How your appraisal contributes to your revalidation, and where and when you should be appraised.

Myth: I can choose my designated body or my responsible officer

You cannot choose your designated body or who your responsible officer (RO) is. There is a strict hierarchy of connections set out in legislation. There are tools on the GMC website which will help you to identify which designated body you should be connected with. Your designated body will normally provide your RO, unless there is a potential for bias or a conflict of interest, in which case you should declare it and you will be assigned an alternative RO.

We recommend that you check your designated body is correctly assigned on GMC Online and that you update your connection promptly whenever there is a substantive change in your circumstances, for example, going from being a GP Trainee to being a qualified GP. It is your responsibility to ensure that you keep your connection up-to-date and have an annual appraisal. There are now many appraisal providers who can provide appropriate medical appraisals for revalidation (for a fee).

If you don't have a designated body, and cannot find a Suitable Person, there is a route to revalidation directly through the GMC.

Myth: Appraisal is the main way to identify concerns about doctors

Potential issues relating to poor performance, conduct or health are almost never first brought to light during appraisal. They are usually discovered through clinical governance processes and become part of an entirely separate investigative process that takes the doctor outside revalidation - which is really a positive affirmation of continued fitness to practise.

Appraisals should support doctors so that they can remain resilient in the light of current pressures on healthcare systems, encouraging and stimulating them to maintain and improve the quality of patient care they can provide.

Myth: Appraisal is a pass or fail event 

Appraisal is not a pass or fail assessment. Appraisal is part of a formative and developmental process (see glossary). It provides an annual chance to reflect on your supporting information and your personal and professional development with the help of a trained appraiser, in protected time.

Appraisal should always include support, encouragement and stimulation. At a time of great stress in general practice, appraisal has an important role in helping GPs who may be struggling and signposting them to local support services, with the aim of retaining GPs within the profession.

Myth: My appraiser will decide about my revalidation recommendation

Appraisers do not have the authority to make your revalidation recommendation. Their role is to facilitate your reflection, support and stimulate your development and help you present an appropriate portfolio of supporting information for your responsible officer (RO) to consider. Part of their role is to provide a comprehensive summary of the evidence supplied to represent you to the RO and show that you are complying with the requirements for revalidation. 

Your RO has the statutory responsibility for making a revalidation recommendation to the GMC. Their decision is based on their determination about whether you have sufficiently engaged in annual appraisal, provided a portfolio of supporting information that meets the GMC requirements, and whether there are any outstanding concerns for any part of your scope of work.

The GMC will make the revalidation decision about whether to renew your licence to practise.

Myth: I need to undertake a minimum number of GP sessions to revalidate

Revalidation assesses your fitness to practise as a doctor. There are no GMC requirements that relate to the number of sessions you need to work in any role. You need to be confident that you can demonstrate that you practise safely in every role you undertake, not matter how little of that work you do.

For any part of your scope of practice, no matter how little time is spent on it, the GMC expects you to reflect on how you:

• keep up-to-date at what you do
• review your practice and ensure that you can demonstrate that it remains safe
• seek out and respond to feedback from colleagues and patients about what you do. 

There will always be times when doctors have a significant break from practice, for good reason, such as maternity or parental leave, sickness or sabbaticals, among others. Your designated body will have mechanisms in place for agreeing to postpone your appraisal, or even agreeing an 'approved missed' appraisal. Approved breaks in practice should be considered separately from doctors doing low volumes of clinical work on an on-going basis.

If necessary, your responsible officer (RO) has the option of deferring your revalidation recommendation to allow more time to collect the supporting information you need. If you have been out of practice entirely for more than two years, you will need to do a refresher course: the Return to Practice (RtP) Programme in England, Northern Ireland and Wales and the GP Returner Scheme in England, Northern Ireland and Wales and the GP Returner Scheme in Scotland. Approved breaks in practice should be considered separately from doctors doing low volumes of clinical work on an ongoing basis.

Myth: If I share my concerns about another doctor with my appraiser, my appraiser will have a responsibility to report my concerns 

It is your responsibility to act in accordance with your GMC Duty of Care to report concerns. Your appraiser should provide you with support and can signpost the correct steps for you to take. The GMC guidance on acting on a concern says:

All doctors have a responsibility to encourage and support a culture in which staff can raise concerns openly and safely.

Concerns about patient safety can come from a number of sources, such as patients' complaints, colleagues' concerns, critical incident reports and clinical audit. Concerns may be about inadequate premises, equipment, other resources, policies or systems, or the conduct, health or performance of staff or multidisciplinary teams. If you receive this information, you have a responsibility to act on it promptly and professionally. You can do this by putting the matter right (if that is possible), investigating and dealing with the concern locally, or referring serious or repeated incidents or complaints to senior management or the relevant regulatory authority.

Appraisers should not go beyond the limits of the appraisal role to adopt other people's concerns. Third party information is not good evidence, and an appraiser could be open to criticism if they repeat something potentially defamatory or destructive to someone's livelihood, without any first-hand evidence.

We recommend that appraisers record that concerns have been raised at appraisal in the summary of discussion. This should not include details about the concern but should include written advice about the next steps and actions agreed with the GP. They should also include an appropriate note in the comments box to make the responsible officer aware that a concern was raised.

Myth: I must have five appraisals before I can have a recommendation to revalidate

You are expected to engage fully in the annual appraisal process to revalidate successfully. The GMC make clear that there is no requirement to have five annual appraisals before a revalidation recommendation can be made. You could be given a revalidation due date that is less than five years from your first appraisal. There are many reasons for having approved missed appraisals, such as maternity leave or sick leave. It is important that any missed appraisals in the revalidation cycle are agreed by your responsible officer (RO) as being necessary and appropriate.

Before the RO can make a positive recommendation to revalidate, you must have collected all the GMC supporting information required to provide assurance that you are up-to-date and fit to practise and reflected on it at your appraisal. This normally requires at least two appraisals but, in exceptional circumstances, a motivated doctor can achieve it at their first appraisal.

If you are struggling to collect all the supporting information before your revalidation recommendation due date, your RO can recommend a deferral. This is a neutral act. The GMC will continue your existing licence to practise, and set a new revalidation recommendation date. You will be able to work while you collect the remaining supporting information that you need. Your RO can recommend a deferral period of between four months and one year depending on how long you will need to collect and reflect on the remaining supporting information.

Myth: If I am not ready for my revalidation, I can ask to be deferred

Only your responsible officer (RO) can decide if your revalidation date should be deferred. It is possible that the RO will decide to tell the GMC you are failing to engage with revalidation, if you have not engaged enough with the appraisal process, or taken appropriate opportunities to ensure that you are ready for revalidation.

Deferral is a neutral act and is normally used in circumstances where more time is needed to demonstrate your continued competence. Your existing licence to practise will continue. This will allow you additional time to meet the GMC requirements for supporting information in full, or for a local process to be completed.

If you feel that your revalidation date should be deferred, for any reason, you should discuss your options and the reasons why with your appraiser and RO at the earliest opportunity. This will help to demonstrate that you are engaged with the process. You may well be right, but your RO will need to make the decision once they have all the facts.

Myth: My appraisal month will always be my birth month

There are a variety of ways to allocate your appraisal month. Most designated bodies follow NHS England guidance and spread appraisals through the appraisal year based on having your appraisal in your birth month. Other designated bodies may have a different way of allocating your appraisal month. There might be an appraisal season, during which everyone has their appraisal. You may have a period of leave which means your appraisal month might move. You might then resume a rolling twelve-monthly appraisal period with the new month as your appraisal month.

