. A senior appraiser carrying out QA may view the appraisal outputs but not the full portfolio. The GMC has the right to view the full appraisal portfolio on request, but this would require exceptional circumstances. Those who routinely see the outputs have confidentiality clauses in their employment contracts and it would be a gross breach if they revealed anything out of turn.
An appraisal portfolio should not contain patient-identifiable information nor anything that would be personally or commercially sensitive for the GP. Appraisers have been advised to describe to a GP at appraisal that confidentiality is qualified and relative, not absolute, such that information that might put patients or the doctor’s self or colleagues at risk or bring the reputation of the profession into disrepute will have to be shared appropriately, preferably with the consent of the GP who should in any case be made aware of this. However, Duty of Care outweighs confidentiality in the same way that the confidentiality of a consultation must sometimes be breached. Please think carefully about what you record and what level of detail you record in your written appraisal documentation.
Some supporting information should perhaps be shared separately to the electronic submission, for example through discussion if this is the best way to protect confidentiality.
Revalidation is the process by which patients and the public, employers and other healthcare professionals are assured that doctors are up to date and “Fit to Practice” which is the responsibility of the GMC. The fitness to practice in the specialty of being a GP is the remit of the RCGP.
When negotiations took place with the profession it was agreed that there would be consistent requirements across all specialities and the Academy of Medical Royal Colleges (AoMRC) brought together all the Royal Colleges and Faculties to achieve this.
The GMC requirements can be found on their website (links below):
The good medical practice framework for appraisal and revalidation
Supporting information for revalidation
The GMC has clarified that every doctor is required to engage with an annual medical appraisal that covers their whole scope of practice. The GMC guidance is backed by law and sets the basic framework and the absolute requirements which must be met in order to revalidate. The GMC delegated responsibility for the fine details for the specialties to the Royal Colleges and Faculties. As such, for general practice, the RCGP guidance is set at a higher level, is about fitness to practice as a GP, and would be considered best practice. A doctor could meet the requirements of revalidation without fulfilling all the RCGP guidance.
Revalidation for GPs
Revalidation is the process by which patients and the public, employers and other healthcare professionals are assured that doctors are up to date and “Fit to Practice” which is the responsibility of the GMC. The fitness to practice in the specialty of being a GP is the remit of the RCGP.
When negotiations took place with the profession it was agreed that there would be consistent requirements across all specialities and the Academy of Medical Royal Colleges (AoMRC) brought together all the Royal Colleges and Faculties to achieve this.
The GMC has clarified that every doctor is required to engage with an annual medical appraisal that covers their whole scope of practice. The GMC guidance is backed by law and sets the basic framework and the absolute requirements which must be met in order to revalidate. The GMC delegated responsibility for the fine details for the specialties to the Royal Colleges and Faculties. As such, for general practice, the RCGP guidance is set at a higher level, is about fitness to practice as a GP, and would be considered best practice. A doctor could meet the requirements of revalidation without fulfilling all the RCGP guidance.
GMC’s Domains for Revalidation
The GMC has defined the four areas in which all doctors must ensure they can demonstrate through appraisals that they address their needs and provide supporting information to demonstrate this.
The domains are:
- Knowledge, skills and development
- Patients, partnership and communication
- Colleagues, culture and safety
- Trust and professionalism
What do you need to do to be revalidated?
You need to participate in an annual appraisal which meets the requirements as defined by the GMC.
The supporting information that is required for revalidation can be divided into the following areas.
- General information – providing context about what you do in all aspects of your work
- Keeping up to date – how you maintain and enhance the quality of your professional work
- Review of your practice – how you evaluate the quality of your professional work
- Feedback on your practice – how others perceive the quality of your professional work
Once every 5 years, at a time decided by the GMC, the Responsible Officer will need to make a recommendation to the GMC about an individual doctor.
