Revalidation - FAQ
All your revalidation questions answered.
UK
Overseas
What is revalidation?
Revalidation will be the single, integrated
process by which doctors will prove that they are fit to practise
medicine. The process will encompass two processes - relicensure
and recertification - and will occur every five years.
From April 2009 all doctors will need a
license to practise. This will demonstrate that they are practising
in accordance with the General Medical Council (GMC) generic
standards of practice outlined in the Good
Medical Practice and elaborated in
Good Medical Practice for General Practitioners
. To be a GP a doctor must
also be on the GMC’s General Practice Register (‘certified’).
Recertification will demonstrate that doctors on the GP or
Specialist Register continue to meet the standards that apply to
their medical specialty or area of practice.
The process will involve the collection and
submission of evidence that meets the requirements of a series of
guidelines. Further information about evidence requirements can be
found in the RCGP
Guide to the Revalidation of General Practitioners.
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Will revalidation affect
me?
In future, all doctors practising in the UK
will need to hold a GMC licence to practise. General practitioners
in the NHS will need to be on the GMC’s GP register. All practising
doctors with a licence to practise will have to participate in
revalidation.
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Why is revalidation
being introduced?
Revalidation is being introduced to ensure that the highest
standards of care are delivered and that patients have the utmost
confidence in the professionals that treat them.
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What is revalidation for?
Revalidation will reassure, as far as is
possible, individual patients, the public, colleagues and the NHS
that individual GPs are up-to-date and fit to practise. It will
promote Continuing Professional Development (CPD) amongst GPs;
encourage improvement in the quality of care, patient safety,
team-working, communications and appropriate behaviour of GPs.
Revalidation will also serve as a process for
identifying GPs, as far as is practicable, for whom there are
significant concerns about their fitness to practise and to detect
early signs of deteriorating performance. The RCGP is working to
ensure that GPs will be supported at every stage during the
revalidation cycle, particularly if they are experiencing
problems.
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What is the
timeline for the introduction of revalidation?
There are still a number of significant
hurdles to be overcome. However, if current plans come to fruition,
revalidation for all doctors will start in the second quarter of
2011, and all GPs will be revalidated over the following five
years.
Some GPs are likely to be involved in pilots
in 2010 which will result in a real recommendation for
revalidation. If these pilots are successful, these few GPs will be
revalidated in April 2011.
In the roll-out from April 2011, revalidation
will have three phases for each doctor. The first is the
preparation of evidence, which will be discussed at annual
appraisals. The second will be the submission and assessment of
that evidence to ensure it meets the standards for revalidation.
The third phase only involves those GPs in respect of whom it is
not possible to make a recommendation that they be revalidated. For
these GPs the GMC will assess their performance through its fitness
to practise processes before their certificate or licence are put
at risk.
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What has to be achieved before
revalidation starts?
The NHS needs to appoint Responsible Officers
in each organisation. The Treasury must allocate funds and the
British Medical Association (BMA) needs to be happy with that
allocation. The RCGP has designed criteria, standards and evidence
for the revalidation of GPs, but these need to be signed off by the
GMC. The RCGP and the Revalidation Support Team need to
successfully complete their pilots. When all these have been
achieved, the GMC has to approve the start of revalidation.
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How will the
process work?
The RCGP will be responsible for recommending
the standards for recertification for all UK general practitioners
on the General Practice Register, whatever their working
circumstances. These standards will need to be approved by the GMC
before they are introduced.
The process will involve the collection and
submission of evidence that meets the
requirements of a series of GMC guidelines and
will occur in a five-year cycle.
Revalidation will be based on elements that
most doctors are familiar with as part of general working patterns
- such as annual appraisals and audits. Collection of evidence will
be on an annual basis through the appraisal mechanism and
submission of a portfolio of evidence which will form the basis of
the recommendation for relicensing and recertification.
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What evidence will I be expected to
submit?