There are therefore many situations where your appraisal may not be in your birth month.

You are advised to check when your appraisal will be due when you move from one designated body to another. Your new responsible officer may ask you to change your month to ensure that you fit in with the local appraisal and revalidation policy and process.

Myth: It is my responsible officer's job to ensure that I have an appraisal

GMC statutory guidance states that, to maintain your licence to practise, you must ensure that you have an annual medical appraisal and demonstrate your continued competence across your whole scope of practice. Your responsible officer (RO) has a duty to ensure that there is a suitable, quality assured, appraisal process for you to participate in. The GMC requires you to engage with your annual appraisal process on an ongoing basis. It is your responsibility to ensure that you have an appraisal.

Some doctors do not have an RO, or a Suitable Person, and still organise their own annual appraisal that meets the GMC criteria for a medical appraisal for revalidation.

If you work in a designated body with an organisational appraisal policy, it is your responsibility to understand what that means for you and how you should be accessing your annual appraisal. Your RO has a statutory responsibility for ensuring that the appraisal process is fit for purpose but you must play your part in engaging fully with the process.

We recommend that you are proactive in ensuring that you have an annual appraisal that is meaningful and meets your personal and professional development needs in the context in which you work. If your appraisal becomes disproportionately burdensome, we recommend that you speak to your appraiser and RO. They can support you and help you to see how to achieve what you need to do.

If you think that you should be offered an appraisal and you are not, we recommend that you are proactive about seeking advice from your designated body and ensuring that you are included in the appraisal process. Administrative errors do happen and you are best placed to highlight such omissions.

Myth I cannot demonstrate my engagement with revalidation if I miss an appraisal

If you are in work when your appraisal is due, it is easy to demonstrate your engagement by having your appraisal meeting before the end of the month in which it is due.

There is currently no GMC guidance that lays out exactly how you should demonstrate your engagement if you are not going to be in work at the time when your appraisal is due. Most responsible officers (ROs) have a process so you can let them know about maternity or sick leave, or if you will be away on a sabbatical. The RO can then authorise a decision to postpone your appraisal month or an approve a missed appraisal. You should do this in advance to demonstrate your engagement with the process.

We recommend that if you are planning a significant period of time out of work for any reason you should speak to your appraiser or RO. Sometimes it will be appropriate to postpone or cancel your next appraisal. Sometimes it may be better to go ahead with it as planned or bring it forward so that it is completed before you go off work. The important thing is for you to decide this in agreement with your RO and their team and for your summary of appraisal to record the circumstances and your reflections on them.

If you do have to miss an appraisal due to a significant period out of work, we recommend that you have an early appraisal following your return. This will give you an opportunity to reflect on all that you have experienced and learned and to plan any changes that you now want to make. An important aim for the 'return to work' appraisal will be the development of an appropriate new PDP arising from the appraisal portfolio and discussion.

If you have been out of clinical work for more than two years, you will need to engage with the Return to Practice (RtP) Programme. This will mean that you are in a training role and do not require an additional whole scope of practice appraisal until after you have completed the programme.

Keeping your documentation professional and maintaining an appropriate level of confidentiality.

Myth: I must use a portfolio defined by my responsible officer to revalidate 

The format of the portfolio of supporting information is not prescribed by the GMC, so having an electronic portfolio is not a requirement for revalidation. We recommend that your portfolio of supporting information should include all the core elements required by the GMC in a format that is professionally presented, typed so that it is legible, and capable of being transmitted electronically. Some other items of supporting information, such as original complaint letters or compliment cards, which may be hand-written, are usually best kept in paper form and shared privately with your appraiser to maintain confidentiality. They can then be referenced anonymously by the appraiser in the summary. 

The medical appraisal guide model appraisal form (MAG 4.2) [PDF] is a free interactive PDF available from the NHS England website. This provides the template for all other toolkit providers and its use is not restricted to England. In some areas, responsible officers (ROs) have commissioned bespoke IT solutions for their doctors to encourage them to use a single system. In Scotland and Wales there are national appraisal and revalidation platforms used by all doctors. Scotland uses SOAR and Wales uses MARS. Your RO may have expressed a preference among the available options, which they are entitled to do under RO regulations. You should check your designated body requirements and variations with your RO. For example, special arrangements might need to be made to solve an issue of accessibility for a GP with a protected characteristic. If you move to a new area of the UK you should check if there is a preferred local choice of portfolio. 

If your RO has not determined that a specific electronic portfolio should be used locally, you should choose a solution that suits you. Remember that your portfolio, with all the GMC required supporting information, needs to be available to your RO potentially at short notice.

Myth: My appraisal portfolio is entirely confidential 

Your appraisal and revalidation portfolio is normally only available to you and your appraiser and responsible officer (or designated deputy). It should follow all relevant information governance and data protection laws. It is inappropriate to include any third party identifiable information, whether about patients or colleagues, without their explicit permission, unless the information is already in the public domain. 

Your portfolio is a professional document and reflective notes included in it should be written in a professional way. It could be subject to a request to disclose, just as clinical notes can be. If they are appropriately written, your reflective notes can demonstrate your learning and insight into any incident under investigation. Your appraiser should be able to support you in ensuring that you have demonstrated your reflective practice in a professional way, that is proportionate and maintains confidentiality as far as possible.

Myth: I do not need to provide examples of my reflective practice in my portfolio as long as I bring them to my appraisal

There has been a lack of understanding about the necessity of meeting the GMC requirement to demonstrate that you are a reflective practitioner working in line with Good Medical Practice. It is not appropriate to avoid demonstrating your reflective practice in your appraisal portfolio. The GMC requires you to demonstrate that you are working as a reflective practitioner by collecting appropriate supporting information, reflecting on it and discussing it at your appraisal. In other words - collect; reflect; discuss. You should demonstrate your professionalism and your engagement with appraisal by including appropriate examples of your professional reflective practice in your appraisal portfolio. It is not sufficient to provide them separately and expect your appraiser to summarise them for you - there has to be some evidence of your reflective practice. You can expect your appraiser to help you to ensure that what you include in your portfolio is appropriate, and proportionate. Original, non-anonymised information, such as the details of complaints and compliments, should be shared separately and cited by your appraiser in the appraisal summary of discussion.

Reflection is a subjective analytic process that seeks to learn and make improvements as a result of thinking about CPD, cases, data, events or feedback. Think quality not quantity of reflection. The factual details are best captured elsewhere, and contemporaneously as far as possible, but your reflection should focus on capturing any lessons that you have learned and any changes that you have made as a result. Your appraiser will help you to ensure that what you include in your portfolio of supporting information is appropriate.

Myth: My appraiser has the choice of appraisal venue

There is good evidence that the most valuable appraisals take place when the environment is private, confidential and provides a ‘safe space’ for reflection and discussion. The appraisal venue should be mutually agreed between the appraisee and the appraiser and you should not feel pressured into meeting at a venue that does not suit you. If you do not have a suitable professional venue to offer, or you prefer to meet away from your workplace, it may be appropriate for you to travel to the appraiser or to meet in some alternative professional venue. Some designated bodies may set out specific arrangements in their medical appraisal policy for the appraisals of doctors connected to them and you should be aware of any such local requirements. Wherever you meet, it should still meet the requirements of a professional venue.