If you are a General Practitioner in the South West of England (this applies to our BSW & Dorset GP’s), you will connect to the local office that manages the performers list for that area:
- NHS England & NHS Improvement South West – Email: england.southwestperformerslist@nhs.net
- Iona Neeve, Head of Professional Performance, South West. – Email: iona.neeve@nhs.net
- Responsible Officer: Dr Rupa Joshi – rupa.joshi2@nhs.net
If you are a General Practitioner in the South East of England (this applies to our Hampshire & IOW GP’s), you will connect to the local office that manages the performers list for that area:
For GP appraisal and revalidation
· NHS England – South East Commissioning Region (Kent and Medway, Sussex and Surrey Heartlands): southeast-revalidationandappraisal@nhs.net
· NHS England – South East Commissioning Region (Hampshire and Isle of Wight, Bucks, Oxon, Berks West and Frimley): england.htvappraisals@nhs.net
For GP performance concerns
- South East Region: ENGLAND.SouthEast-Performance@nhs.net
- NHS England & NHS Improvement South East – Hampshire, Isle of Wight, Thames Valley – Email: htvps@nhs.net
- Jeniene Scott, Head of Professional Standards Email: jeniene.scott@nhs.net
Alternatively, If you aren’t sure who your RO and/or designated body is or should be then look here – GMC – Find your connection for revalidation
Each RO is responsible for between 1-2500 doctors, and you will, therefore, not be required to have a face-to-face meeting with the RO.
A small team working with the RO will ensure you have:
- successfully completed your annual appraisals
- provided all the required supporting information
- undertaken the colleague and patient surveys
- discussed the results with an appraiser
and that there are no outstanding concerns or complaints about you. They will then feedback to the RO who submits the required positive revalidation recommendation to the GMC.
The RO will check that you have completed the annual appraisals to the required standard. They will ensure a colleague and patient feedback process has been completed. They will then triangulate this with any outstanding performance issues with the GMC or through the local procedures and ensure there are no other local concerns.
The RO will not decide if you will receive a license to practice just make one of the following 3 recommendations:
- There is no reason know that this individual doctor should not be issued with a license to practice;
- The renewal of the license to practice should be deferred. This is a neutral act, the only people who will know this has happened will be the GMC the RO and yourself. The deferral could be for 3, 6 or 12 months. This would allow time for completion of one or more elements required for revalidation. It could have resulted from a period of sickness or maternity leave, but will not be used for those who simply can’t be bothered to participate in the process.
- Failure to engage – if the RO believes that, despite their best efforts, you are not engaging in the process they can refer this to the GMC for investigation or action. The RO cannot, therefore, fail a doctor and remove their license to practice.
Therefore the vast majority of GPs will know nothing of the process until they receive their renewed “licence to practise” from the GMC.
Those doctors who have not been able to fullfil all the requirements in time for their recommendation date for good reasons, or who are in an ongoing investigation, may be deferred.
Very few doctors, who fail to engage with the appraisal and revalidation process, will be referred to the GMC for failure to engage.
Wessex LMCs has worked in collaboration with FourteenFish to develop a web based revalidation toolkit that is easy to use and compliant with RCGP revalidation requirements. Advice has been taken from Appraisal Leads and a Responsible Officer. They are essentially the same site but with different names.
The toolkit has a yearly subscription which can be reviewed via their website, and there are additional charges for various parts including colleague and patient surveys.
The appraisal toolkit is designed to be easy to use and anyone that has started using a MAG form can transfer the data from the MAG form onto the toolkit if they wish.
Colleague Feedback
Colleague Feedback also known as Multi-Source Feedback (MSF)
In every 5-year revalidation cycle you are required to undertake at least one colleague, and one patient feedback survey.
It is important that these are conducted appropriately.
Colleague Feedback
You must use a recognised questionnaire and this needs to be conducted independently, with feedback that allows individuals to make comments that are anonymous. It is also important that the results are benchmarked and fed back to you in an appropriate format.