Your evidence will be limited to that required
for annual appraisal, so should be achievable by any GP. If you do
not provide evidence for the period prior to 1 April 2009 you will
not be penalised, but the vast majority of GPs will have evidence
from earlier appraisals that they will wish to include in their
revalidation portfolio. It is recommended that you begin to collect
appropriate evidence now. A full description of the required
evidence is given in RCGP
Guide to the Revalidation of General Practitioners.
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What happens after I’ve
submitted evidence as part of my application for
revalidation?
Electronic portfolios submitted as part of the
revalidation process will be reviewed by a Responsible Officer who
will recommend whether or not the applicant should be
revalidated
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What is a
Responsible Officer?
This is a new role created under the
provisions of the Health and Social Care Act 2008 and
being developed. Responsible Officers will usually be a senior
doctor in a healthcare organisation, such as the medical director.
For GPs, the Responsible Officer is likely to be from the Primary
Care Organisation on whose performers list they are included. Every
licensed doctor will be linked with one, and one only, named
Responsible Officer.
The RCGP and the BMA hold a view that
Responsible Officers should be advised by a GP assessor and a
trained lay person. Assessors, who will be carefully selected and
trained, will be members of a UK panel and will advise Responsible
Officers from outside their area.
Responsible Officers will make recommendations
to the GMC about doctors who should be revalidated and the GMC will
confirm that doctors are both relicensed and recertified for the
General Practice Register.
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What will be done to ensure
processes and procedures are in place to reflect the fact that GPs
have diverse roles that don’t always match a standard
template?
Revalidation must be proportionate and
achievable for all GPs, regardless of their working pattern. The
RCGP is currently co-ordinating a number of pilots to determine how
feasible it would be for certain groups of GPs, such as peripatetic
locums and remote rural GPs, to collect specific areas of evidence.
The types of evidence required may be modified in light of the
outcome of these pilots.
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What is the role of the
RCGP?
The RCGP has an important role to play in the
implementation of the new revalidation system and is responsible,
on behalf of all GPs, for proposing the standards for revalidation
specifically of GPs. The RCGP is working closely with the other
medical royal colleges, the BMA and the GMC. The RCGP has presented
its proposals to the GMC – they are subject to the GMC’s approval.
These proposals aim to support all GPs, regardless of whether they
are members of the College. The RCGP’s proposals are sensitive to
GPs’ different working patterns, including locums, those working in
remote practices, prisons, etc. The RCGP is striving to ensure that
revalidation of GPs is fair, equitable and not unduly onerous.
The RCGP will be fair to all doctors, whether
members of the College or not. There will be no requirement to be a
member of the College for revalidation.
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Will there be a minimum number of
sessions of clinical work to complete per annum in order to be able
to achieve revalidation?
The RCGP’s current proposals include a minimum
number of clinical sessions before a revalidation portfolio can be
considered – 200 in the five-year revalidation cycle period (100 of
which should be in the two years prior to revalidation). The RCGP
believes that a Responsible Officer should not consider a portfolio
from a GP who had not completed the minimum sessions and that such
a GP would have to apply directly to the GMC to be revalidated.
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I am planning on having a career
break. Do I need to be revalidated?
There’ll be no problem with revalidation if a
GP is away from work for two years or less. However, the minimum
criteria for considering a portfolio for revalidation will need to
be met. These are three appraisals, three years’ of learning
credits, and at least 200 half days of clinical practice in the UK
(100 of which should be in the two years prior to
revalidation).
If the career break is more than two years, a
GP will be expected to do a re-entry course. However,
arrangements for are still being developed. At the time a GP
decides that they wish to go back into practice they will need to
apply to the GMC to be ‘reactivated’ on the GP Register. It is
expected that they will then be given restricted registration, as
they will have been on the GP Register previously, and will be set
a time-limit to undergo revalidation. Once revalidated, they
will be updated on the GP Register and will then have to undergo
revalidation every five years.