A professional venue is private, free from interruptions and has full access to the internet and other necessary facilities. In exceptional circumstances, it may be appropriate to hold an appraisal meeting in an unusual venue, such as a home office, if it can be demonstrated that the venue is appropriately professional and there is good reason for such a choice.
The RCGP recommends that any decision to hold the appraisal meeting in an unusual venue should be agreed in writing with the appraisal lead or responsible officer (according to the appropriate appraisal policy) before the proposed meeting takes place, and that the agreement should be attached to the appraisal documentation for transparency. This provides protection to the individuals concerned and assurance to the responsible officer.

Myth: I should do my appraisal outside working hours

Your medical appraisal for revalidation is a professional responsibility. The RCGP recommends that the appraisal meeting should take up to half a day and be done when you are alert and able to give it your full energy and concentration, and ideally when you will have time to relax and reflect afterwards. It should take place in your normal working hours. 

When appraisal was introduced in primary care in the NHS it was resourced (funded) for a full day – half a day to prepare and half a day to have the appraisal meeting. Although the money is now in the global sum and not paid to individuals, this supports professional appraisals in working hours. 

There should be no pressure on you to have your appraisal outside your normal working hours. If you choose to do your appraisal in your own time, for example on your half day, because it is mutually convenient for you and your appraiser, then you should be entitled to time in lieu.

The RCGP recommend that you should seek advice and support from your responsible officer (RO) if you feel that your appraisal is not being supported appropriately. The RO is responsible for the quality assurance of the appraisal process.

Myth: My appraisal has to be face to face

Although it is considered best practice to have your appraisal face to face (particularly for the first appraisal in a new appraiser-appraisee pairing) many doctors have satisfactory remote appraisals with the prior permission and agreement of their responsible officer and appraiser. The Medical Appraisal Policy for your designated body will have clear guidance on the circumstances in which a remote appraisal may be appropriate and how to get prior agreement from your RO. The expectation is that within the NHS, and for GPs, it will remain exceptional to have a remote appraisal. 

Myth: I am only allowed to have three appraisals with the same appraiser (in England)

There may be exceptional circumstances where it would be appropriate for you to have a fourth appraisal with the same appraiser, providing that you have the prior permission and agreement of your responsible officer and appraiser. For example, a doctor approaching retirement may get more value from a fourth appraisal with the same appraiser in celebrating their career and planning for their retirement than trying to form a relationship with a new appraiser when they have very little time left in practice. The RCGP recommends that you think about what will enable you to have the most meaningful and valuable appraisal and take action if you feel that you would benefit from an additional year for continuity. You will need the agreement of your responsible officer and appraiser and to demonstrate how you will fulfil the strong recommendation that it is good practice to have at least two different appraisers in a five-year revalidation cycle.

Myth: I am a GP working in (any particular scope of practice, for example, a secure setting) so I must have my appraisal with someone who has experience of this setting

Medical appraisal for revalidation, by definition, is the forum to reflect on and discuss the whole scope of your practice. It is inappropriate for a medical appraiser to fail to appraise any part of your scope of work. Doctors working in roles that may be quite isolated need their generic appraisal as a chance to have appropriate support and challenge. All appraisers should feel competent and supported to appraise the whole scope of practice and if they have any concerns, the RCGP recommends that they take them up with their RO.

There is no requirement for you to have your appraisal with someone who has experience of your setting. The scope of work of general practitioners is so broad that it would be impossible to match the experience and backgrounds of all appraisers and appraisees. There is good evidence that GPs value having an appraisal with someone from outside their own setting because of the objectivity that this allows and the perception of being able to speak in confidence. 

In order for your appraisal to be valuable to you and to your patients, the training and support for the medical appraiser must give them sufficient credibility to appraise your whole scope of practice. You are entitled to request a reallocation, after you have been appraised for the first time by a new appraiser, if you do not find them credible as there is good evidence that appropriate rapport is essential to a productive appraisal discussion.

Keeping your supporting information simple and proportionate.

Myth: I must document all my learning activities

You do not have to document all your learning activities. We recommend that you focus on the quality not quantity of your supporting information.

You should be selective about documenting your reflection on your most valuable and meaningful learning, over the course of the year. You do not need to record and reflect on every learning activity.

If you find it convenient and helpful to record significantly more than 50 CPD credits for your own benefit to capture your learning then that is your choice, but your appraiser will focus on the quality of your learning and reflection and challenge you to highlight what has been most important over the course of the appraisal period.

Myth: I need to scan certificates to provide supporting information about my CPD 

The GMC has not set any requirements about exactly how CPD should be evidenced or recorded. Certificates of attendance may prove attendance at an event, but they are not proof of learning or development. They say nothing about what has been learned, or any changes you have made as a result. Recording and demonstrating your CPD by scanning and storing certificates is not likely to be a good use of your time. 

A reflective note, no matter how brief, on your learning and what difference it has made (or will make), is more valuable evidence of reflective practice and continuing professional development than a certificate. A lot of valuable learning takes place in ways that do not generate a certificate, such as personal reading and professional conversations with colleagues. We encourage you to think about how and what you have learnt rather than collecting certificates.

The RCGP recommends that you should keep a simple learning log in a way that is convenient to you so that you can capture your key learning points and their implications for the quality of your care. 

There are several useful apps available, for example the GMC CPD app. Some electronic platforms include learning diaries that can be accessed or emailed from your Smartphone or other devices. A document record, table or spreadsheet can work just as well.

Appraisers should not be asking to see certificates of attendance; they should be asking what your most important new learning has been over the past year and what difference it has made to your practice.

Myth: I am not allowed to scan certificates to provide supporting information about my CPD

It is appropriate to include scanned certificates in your appraisal portfolio when scanning and storing them is going to be useful to you. Your aim should be to avoid duplication of effort.

Many CPD facilitators now provide certificates that include a structured format or template for you to write appropriate reflective notes about learning and planned changes that will have an impact on your practice. While the RCGP recommends that you capture your reflective notes in a way that is compatible with the appraisal system you are using (such as MARS in Wales) it is reasonable to scan in CPD certificates that include reflection if it is helpful to you. For most GPs, it will be less burdensome to choose not to complete the certificate at all and capture the reflective note elsewhere in a learning log or electronic toolkit. 

You might want to scan certificates relating to training specifically required by your designated body or any organisations in which you work, often called mandatory training. This does not make them part of the GMC requirements for revalidation, but it does allow you to collect and keep important documentation securely and demonstrate your fitness for purpose to your employer. Your RO is entitled to ask you to keep this information securely for employment purposes.

If you prefer not to scan a certificate but you refer to it in your appraisal submission then your appraiser may reasonably ask to see it, so you should bring it separately to your appraisal.

Myth: It is reasonable to spend a long time getting the supporting information together for my appraisal 

Organising supporting information into your portfolio, and making the sign-offs and statements before appraisal discussion, should not take long. 

We recommend that your supporting information should be generated from your day-to-day work and added to your portfolio as you go along. Producing a CPD log can be difficult and time consuming as a retrospective exercise. It is much easier to make regular entries into your learning diary throughout the year. There are now many tools and apps to help you to do this in a simple and timely way.

We recommend that the final stage of organising the supporting information and completing your portfolio before your appraisal should take no more than half a day, around 3.5 to 4 hours. This is based on the original financial provision for annual appraisal, which was for one day of activity, half to prepare and half to have the appraisal discussion.

If your preparation is taking longer than four hours, or the effort feels disproportionate, you should discuss with your appraiser how you can simplify what you do. Some doctors with complex portfolio careers and several roles to include may reasonably take a little more time than this, but you should seek advice if it takes more than a day to organise.

Myth: I only need to provide all six types of GMC supporting information about my clinical role 

The GMC requires doctors to provide appropriate supporting information across the whole of their scope of practice that requires a licence to practise, not just clinical roles. 