NHSE guidance requires a minimum of 12 responses for this to be valid. However, one of our local NHSE regions require 15 which aligns to GMC recommendations. It is advisable to ask more individuals than the minimum number to complete the feedback.
It is not acceptable to conduct your own colleague feedback by handing out questionnaires, collecting them and taking them with you to your appraisal to discuss the results. The feedback must be externally collated to maintain anonymity for the respondents. You should take your reflection on your feedback to your appraisal to discuss further.
Please remember that you need to complete the survey and discuss the results with your appraiser before your revalidation date.
There are a number of providers of the surveys who will analyse the results and provide you with a report suitable for revalidation.
By colleagues this would include GPs but could also include Practice Managers, Nurses Admin staff and hospital colleagues who know your work.
The feedback needs to be administered and structured according to the GMC Guidelines. Also see the RCGP Patient and colleague feedback mythbuster webpage.
Some key messages:
- The feedback needs to be carried out independently of the GP and their practice.
- It is not acceptable for a GP to hand a questionnaire to a colleague and ask them to complete this and give it to their Practice Manager for analysis.
- A colleague feedback must include your own self-assessment and also a benchmark to your peers.
- NHSE state a minimum of 12 returns is required but one of our NHSE regions required 15 (which is in line with GMC guidance).
- For those working in rural isolated practice less than the minimum required number may be acceptable but this would need to be discussed with your appraiser.
- When providing feedback for a colleague this needs to be constructive, if there are negative comments then these may be helpful, but ensure the comments are not personal, inappropriate or identifiable (because this should be anonymous feedback).
To meet the requirements it would be best to use an approved colleague feedback which allows all of the above. There are a number of options available on the internet.
Continuing Professional Development
You are expected to be involved in a variety of regular learning activities that are relevant to your practice and reflect your scope of work.
There is no absolute minimum number of hours defined by the GMC, who require you to do enough to keep up to date across all of your scope of work. The RCGP no longer specifies a specific amount of CPD per year for a GP (having previously suggested a minimum of 50 hours of learning per year for doctors providing the full range of general medical services). CPD can include attending formal conferences and lectures, informal practice meetings and professional conversations about patients, self-directed PUNs and DENS, reading and e-Learning, reviewing data, significant events, complaints or compliments and changing practice, undertaking clinical audit or even teaching others.
It is important to have a system that is simple and easy to use to record your learning, your reflections and how you will implement the learning. It is also important to keep your recording proportionate and only include what is most relevant and valuable to you – as most doctors do a lot more than 50 hours of learning if they start to recognise their activity as learning – and could spend excessive time recording as a result.
Remember – the GMC is interested in evidence of lessons learned and changes made as a result. Recording one or two high quality examples of reflection is better than a large quantity of headlines only. The former recommendation that all credits should be demonstrated through a reflective note on lessons learned and any changes made as a result has been removed because it was being interpreted in a disproportionate way and adding to the burden of revalidation. You should still include reflection on your CPD and highlight the most important lessons learned and changes made as a result, but you need not reflect on every CPD credit.
Quality Improvement Activity
For the purposes of revalidation, you are required to demonstrate that you regularly participate in activities that evaluate the quality and improvement of your work across your whole scope of practice. Examples of quality improvement activities:
- Clinical audit – measures the quality of care individual doctors are involved in.
- Review of clinical outcomes – this could include review of morbidity or mortality data, minor surgery data or commissioning information.
- Case review or discussion – this could be peer review of an interesting or challenging case. This would include significant event reviews. It is important to reflect on the discussion, detail what has been learnt and what will change in your clinical practice as a result of the discussion.
- Audit and monitor – the effectiveness of a new system, process or teaching programme.
- Evaluate the impact – this could be a new service developed and implemented.
The RCGP consider significant event review and clinical audit as being core elements to quality improvement but are happy to accept other appropriate quality improvement activities that you can demonstrate have had a positive impact on your care of patients.