The requirements for a GP to re-enter general
practice after an extended absence (of two years or more) are not
yet clearly defined and work is being done to address this. The
College is working with Deaneries and PCTs to develop a system that
is fit for purpose for GPs re-entering general practice.
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How is the RCGP developing its
revalidation proposals?
The RCGP is working with the Department of
Health’s Revalidation Support Team and the Academy of Royal Medical
Colleges to undertake pilot projects. A pilot of “learning credits”
has been completed. Pilot projects for evidence collection and
evaluation are underway in England, Wales and Scotland. Other
pilots concerning sessional doctors, doctors in remote practices,
doctors in the defence medical services and prisons are also being
conducted.
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What help is available from RCGP
now?
The RGCP is developing a suite of tools to
support GPs in collecting evidence for revalidation. As these
become available they will be signposted on the RCGP website.
These tools currently include:
Annual appraisals and accompanying Personal
Development Plans. The RCGP is anxious to ensure that the quality
of appraisal is consistent for everyone, and has developed several
papers to explain how the College can support this
process.
Learning Credits. Every GP will need to collect at least 50
Learning Credits per year, amounting to 250 over the five year
revalidation cycle. The RCGP has developed a credits system based
on time and impact. One learning credit is earned per hour of
education. If the GP can demonstrate impact from that learning,
each hour will then be worth two learning credits. For more
details, see Evidence Section 6 in the RCGP
Guide to the Revalidation of General Practitioners.
The RCGP has also developed the Essential
Knowledge Updates (EKU) and Essential Knowledge Challenge (EKC).
The EKU is a scenario-based learning tool that will enable GPs
to collect Learning Credits while keeping up-to-date with new and
changing knowledge in general practice. The EKC is a multiple
choice, voluntary assessment that tests an individual's
understanding of the Knowledge Updates. GPs who achieve at least
70% in the challenge can download a certificate for their
portfolios of evidence.
The RCGP commissioned a study into some of the
Multi-Source Feedback tools (MSF tools) that are currently
available and their suitability for use in revalidation. At
this stage, only the
GMC Colleague Questionnaire has been deemed suitable for use in
revalidation. However, the RCGP is continuing to investigate
available and developing MSFTs to ensure that it will be able to
recommend a selection that are suitable for general practice.
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Where can I find the GMC MSF
questionnaire?
The GMC MSF questionnaire can be found
here.
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What if there
is a problem in me achieving revalidation?
It is anticipated that the vast majority of
GPs will have no difficulty in meeting the standards required for
revalidation. For those GPs who do not, the GMC will assess their
performance through its fitness to practise processes before their
licence or certificate are put at risk. Support for GPs will be
available throughout the five year cycle.
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What is
ePortfolio?
The RCGP believes that an electronic method is
the best solution for collecting and maintaining the evidence
required for revalidation. The College is developing an electronic
portfolio to support the revalidation needs of all GPs. The
portfolio will be simple and easy to use, it will aid reflection
and will enable GPs to collect and demonstrate the evidence
required for revalidation. It will have sections for use by your
appraiser, your Responsible Officer, Primary Care Organisation
staff and others with key roles in the revalidation process. The
College is committed to ensuring that the system will integrate
with other RCGP CPD products, including the trainee ePortfolio, and
with other available appraisal tools. It will aim to provide a
complete solution for revalidation that builds on existing
appraisal experience and the development of the RCGP trainee
ePortfolio. A first version of the ePortfolio is piloting now and
will report in Spring 2010.
It is recommended that all GPs start
collecting evidence now and store it electronically, ready to
populate their revalidation ePortfolios. Existing toolkits should
be used in the meantime.
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Can I record evidence for revalidation on
paper?