You must declare all parts of your scope of practice and, for each of them where appropriate, provide all six types of supporting information over the revalidation cycle:

• CPD
• QIA
• significant events, if there are any
• patient feedback
• colleague feedback 
• complaints and compliments, if there are any

We recommend that you keep the documentation of your supporting information reasonable and proportionate while ensuring that you have demonstrated that you are up-to-date and fit to practise in every scope of practice. Your appraiser will help you determine whether there are any gaps in your portfolio of supporting information and support you in working out how best to fill those gaps. Your responsible officer (RO) will tell you if your portfolio demonstrates sufficient engagement in reflective practice and provides the supporting information required by the GMC. 

If you have any queries that your appraiser cannot resolve, we recommend that you seek early confirmation from your RO that what you are planning is going to be acceptable. 

Myth: All my supporting information must apply to work in the NHS 

Your supporting information must cover the whole scope of practice for which you require a licence to practise, if you are working in the NHS or not. 

There are GPs working entirely in private practice who maintain a licence to practise through revalidation. Even if the NHS provides your designated body and responsible officer, your medical appraisal for revalidation must cover your whole scope of practice, including any roles outside the NHS for which you require a licence to practise. Appraisers are trained and supported to provide whole scope of practice appraisals and to facilitate reflection on supporting information from inside and outside the NHS. 

Myth: There are some parts of my scope of practice that my medical appraiser cannot appraise for which I will need an additional appraisal

It is inappropriate for a medical appraiser for revalidation to say that they cannot appraise any part of your scope of practice. They should have the training and support to provide a whole scope of practice appraisal for any type of work that you may undertake which requires a UK licence to practise. If your medical appraiser for revalidation suggests that they are unable to provide a whole scope of practice appraisal, you should discuss this with your RO and the RCGP as soon as possible.

Every separate place where you work has a duty to supervise and support you in the role they are engaging you for. Within this, it is good practice that they should undertake some form of performance development review with you on a regular basis. In some places this may be referred to as an 'appraisal'. It is important to recognise the difference between a single-role performance review and your full scope of work medical appraisal. It can be helpful to reserve the term 'appraisal' for the latter. 

The RCGP recommends that you include the outputs of performance development reviews from any part of your scope of work (where you have them) separately in your main medical appraisal. You should reflect on the outputs of these reviews in your main appraisal rather than presenting all the original supporting information again. It is not appropriate to duplicate effort and be appraised twice in the same way.

For some parts of your scope of practice, it may not be possible to have an external performance development review. For example, you may not be working in a governed environment with any oversight of your performance, so there may not be anyone to provide such a review. For these roles, you will need to provide all the GMC required supporting information to demonstrate that you remain up-to-date and fit to practise at what you do, reflect on it and discuss it at your main appraisal.

Myth: If I have already had an in-house 'appraisal' for one part of my scope of practice, I have to present all the same information again for my medical appraisal for revalidation

Where an employer offers a periodic performance or development review, whether or not it is called an appraisal, then the outcomes of that should be included in the medical appraisal, reflected on and discussed. There is no need to repeat the review of the original supporting information if it has already been reviewed in-house and the outputs included in the appraisal and revalidation portfolio, although it is appropriate to consider with your appraiser whether all the GMC requirements have been met for that role and to include the outcome of that discussion in the appraisal summary. Where there is no such review, you must collect and reflect on the GMC required supporting information for that part of your scope of work and discuss it at your medical appraisal.

Myth: Supporting information from work overseas cannot be included in my appraisal portfolio 

The GMC Protocol for responsible officers (ROs) making revalidation recommendations states at 2.3.2: 

Doctors may practise in settings where they do not require a UK licence – for instance, they may work abroad, or they may undertake specific functions in the UK that do not legally require a licence to practise. Where this is the case, it is at your discretion whether you consider supporting information from these practice settings in making your judgement. You should consider whether such information is material in your evaluation of their fitness to practise, taking account of whether it is demonstrably relevant to the doctor's licensed UK practice and the proportion of the doctor's supporting information that it represents.

The GMC requirement is that your appraisal and revalidation portfolio should include supporting information about every part of your scope of practice that requires a UK licence. As the above makes clear, your RO has the discretion to consider supporting information from other settings in making their revalidation recommendation. 

Myth: I cannot use any supporting information from overseas

At revalidation the GMC is issuing a renewed UK licence to practise so the GMC required supporting information must demonstrate your continued competence for your UK practice. Sometimes clinical work overseas has a significant overlap with clinical work in the UK. Your RO has discretion to consider any additional supporting information from work that you have done overseas where it is relevant to your UK practice in demonstrating your reflective practice, how you review and make improvements in your work, and how you seek and act on feedback. The RCGP recommends that this can provide powerful evidence of your professional behaviours and habits, one of which is to collect information that demonstrates that you remain up to date and fit to practise across your whole scope of practice wherever in the world you are. With modern electronic learning diaries and web-based portfolios, this should be easy. 

Even in UK practice, you may attend CPD events overseas. It is appropriate to check that the content of such an event is applicable to your scope of practice rather than assuming that it will be acceptable. We recommend that you discuss any proposal to include any such additional supporting information with your RO in advance of your revalidation recommendation date. 

If you are unsure, use your appraisal as an opportunity to reflect on what is appropriate and proportionate with your appraiser, and then agree it with your RO before your revalidation recommendation is due. 

Myth: Having a 'disagree' statement from my appraiser is always a bad thing

There are five key sign-off statements that are normally agreed by your appraiser at the end of your appraisal. If your appraiser decides that one, or more, should be marked as 'disagree', this sends a message to you, your next appraiser and the responsible officer (RO) that something may not be ready for revalidation. This is not, in itself, a bad thing. It is an important part of ensuring that the appraisal supports you in preparing a portfolio of supporting information appropriate for a positive recommendation to revalidate. Ultimately, your RO makes the decision about your revalidation recommendation, not your appraiser.

There are two different comment boxes for the appraiser, and one comment box for you, to provide an explanation for the disagree statement. It is relatively common for a doctor to have made no progress with their previous PDP, either because they had no previous PDP, in the case of a first ever appraisal, or because circumstances changed significantly during the year, making the earlier PDP goals less appropriate. In these circumstances, it is appropriate for the appraiser to mark 'disagree' to the statement about progress with the previous PDP, and enter an explanation in the comments box.

Even the fifth sign-off statement, which states that there are no concerns arising from the appraisal documentation or discussion that suggest a risk to patient safety, may sometimes need to be marked as 'disagree'. For example, if a doctor is currently under investigation, and has their annual appraisal in the period before the investigation is resolved, they could not be revalidated as there are outstanding concerns, and the appraiser should indicate this by marking the fifth statement as 'disagree'. It is important that the appraiser puts an explanation in the comments box provided in every case where they have marked a statement as 'disagree'.

In all cases, you also have a box in which to enter your comments, although you do not have to comment if you have nothing to add to the appraiser's explanation.

Myth: I must get sign off statements from all parts of my scope of work every year

The RCGP does not recommend that you seek sign-off statements that there are no concerns about your practice in all of your roles every year. Instead, you should reflect on how the safety of patients is being assured and the governance, clinical or otherwise, of the systems you are working in. You should always know how to report on a significant incident and how you would find out if there was a complaint about you. It is important that you have declared all the different parts of your scope of practice and provided appropriate supporting information to demonstrate that you are keeping up-to-date, reviewing and maintaining your performance and seeking and acting on feedback in each. It is also important that you ensure that your responsible officer (RO) knows how to contact the clinical governance leads from any part of your scope of practice that is not for your main designated body so that they can seek the assurance that they need when they need it.