It is important to remember that the GMC does not require doctors to undertake clinical audit if there are other more appropriate methods of delivering quality improvement of your clinical care.
Each year at your appraisal you will need to demonstrate that you have been involved in quality improvement activities.
The LMC’s advice is to undertake a variety of quality improvement activities and ensure that, over the five-year cycle, some of these enable you to provide evidence that demonstrates the impact and change this activity has had on your clinical practice.
Practice based audits are acceptable so long as you reflect on the outcomes personally and this impacts your clinical practice and you detail your role in the audit.
QoF is a simple way to audit quality but simply recording and comparing 2 years’ results is not acceptable; you need to discuss the outcomes in one year, suggest and implement change and evaluate the impact at a later date.
Because of the GMC definition of significant events as patient safety incidents, it is nationally agreed that the learning opportunities that GPs historically called significant event analysis should be renamed learning event analysis. Learning from events should be considered a normal part of review of practice and examples included in quality improvement activities.
CQC – GP Appraisals
The LMC has been made aware that some of the lead inspectors are asking to see dates and evidence of appraisals for everyone in a practice. Having taken this up with CQC, we can confirm that they are not entitled to see GP appraisals as these are between the GP and their appraiser but it would be helpful to have the appraisal dates listed for all GPs and staff.
Locum / Sessional GP Appraisal and Revalidation
The RCGP and GMC are aware that fulfilling appraisal and revalidation requirements can be more difficult for sessional GP’s and changes have now been made to help others address this. Make sure you (and your appraiser) are clear on what is needed.
BMA Appraisal Tips for Sessional GPs
The BMA also suggest further reading the RCGP guidance to appraisal and revalidation: https://www.rcgp.org.uk/training-exams/practice/revalidation/guide-to-supporting-information-for-appraisal-and-revalidation.aspx
FourteenFish Appraisal Toolkit
Wessex LMCs has worked in collaboration with FourteenFish to develop a web based revalidation toolkit that is easy to use and compliant with RCGP revalidation requirements. Advice has been taken from Appraisal Leads and a Responsible Officer. They are essentially the same site but with different names.
The appraisal toolkit is designed to be easy to use and anyone that has started using a MAG form can transfer the data from the MAG form onto the toolkit if they wish.
Appraisal toolkit for Doctors: https://www.fourteenfish.com/about/appraisal
Revalidation tips for Locum Doctors https://www.youtube.com/watch?v=tsbEub-xlrw
Revalidation for Locums
Challenges for Locums
- Locums may face practical difficulties in gathering supporting information due to:
- Working across multiple practices
- Limited access to feedback loops
- Isolation from regular team-based learning
CPD Planning Tips for Locum GPs
Be Strategic and Reflective
- Focus on quality over quantity: The GMC and RCGP no longer require a fixed number of hours or credits.
- Prioritise reflection: Record what you learned, why it matters, and how it impacts your practice.
Keep a Simple, Consistent Log
- Use tools like:
- FourteenFish (free learning log and exportable PDF)
- MAG form
- RCGP portfolio
- Include:
- Date
- Activity type
- Duration
- Reflections and outcomes
Diversify Your Learning Activities
Include a variety of CPD formats:
- External lectures or conferences
- Practice-based education (ask Practice Managers if you can join)
- Small group learning (e.g., PBSGL)
- Reading journals or using apps like GP Notebook
- E-learning modules and podcasts
- Teaching or mentoring
- Case-based discussions
- Clinical audits or data reviews
Join or Form Peer Groups
- Reduce isolation and enhance learning by joining locum support groups.
- Share guidelines, updates, and reflections.
- Double your CPD value by discussing and applying shared learning.
Align CPD with Your Scope of Work
- If you work in multiple roles (e.g., OOH, GPwSI), ensure CPD covers all areas.
- Tailor learning to your current challenges and patient needs.
Use Technology to Your Advantage
- Track learning needs using tools like GP Notebook’s GPTracker.