The RCGP believes an ePortfolio is the best
solution for both collecting and maintaining evidence required for
revalidation. However, in exceptional circumstances, it will be
possible to complete a paper portfolio for revalidation. GPs who
believe they will be unable to complete an electronic portfolio
should email the RCGP
Revalidation Team to seek advice.
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Who is going to pay for
revalidation?
The RCGP is working closely with other
stakeholders, including General Practitioners’ Committee (GPC), to
ensure that the costs of revalidation do not largely fall upon
individual GPs to meet. The RCGP is also looking at the most
cost-effective way of delivering multi-source feedback from
colleagues. Professional responsibility for preparing for appraisal
and keeping up-to-date will remain with individual doctors.
Revalidation will be largely built on existing or enhanced local
systems of appraisal and clinical governance, so it is anticipated
associated costs will be linked to the enhancement of these
existing, local systems. Extra funding to support remediation will
be required. The Department of Health (England) is undertaking a
full regulatory impact assessment, including a costs and benefits
analysis.
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I am a GP with a
Special Interest (GPwSI). How will I be revalidated?
Many GPs have areas of special interest in
which they deliver care. If the care is delivered to the practice’s
own patients and is a common activity (e.g. practice lead for
diabetes) no extra evidence is required. However, if the special
interest is delivered within an NHS contract (i.e. the GP is
contracted by their PCO as a GP with Special Interests (GPwSI)),
that GP will need to answer a series of questions relating to their
role and also provide a certificate of accreditation. If, however,
the special interest is not within an NHS contract, evidence of
appropriate skills before starting, keeping up-to-date, and the
quality of care provided will be need to be provided. Evidence Area
13 in the RCGP
Guide to the Revalidation of General Practitioners
contains more information.
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I am a Locum GP. How will I collect all the
necessary areas of evidence for Revalidation?
The RCGP is discussing the needs of locums
with the National Association of Sessional General Practitioners,
the General Practitioners’ Committee of the BMA and locum doctors
themselves. The College is undertaking a main revalidation pilot
that includes all types of sessional GPs and a separate
pilot for peripatetic locums. The intention is to design a
system for revalidation that is sensitive to the diverse range of
circumstances in which general practitioners work.
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What
involvement will patients have?
The revalidation portfolio will, in time,
contain the results of patient surveys. Once
revalidation is fully established, the
portfolio should include the results of two patient surveys, one
undertaken in the first two years of the five-year revalidation
period and one in the last two years.
The RCGP has commissioned a review of patient
surveys and will recommend which ones are appropriate for use in
revalidation. They will need to seek the views of the patients
actually consulting the GP – practice-based surveys of the
registered population will not be acceptable. Although it will be
permissible to scan in the results of a patient survey and attach
that file to the revalidation portfolio, it is expected in time
that the results of approved patient surveys will be automatically
inserted into the GP’s ePortfolio.
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What should I
do now?
GPs should ensure that they have their annual
appraisals, and use an electronic toolkit to record their evidence,
including their Personal Development Plans (PDPs). They should
consider recording their Significant Event Audits or Clinical
Audits. They should deal with any complaints properly, recording
their reflections. The learning credits system is still being
refined. GPs should record all their education, including the hours
spent, in preparation for the introduction of learning credits.
There is no need to undertake colleague surveys or patient surveys
yet – when the approved surveys are ready for use the profession
will be notified.
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I am a trainee GP, will revalidation
affect me?
Most doctors in training will pass the MRCGP,
and thus be certified for the General Practice Register of the GMC,
within five years of full registration. This can be regarded as the
first revalidation for doctors in training. They will then need to
be revalidated every five years for their professional
lives.
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Will there
be any changes to appraisal with the introduction of
revalidation?
A strengthened form of appraisal will underpin
revalidation and form a key part of the evidence that GPs will
provide to ensure that a positive recommendation for revalidation
can be made by their Responsible Officer. This strengthened form of
appraisal has been developed to support and develop doctors to
improve patient care by ensuring more consistent clinical
governance and appraisal arrangements, which will enable their
practise to be objectively and fairly assessed against clear
standards. Strengthened medical appraisal will also support GPs to
further develop their skills and experience through life-long
learning with the ultimate aim of improving patient care.