We recommend that any governance concerns arising about a doctor should be communicated to the RO as and when they arise, by those responsible for the governance surrounding a doctor's work. It is crucial that concerns can be dealt with in a timely fashion and are not linked to the revalidation cycle.

In some cases, a doctor will be working in an environment where there is no external governance and the reporting of any issues will depend on the professionalism of the doctor. Significant incidents and complaints can arise in every type of practice, and the GMC requires that all such incidents and complaints should be declared and reflected on at appraisal. We recommend that GPs talk to their RO whenever they have a governance concern to agree the best way forward and because the RO will often be able to signpost appropriate resources or courses of action.

In summary, normally concerns will be generated and 'pushed' to your RO as and when they occur to be dealt with in a timely fashion outside the revalidation process. As part of this, you are personally responsible, as a professional, for declaring any concerns that you are aware of as they arise. In addition, your RO needs to have up-to-date contact details for all parts of your scope of practice to 'pull' information about your work at any time, should this be necessary.

Demonstrating examples of your ability to learn from CPD, cases, data, events and feedback, and make changes if needed.

Myth: Reflection is difficult 

Reflection is a professional habit that all doctors should have. None of us would want to be treated by doctors who never considered how effective their care was or whether it could be any better. Reflection should be something you do all the time. It is part of your professional training. Like any habit, reflection can be such a subconscious activity that it can be hard to be sufficiently aware of it so you can capture it and write it down. Demonstrating reflection is what some doctors find difficult. You do not have to record all your reflections as this would be disproportionate. It is important to find a method of capturing reflection that works for you and to keep it simple and proportionate. Some people are more natural reflectors than others. You might find it helpful to understand your own preferred learning style. Your appraiser will have training and knowledge to help you, so you should discuss any concerns with them.

You might find that your appraiser helps your reflection through active listening, careful questioning and feedback. The appraisal discussion is an important trigger to generate new reflective insights which can be captured in your appraisal summary. It should build on your own demonstrated reflective practice. Remember: collect, reflect, discuss. 

Myth: Documented reflection must be lengthy

Remember the principle of quality not quantity of supporting information. Documented reflection should be brief and to the point as far as possible. Capturing the key learning points that have influenced, or will influence, your practice, and thinking about any changes that you may make as a result, and what difference they will make, can be recorded in bullet points, a couple of sentences, or a short paragraph. Some doctors are experimenting with recording brief audio reflections. Do what is appropriate for the specific reflection. Experiment with a variety of styles. Some methods may work better for some types of learning than others. If you are doing a postgraduate qualification then you might want to include a whole reflective essay, but, in most circumstances, this would be disproportionate. Some doctors find structured reflective templates that walk you through a process of reflection helpful. Others prefer not to be constrained. 

We recommend that you keep it simple and record what is meaningful to you. We suggest you focus on what you will do differently as a result of what you have learned, and how you will know if the change is an improvement.

Myth: I must write a separate reflective note for every hour of CPD I do

You do not have to write a separate reflective note for every hour of CPD, or even every learning activity. This is a change in emphasis from our previous guidance because we found that some GPs were doing far more than was appropriate and writing a page of reflection for every CPD credit. We recommend that you only provide reflective notes for your most valuable CPD. 

Ideally, your CPD log should be a record of your most important and relevant learning throughout the past twelve months in a succinct and useful format.

Your appraiser does not want to read a summary of what you looked up online, the whole article, or all that you were taught at an educational event or learned at a conference. If you find it helpful to make notes on the detail, for your own benefit as an aide memoire, you should do so as a personal choice based on your learning preferences, but it is not important to your appraiser. Your reflection should not be not about the factual detail, it should be about the impact of what you have learned on what you already do, or plan to do, so that you can maintain and improve the quality of your practice.

Myth: Reflection is dangerous if something has gone wrong

The RCGP recommends that professionally documented examples of your reflective practice are your best defence against any concern about whether you are working in line with Good Medical Practice. Things sometimes go wrong, for all of us. Patients and the public are rightly concerned that doctors and organisations should learn from things that go wrong. Your subjective analysis should demonstrate the lessons that you have learned, individually and collectively, and any changes that you, the team, or the organisation, have made as a result. They should provide reassurance that, if something has gone wrong, steps have been taken to ensure that it should not happen again.

The GMC have made clear that they will never require your reflection in an investigation. Sometimes, defence organisations recommend that a doctor submits evidence of reflection as evidence in their defence in the event of an inquiry, but this is a matter of choice for the doctor.

Myth: It is OK to make a statement saying that I will provide my reflection separately to my appraiser

The GMC requires you to demonstrate that you are a reflective practitioner working in line with Good Medical Practice. It is impossible to do this by proxy. You should include a few high-quality examples that demonstrate your professional habits of reflective practice in your appraisal portfolio. Remember quality not quantity.

The RCGP recommends that original compliments and complaint letters, or the factual data about a significant event, should be provided separately if they cannot be appropriately anonymised - but your reflection on them should form part of your portfolio. Providing reflection separately and expecting your appraiser to summarise it is not appropriate and does not show that you are a reflective practitioner. 

Writing your reflective notes professionally and ensuring that they provide supporting information about the way you reflect and use your reflections to make quality improvements is important. During your appraisal meeting your appraiser can help you to complete a second level of reflection through discussion around your own subjective analysis of what you have learned and your thoughts about the impact on your practice, but they cannot demonstrate your initial reflection for you. Your appraiser can also help you to make sure that what you have written is professional and fulfils the requirements for good information governance and maintaining confidentiality.

Myth: My reflection is privileged data

Your written reflection is not privileged data and could be required by a Court of Law if it was felt to be pertinent. This is very unlikely because reflections are not facts in the eyes of the Court; reflection is by definition a subjective analytic process. Courts are primarily interested in the contemporaneous medical records and we are used to writing our clinical notes promptly and accurately with this in mind.  

It is important to document your reflective notes in a professional way, taking care to meet the requirements of good information governance and maintaining confidentiality. Your appraiser should be trained to help you with this and can offer you this advice during your appraisal meeting.

Demonstrating that you have kept up to date. CPD credits and the variety of CPD you can and should do.

Myth: Only courses and conferences count as CPD

Continual professional development (CPD) activities should be very broadly defined and include personal, opportunistic and experiential learning as well as activities targeted at identifying unknown unknowns. Any learning activity where you spend time learning something and deciding how it can be put into practice in your current, or proposed work can be counted as CPD. You should only expend time and energy in documenting a sample of your most relevant and important learning. 

The aim is to demonstrate a balance of learning across the curriculum relevant to your scope of work over the five-year revalidation cycle. You should choose to demonstrate reflection on your most valuable learning events across a variety of learning. This is not just courses and conferences and should include:

• learning from cases, data, events and feedback
• personal reading and online research
• online modules
• professional conversations about clinical care 
• everyday leaning from your work and the experiences of others

As there is so much learning in primary care that takes place in teams, you should demonstrate where this has led to important changes and developments. It is also important, where possible, to demonstrate some learning with others outside the usual workplace to allow for external calibration of ideas and processes. For any learning activity, you need to reflect on what you have learned and any changes you have made (or not) as a result, but you only need to document and share your most valuable learning. Many GPs have been doing far too much and making the recording of their CPD disproportionate. Your documentation should not detract from your patient care, or family or leisure time.