- Use SMS or online platforms to collect feedback and link it to CPD.
Plan Ahead for Appraisals
- Spread CPD activities throughout the year.
- Avoid last-minute evidence gathering.
- Discuss your CPD plan with your appraiser early.
Significant Event Review
- Locums should request access to minutes or summaries of events they were involved in.
- Can include this in terms and conditions with practices.
Colleague & Patient Feedback
- Must be independently administered.
- Locums should:
- Use recognised tools (e.g., FourteenFish)
- Include a mix of clinical colleagues (not just doctors)
- Use SMS or paper surveys for patients
- Ensure anonymity and validity (e.g., 34 patient responses)
Compliments & Complaints
- Reflect on both positive and negative feedback.
- Discuss lessons learned and changes made in practice.
Quality Improvement Activities
- Locum-friendly options include:
- Case-based discussions
- Retrospective review of clinical sessions
- Action audits (e.g., tracking referrals or outcomes)
- Equipment audits (e.g., emergency drugs, consulting tools)
- PUNs and DENs (Patient Unmet Needs & Doctor’s Educational Needs)
Working in Small Groups
- Encouraged to reduce isolation and enhance learning.
- Benefits include:
- Shared CPD
- Peer support
- Access to local updates and guidelines
Suggestions for joining or forming groups:
-
- Contact GP tutors, LMCs, or RCGP First5
- Use Practice Based Small Group Learning (PBSGL) format
Appendices
- Appendix A: Template for retrospective reflection on a clinical session.
- Appendix B: Checklist of equipment for general consulting.Items to consider depending on work being undertaken:
- stethoscope
- appropriate IT to record consultations, make requests for investigations etc
- ophthalmoscope/otoscope
- blood pressure machine or manual sphygmomanometer
- tape measure
- thermometer
- glucometer
- pulse oximeter
- disposable ear probes for thermometer and otoscope
- pregnancy urine test kit (e.g., Clear Blue)
- British National Formulary access (book or remote BNF app/online)
- access to portable textbook via apps, on-line or paperback (e.g., Oxford Handbook of General Practice, GP notebook)
- desk aids – peak flow chart, Snellen chart, pregnancy calculator, BMI chart
- latex gloves
- urine dipsticks
- urine specimen bottle
- peak flow meter; adult and child range
- peak flow tubes
- Maglite AA torch with spare batteries/or use mobile phone torch
- lubricating jelly
- fluorescein eye drops
- A4 paper, envelopes, blood forms, X-ray forms
- swabs
- forms for biochemistry/haematology and microbiology
- If taking blood test specimens:
- Tourniquet
- Blood tubes
- needles and syringes
- butterfly needles
- sharp box (in date according to local IPC policies)
- gauze swabs, plasters and alcohol wipes
- vomit bowl
- clinical waste bags
- alcohol hand gel
From: Locum Doctor Survival Guide by R.Coull, locum123.com,2005.
Further Reading
NHS England – This webpage gives an overview of the medical appraisal process and includes information and resources to help medical appraisers carry out their roles effectively and consistently.
The RCGP has an excellent part of their website developed and written by the Head of the Wessex Appraisal Service who is the RCGP Lead for Appraisal, Dr Susi Caesar. It is really great guide to read and understand what is and isn’t expected of you as a GP to negotiate your way with ease through Appraisal and Revalidation processes. We would highly recommend that you look here if you require more detailed information.
The RCGP – Appraisal and Revalidation Mythbusters. Addressing some of the common misunderstandings about appraisal and revalidation to help you get the most out of every appraisal.
Wessex LMCs Appraisal forms for Staff – samples of a selection of appraisal forms
Wessex LMCs – Performance Procedures It is unlikely that a practitioner will end up in difficulties with performance procedures if they actively engage in the appraisal process, have an open and supportive practice environment, positively respond to patient concerns, observe their duty of candour and work in an environment where learning from mistakes is encouraged and shared via significant event analysis.