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What is a learning
credit and how are they accumulated?
The RCGP is developing a credits system
related to record the Continuing Professional Development (CPD)
activities of GPs. The credits system will provide a mechanism for
GPs to record their CPD based on the time spent on the activity and
the impact it has on the doctor, their patients and the service.
Credits are self-assessed and verified at appraisal.
At its simplest, each recorded hour spent on a
CPD activity, which can include planning and reflection, will count
as a credit. However, it will be possible to increase credits by
demonstrating the impact of learning on practise. Demonstrating
impact is rewarded by a multiplication factor of two applied to
time spent.
For instance:
An individual attends a meeting (one hour) on
heart failure, acquires the knowledge that certain beta-blockers
are beneficial in this condition and then records this within their
appraisal documentation as well as this, the individual includes
two patient case studies demonstrating the introduction of
beta-blockers in heart failure.
• Credits claimed 1
x 2 (Impact) = 2
Find out more details about the RCGP's CPD Credits Scheme
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Why
can’t practising GPs be registered within their own
practice?
The RCGP
Guide to the Revalidation of General Practitioners states
that ‘…the GP is in a position to receive independent, impartial
healthcare advice (for example is not consulting a family member)
and that he or she accesses that health care appropriately. Unless
there is a good reason (such as working on a military base in the
Defence Medical Services or geography) it is best practice for a GP
to be registered in a practice in which he or she does not work
(or, in the case of a locum, rarely works)’... This is a
requirement set by the GMC through its Good
Medical Practice guide and the College fully supports this
best practice measure.
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Where can I find more
information?
The RCGP
Guide to the Revalidation of General Practitioners is
still evolving and will be regularly updated so we are only
publishing online to ensure that the information is as up-to-date
as it can possibly be.
The guide continues to evolve as work
progresses on implementing the new revalidation scheme and will be
regularly updated. It is being published online to ensure that the
information is as up-to-date as possible.
The revalidation section of the RCGP website
is also updated regularly and it is recommended GPs check this site
to stay up-to-date with developments on revalidation for GPs.
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Where can I get a
printed version of the RCGP Revalidation Guide?
If you require a printed version you will have
to make arrangements to print a copy.
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Overseas
I work in the Republic of Ireland but
am also licensed with the GMC, how will revalidation affect
me?
All doctors who wish to remain on the General
Practice Register will need to be revalidated.
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I work overseas but
am on the UK GP Register, how will revalidation affect
me?
Whilst only evidence gained the UK will be
used to meet the minimum criteria (see RCGP
Guide to the Revalidation of General Practitioners) the
GMC will wish to look at the merits of each case. GPs in this
situation should therefore aim to collect all the appropriate
evidence that they can, regardless of the setting. If it is decided
that a GP has not been able to provide enough evidence for a
recommendation, it is likely that they will be asked to leave the
GP Register on a temporary basis and undergo a re-entry assessment.
During this time, we anticipate that the GMC will give the doctor
‘conditional registration’ until the time that they can be
revalidated.
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Can I be
appraised for revalidation while I am overseas?
It will only be possible for appraisals to
occur in an Approved Environment which, in practice, will be the
NHS.
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Will overseas learning
systems count towards revalidation in the UK?
When designing a re-entry programme, the GP’s
recent education will be important. Also, your education log will
help your appraiser to advise you on your Personal Development
Plan. However, only evidence gathered in an approved environment
(at present that means the UK or in the defence medical services)
will be submitted through the revalidation ePortfolio. The GMC will
wish to look at the merits of each case.
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How will I
be contacted about revalidation while I am overseas?
Work is being done to address this issue.
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To provide feedback on any aspect
of Revalidation please click here.