Myth: I must do an equal amount of CPD every year despite different circumstances 

You do not have to do the same amount of CPD every year. Your revalidation recommendation will be informed by a portfolio that will normally cover a five-year cycle. We recommend that you should learn from a wide variety of sources and ensure that you always keep up-to-date as part of normal professional practice. 

You should view documentation of CPD as a selective process that must be kept reasonable and proportionate, documenting your reflection on your most important learning and any changes made as a result every year. Sometimes it is obvious that a major commitment, such as a postgraduate qualification, will take up almost all your CPD in one year. It is important to ensure that there is a spread from the GP curriculum over the five-year cycle if you are doing undifferentiated general practice. This may involve identifying and making up any gaps in your knowledge.

You should talk and work with your appraiser to ensure that the spread and variety of your CPD across the curricular for your scope are documented. Your appraiser can help you to recognise gaps and document your CPD appropriately. They can also help you to plan to ensure that your portfolio covers the whole of your scope of practice over the five-year cycle. 

Myth: As a part-time GP, I only need to do part-time CPD 

When you are providing undifferentiated primary care, whether full or part time, you cannot expect to demonstrate that you are up-to-date and fit to practise on part-time CPD. You need to cover the whole of the GP curriculum. The RCGP recommends that part-time GPs, who have less experiential learning to draw on need the same amount of CPD as full time GPs . It would be inappropriate for a doctor working one surgery a year as a GP to suggest that they could demonstrate that they were up-to-date for that role after completing only one credit of CPD relevant to such work. 

Myth: My CPD for each part of my scope of work must be different

Most doctors find some of their CPD appropriately demonstrates they are up-to-date in different parts of their scope of work. For example, the learning about diabetes done for a specialist interest role is likely to be applicable to a broader undifferentiated care GP role. You can use the same CPD to demonstrate keeping up-to-date for all applicable roles. 

If different organisations, in different parts of your scope of work, have required training in common, such as Equality and Diversity training or Information Governance updates, an annual update in one organisation should be accepted by others. This avoids duplication which could take you away from clinical care. You should check with the organisations in which you work that your training will cover all your roles. Organisations should be prepared to accept equivalent learning and understand the importance of not taking doctors away from front line care. 

It is the responsibility of individual GPs to check that the content of the training they undertake is appropriate to all their roles and to agree the equivalence with the organisations in which they work. 

Myth: My supporting information from part of my scope of work already discussed elsewhere should be presented again at my medical appraisal for revalidation 

Some parts of your scope of practice may be subject to some form of local 'appraisal' or performance review. Where this happens, the RCGP recommends that your portfolio should include a signed-off summary of that appraisal discussion and outputs and your reflective notes on them, rather than the original supporting information. You should not be appraised twice on the same material but you should discuss your reflection on the outcomes of such a review at your main appraisal. You should include appropriate contact details for the appraiser and relevant organisation for parts of your scope of practice appraised elsewhere. Your responsible officer can follow up on that part of your work if they need to. If part of your scope of practice is not appraised elsewhere, the GMC requires the six elements of supporting information and reflections about that part of your practice to be shared in the portfolio and discussed in the main medical appraisal for revalidation before a positive revalidation recommendation can be made.

Myth: The GMC requires GPs to complete Basic Life Support and Safeguarding Level 3 training annually to revalidate successfully

The GMC does not set any specific revalidation requirements in relation to CPD or specific types of training. The GMC's requirements for revalidation are about maintaining your licence to practise as a doctor. You must demonstrate that you are up-to-date and fit to practise as a doctor. 

In many areas, responsible officers (ROs) have asked doctors to include additional training requirements in their portfolio of supporting information. This is to ensure that organisational requirements are understood by every doctor. This does not make them part of the GMC requirements for revalidation. It is important that you recognise the difference between the requirements for revalidation and training requirements for other purposes, and that your appraiser and RO do not allow the two to become confused.

The GP curriculum includes demonstrating competence in Basic Life Support and Safeguarding Level 3 training, so keeping these up-to-date is an RCGP recommendation, but not a GMC requirement. The organisations in which you work might set specific training requirements, or your inclusion on a performers list might require you to undertake specific training. These are not requirements for revalidation. You should be aware of any training required by your organisation, as well as any training required for inclusion on a performers list to ensure that you remain fit for purpose. The RCGP recommends that you demonstrate how you have covered the breadth of the GP curriculum over the five-year cycle to demonstrate fitness for purpose as a GP. Some doctors who qualified as GPs might demonstrate that they are up-to-date and fit to practise as a doctor, without being able to demonstrate that they are fit for purpose as a GP, if they are no longer in a GP role.

Myth: I cannot claim any credits for a learning activity if I do not learn anything new

When you have spent time undertaking a learning activity, it does not always result in learning something new. If it simply reinforces your existing knowledge and skills, and you discover that you are already up-to-date without learning anything new, you can still count your CPD credits for the time you have spent consolidating your knowledge or skills. You may also wish to provide a reflective note that explains that there are no changes that you need to make at the current time. This can be very reassuring and provide a confidence boost.

Myth: My appraiser will be impressed by my hundreds of credits

The GMC does not set any specific revalidation requirements in relation to CPD or training. You need to demonstrate that you have done sufficient relevant CPD to keep up-to-date at what you do in a proportionate way. Your appraiser will not be impressed if you have spent time that would be better spent on your patients, family or relaxation on documenting credits over and above the recommended amount. If you wish to demonstrate more than 50 credits it is your responsibility to ensure that the way that you record and demonstrate your CPD is proportionate and reasonable and does not become unduly time consuming. Your appraiser should be trained to challenge you to keep your documentation proportionate and make sure that your recording of your reflection is done in a way that is useful to you. 

You should not expect your appraiser to review huge amounts of supporting information over and above what is required. Nor should you spend a disproportionate amount of time and effort on documenting your reflection on everything you learn throughout the year. Try to create sensible habits that make your documentation simple and streamlined and use the knowledge and skills of your appraiser to help you.

Myth: I must do 50 credits of CPD every year

The emphasis for CPD is on the quality of reflection on what you have learned and the impact on quality of care, not quantity of credits documented. In fact, it is impossible to put a number on the credits that you need to do to keep up-to-date and fit to practise. The GMC requires you to do enough CPD to keep up-to-date across your whole scope of work but they do not attempt to define or require a quantity. 

We recommend that you demonstrate 50 credits for every twelve months in work with a spread across the GP curriculum over the five-year cycle if you are doing undifferentiated general practice. This recommendation can help you estimate what is right for you as an individual GP - but it is not a GMC requirement. If you demonstrate 50 credits, your portfolio is unlikely to need any additional scrutiny of your CPD. If you do not, then it is likely that your responsible officer (RO) will want to understand exactly why you believe that your CPD is sufficient to keep you up-to-date and fit to practise and the RCGP recommends that you provide a reflective note of explanation.

The recommendation that you undertake 50 CPD credits is not a requirement. It relates to the current Academy of Medical Royal Colleges (AoMRC) recommendations for all doctors, bringing the RCGP into line with other specialties, to try to ensure that there is a level playing field for everyone. We recommend that those who have a restricted scope of work should discuss with their appraiser what constitutes sufficient CPD to keep up-to-date at what they do and to agree this with their RO if necessary. 

For example, those who were historically GPs but now have a very restricted role providing only family planning services, will follow the recommendations of the Faculty of Sexual and Reproductive Healthcare (FSRH) for their CPD, and will not need to complete 50 credits to demonstrate that they are fully up-to-date across the whole of their work. However, GPs who wish to remain entitled to undertake undifferentiated primary care sessions need to keep up-to-date across the whole of the GP curriculum.

