The first comprehensive study of the UK’s revalidation process for doctors reports a lack of certainty that the scheme is meeting its goals.
However, the three-year study backed by the General Medical Council did identify a number of concerns with the system to judge ongoing fitness to practice during a doctor’s career.
In the first five years of revalidation, it found “deferral rates” were higher for women, younger doctors, and those from black and minority backgrounds, independent of where they had qualified in medicine.
The odds of doctors aged 70 or more being deferred for further assessment were also greater, while those in their 50s and 60s had slightly lower odds than those in the 40 to 49-year age group.
While the Medical Board in Australia has rejected the UK model, it has adopted a policy of competency checks for doctors in the 70-plus age group and those who practise in isolation.
The UK report noted complaints that appraisers had lacked appropriate seniority or experience.
It also referred to “inconsistencies” among doctors who conducted appraisals of colleagues.
“In my view, it is inappropriate that my appraiser is over 20 years less experienced than me,” a paediatric consultant said in a 2015 survey used in the study.
“One of my previous appraisers was not a GP and had little understanding of what it involved,” a GP practice principal said.
Only about one-third of doctors had been able to choose their own appraisers for revalidation under rules that vary within UK jurisdictions.
“I am unable to choose my appraiser, the venue, the date or time and now it seems the way I record my life,” a GP principal said.
The UK revalidation regime, launched in December 2012, demands doctors collect information about their practice and take part in annual appraisals.
Using the outcomes, a senior practitioner, known as a Responsible Officer, conveys one of three outcomes to the General Medical Council every five years: revalidation, deferral, or failure to engage with revalidation.
A “significant minority” of doctors reported changing an aspect of their clinical practice, professional behaviour or learning activities as a result of their most recent appraisal, the report said.
Overwhelmingly these changes related to the focus or quantity of their CPD activities.
“However, some doctors identified potentially negative impacts on practice or for professional autonomy,” the report found.
“Revalidation, through appraisal, provides a means to document practice but may not necessarily improve professional practice.”
The report, titled Evaluating the Regulatory Impact of Medical Revalidation, said many doctors believed the main aim of revalidation was to identify “bad doctors” but they doubted that appraisals would achieve this aim.
Since late 2012, fitness-to-practise referrals from employers have returned to pre-2009 levels, following spikes in the period leading up to revalidation’s introduction, it said.
“There is no statistical evidence, as yet, that referrals from employers have dropped as a result of the earlier identification and local remedy of concerns.”