Myth: I need 50 credits of clinical CPD every year 

The RCGP recommends demonstrating 50 credits across the whole GP curriculum, which is much broader than purely clinical CPD. It has always been important to have a balance across the whole GP curriculum relevant to the work that you do.

Myth: I must demonstrate 50 credits each year even if I have not been able to practise for much of the time

If you have a prolonged career break in an appraisal period, for example due to maternity or sick leave, we recommend that you demonstrate CPD proportionate to your time in work. You should not be burdened with a double load of CPD in the year when you return to work. 

While you may choose to front load your CPD to be up-to-date and confident to return to work, this would not be appropriate for everyone. If you have a shortened appraisal interval, for example because you have pulled your appraisal forwards for organisational or personal reasons, you can provide CPD proportionate to the time in work between your appraisals. The GMC requirements for revalidation remains constant whether the review period is three months in work or twelve, but the supporting information should be proportionate to the time in work. 

For example, if your appraisal is brought forward so that it is nine months after the previous one, then you should consider what supporting information is proportionate for a nine month period in work. We recommend that you focus on making progress with your previous PDP, even if not all goals can be achieved, and that you document reflection on a proportionate number of credits of CPD as well as the other types of supporting information. If an appraisal takes place more than twelve months after the previous one, the supporting information presented should be proportionate to the whole time spent in work between appraisals. You should discuss any question about what is appropriate and proportionate in advance with your appraiser and your responsible officer (RO) if necessary. 

If it has been impossible for you to demonstrate all the GMC required supporting information before your revalidation recommendation due date, for good reason, then the RO has the option of deferring your revalidation recommendation. This gives you more time to collect the information you need. Deferral is a neutral act to enable you to maintain your licence to practise during the deferral period. For many doctors a deferral decision gives them time, rather than trying to produce a disproportionate amount of supporting information after a period when they have not been able to work.

Myth: 50 credits is always enough CPD 

The GMC requires you to do enough CPD to keep up-to-date across the whole of your scope of practice. This may require more, or less, than 50 credits depending on the scope of practice and your qualifications and experience in each area of work.

You should determine what is enough CPD for you to be up-to-date and fit to practise across all of your work. You should discuss this with your appraiser and, when necessary, get explicit agreement from your responsible officer that what you are doing is appropriate for your circumstances. 

As an exception, if you have a complicated portfolio career and several roles to include, you may feel you need to demonstrate more than 50 credits to demonstrate reflection on appropriate CPD to keep up-to-date for each part of your work. You should keep the detailed documentation proportionate and reasonable. Most doctors find it easier to keep a learning log that builds up as they go through the year and this could amount to over 50 credits by the end of the year. If the documentation of the reflection has not been allowed to become disproportionate, you should be the one to decide what works for you. 

The appraisal discussion should focus on the credits that reflect on the most valuable and representative learning. We recommend that you should reflect on the balance of your CPD and discuss it with your appraiser. If you are still working as a GP providing undifferentiated primary care, we recommend that you demonstrate 50 credits of CPD relating to the breadth of the GP curriculum. Some elements of CPD are applicable across several roles and where possible you should avoid duplication.

Myth: I can stop learning and reflecting once I have reached 50 credits of CPD 

No doctor should ever stop learning and reflecting on their practice if they want to keep up-to-date and stay safe. 

You should not change your professional habits of learning and reflection, but you don't need to document it all. You should focus on what has been particularly important or valuable to you over the course of the whole period being appraised. 

Myth: There is a maximum number of credits I can claim for any one type of learning or one activity 

We do not recommend any arbitrary limits to the number of credits that can be claimed by a doctor. The emphasis is on keeping the recording of reflection proportionate. You do not need to go on recording copious reflective notes once you have demonstrated that you are up-to-date and fit to practise.

It is not appropriate for appraisers to be unduly critical about the exact amount of time recorded, or credits claimed, as it creates tension where none is necessary. For example, most diplomas are hundreds of hours of learning, with direct impact on patient care, so setting an arbitrary limit to the amount of credits that can be claimed is not helpful, or proportionate. Spending time cutting down credits when you have done the learning and recorded your reflection, is as disproportionate as spending time recording credits over and above those that are sufficient to demonstrate keeping up-to-date. GPs providing undifferentiated primary care need to have CPD that covers the GP curriculum over the five-year cycle.  Documenting and evidencing hundreds of hours of learning from study for a diploma may not be enough CPD to demonstrate continued competence if you have not recorded any other CPD, as it might not cover your whole scope of practice. 

We do not recommend an arbitrary limit for how much CPD can be attributed to one type of learning. It is possible for you to provide high quality reflective notes on 50 credits from just one type of learning that covers the whole scope of your practice. However, it is best practice to have supporting information about a variety of types of learning. To remain up-to-date across the whole scope of your work you should demonstrate:

• targeted structured learning aimed at addressing identified learning needs or your unknown unknowns 
• opportunistic experiential learning from cases, data, events and feedback. 

It is important to include evidence of learning with others to calibrate professional judgements and support team learning. 

Doctors who do not have a breadth of variety of learning types or a significant proportion of learning with others should use their appraisal to discuss this. We recommend that you share a reflective note exploring why this is and what you plan to do to ensure that your practice remains mainstream and not isolated from peer support and review. If you have not included this type of reflection in the pre-appraisal documentation, you should discuss it during the appraisal. Your appraiser should document this reflection in the summary. 

Myth: I cannot include contractual training as part of my CPD

We recommend that all learning activity should be eligible to be counted as CPD. It is important to reflect on contractual or required training, as it is required for good reason and part of being able to demonstrate that you are 'fit for purpose' in your role. The appraisal documentation is a good place to record when any mandatory training was completed. Because of the importance of being able to demonstrate compliance with this training in meeting contractual, or performers list, obligations, it may be appropriate to upload your certificates of attendance as well any reflective notes.

If you have more than one part of your scope of work with the same training requirements, for example, equality and diversity training, we recommend that you negotiate to ensure that the training that you do will meet the needs of all your roles. This avoids duplication of effort and the unnecessary burden of repeating the same training for different employers.

How to review your practice through a variety of QIA that demonstrates quality improvements in your work and patient care.

Myth: Time spent on quality improvement activities is not CPD 

All learning activities can be included in CPD credits. They should be demonstrated by an appropriate reflective note about the time taken, lessons learned and any changes you made as a result. 

Continual professional development can include:

• traditional CPD
• QIA 
• significant events
• reflecting on feedback from patients and colleagues, including complaints and compliments. 

You should avoid unnecessary duplication. Once you have demonstrated sufficient CPD to keep up-to-date across your whole scope of practice you do not need to write additional reflective notes. You should not stop learning, and reflecting on what you learn, but we recommend that you stop documenting in detail what you have learned and reflected on, unless it is important to you. 

Myth: I must do at least one clinical audit in the five-year cycle 

For the purposes of revalidation, the GMC requires that all doctors demonstrate that they regularly participate in activities that review and evaluate the quality of their work. Clinical audit is not a revalidation requirement, but it can form part of quality improvement activities or projects. 

The RCGP recognises that there are many different types of quality improvement activity, in addition to clinical audit, that are equally acceptable as QIA. You should show that you have:

• thought about the quality of care you provide
• reviewed your care in the context of current guidance on good practice
• celebrated where there are no changes that you need to make 
• made changes where necessary or appropriate to improve the quality of care you provide
• revisited the question to see if the changes have made an improvement.

It is important that you routinely review the effectiveness and appropriateness of the care that you provide to keep patients safe. Demonstrating that this is a professional habit is a matter of choosing examples that show what you do and how you do it. You do not need to document every review of your work that you do. 

Depending on your circumstances, different quality improvement tools are helpful including:

• reflective case review
• learning event analysis
• review of personal outcome data
• search and do
• plan, do, study, act cycles
• clinical audit

You may wish to plan your quality improvement activities for the coming year with your appraiser and include them in your PDP. If you are aware that what you are planning as a quality improvement activity is unusual, you should discuss it with your appraiser and agree it with your responsible officer before including it. 

Myth: I must do all my QIA myself 

You do not need to do all the background work and data collection or analysis for your quality improvement activity yourself. For some doctors there are national clinical audits into which they contribute their personal outcome data. Where this exists for part of your scope of practice, it is important that you review the audit results to see how your performance relates to that of your peers. If the audit is not comparing like with like, this is your chance to reflect on how to improve the quality of the data being used.

Delegating someone else to run a search, or do some of the research, is a reasonable and proportionate use of your time. We recommend that you select QIA that allow you to review what you do. Your personal reflective notes should include an explanation about your role in the quality improvement activity and a description of the findings, including any lessons you have learned and the impact they have had on the quality of care that you provide. 

GPs work in teams and much of the quality improvement activity that it is important for us to reflect on arises from teamwork. You can learn from the review of your own performance, and we recommend that you also try to learn from review of the performance of the team, including the mistakes and near misses of others. Learning event analysis in primary care is often a team activity.

The questions to ask yourself are about what you have learned about the quality of the care you provide and what, if any, changes you should make as a result. 

Myth: There are specific types of QIA that I must include 

You do not have to include any specific type of quality improvement activity but you must reflect on the quality of your practice and how you meet the requirements of Good Medical Practice (GMP).

The GMC requirements are sufficiently broad to recognise all activities that allow you to review what you do. We recommend that where you maintain a clinical skill, such as IUS insertion or minor surgery, you keep a log of your personal outcome data. You can then reflect on this at least once in the revalidation cycle to demonstrate the appropriateness of the quality of care you are able to provide in these areas. We recognise the value of reflective case review and learning  event analysis as useful QIA but no longer specifically recommend that you include two every year in order to allow more personal choice and flexibility. Similarly, we recognise the value of clinical audit but no longer recommend that you should include one two-cycle audit every five years. There are many other types of QIA that may be equally, or more, appropriate for your circumstances, which will also meet GMC requirements.

Where your organisation provides you with clinical governance data about your practice, or there is a national clinical audit to which you contribute, which allows you to benchmark your work, it is appropriate to include this information in your portfolio of supporting information and reflect on what you have learned from the results and any changes you will make as a result.

Which significant events you need to declare, reflect on and discuss at appraisal and how to demonstrate learning from other events as QIA.

Myth: GMC significant events are the same as GP significant events 

The GMC definition of a significant event is not the same as that commonly used in primary care. The GMC says:

A significant event (also known as an untoward or critical incident) is any unintended or unexpected event, which could or did lead to harm of one or more patients. This includes incidents which did not cause harm but could have done, or where the event should have been prevented.

The GMC requires you to declare and reflect on those significant events in which you have been personally named or involved and in which a patient or patients could have or did come to harm.This means that all significant events that meet the GMC threshold of harm must be included in the Significant Events at your appraisal, but you do not need to provide your reflection on them.

There is no limit to the number of such significant events that you must include. However, if you have had no significant events that meet the GMC threshold of harm, you should declare that in the relevant sign-off statement. 

We recommend that you do not use the Significant Event section of your portfolio to record GP learning events. These are essentially any event, positive or negative, that has triggered a learning process for you or your team. They should be reflected on and included as quality improvement activities, where you are demonstrating your learning from events in your scope of practice.

Myth: I must include two significant events every year 

There are a very wide range of possible types of quality improvement activity (QIA) that can be used to demonstrate review of work, not just significant event analysis.

The RCGP previously recommended that GPs should include two detailed case reviews or learning event analyses (or one of each) every year as an easy way to demonstrate review of work. This was sometimes misinterpreted as a requirement, rather than a recommendation. While these are still an entirely acceptable way of demonstrating review of practice, we now recommend that there are many other types QIA that may be included as supporting information.

In some areas, such as Northern Ireland and Scotland, the appraisal policy (and the electronic platform) still includes a requirement to include two significant event analyses. These should be seen as learning events and quality improvement activities, not as implying that GPs in these areas have more patient safety incidents that reach the GMC level of harm than GPs elsewhere. We recommend that you ensure that you are aware of the requirements of your local appraisal policy in this area.

All GPs must ensure that they include all significant events that do reach the GMC threshold of harm. The GMC says:

A significant event (also known as an untoward or critical incident) is any unintended or unexpected event, which could or did lead to harm of one or more patients. This includes incidents which did not cause harm but could have done, or where the event should have been prevented.

Seeking and reflecting on feedback from those you work for and those you work with.

Myth: I must use the GMC questionnaire for my patient and colleague feedback 

The GMC questionnaires provide the template on which many appropriate patient and colleague feedback tools are now based. There is no GMC requirement to use the GMC questionnaires. They are not suitable for all patient or client groups, or accessible to all. There may be better tools for your circumstances, such as a very specific scope of practice or a hard to reach group. 

The GMC has provided Guidance on developing, commissioning and administering patient and colleague questionnaires as part of revalidation. You do not need to use a specific tool, but you should choose one that is appropriate to your patient population. It should be accessible to as many different types of patient across your scope of practice as possible. You should include feedback from at least the minimum number of patients required by the tool you choose to use. Patients must understand that their responses will be anonymous. 

For example, you should not collect the responses yourself in such a way that patients think you might be able to read them, or choose only the best. One option is for them to be collected into a sealed box that is opened by someone else who passes them on to someone outside your own practice to collate. You may want to use a professional questionnaire company or service. The results should be externally collated into a report that gives you the feedback you need so that you can reflect on the results in preparation for your appraisal. 

Myth: All my patient and colleague feedback must meet the GMC requirements 

You will have many sources of patient and colleague feedback, both unsolicited and formally requested. The GMC guidance on Your supporting information – feedback from patients or those to whom you provide medical services has on developing, commissioning and administering patient and colleague questionnaires specifically applies to the solicited patient and colleague feedback which is required once in the five-year revalidation cycle. Other feedback does not have to meet this guidance. Some of the most compelling feedback is not anonymous. 

Some GP roles do not have enough patients or colleagues to meet the numbers required by the feedback tools. Including representation from across the whole of your scope of practice in one survey can sometimes work and provide helpful feedback but some roles are so different that this may make the results hard to interpret. We recommend that feedback is sought across the whole of your scope of practice in ways appropriate to each context and recognise that sometimes this means that some feedback will not meet the GMC requirements. 

The main solicited patient and colleague surveys from your clinical work, normally undertaken once every five years, should be GMC compliant. Other feedback does not need to be GMC compliant. You should make sure that any feedback included in the portfolio is appropriately anonymised, which will involve presenting data that is difficult to anonymise separately to your appraiser, or redacting it if you wish to include it. The priority is to include your reflections on the feedback, any lessons you have learned and any changes you intend to make as a result, in your portfolio. 

If you are in any doubt about the best way to collect and reflect on feedback you should seek advice and support from your appraiser at an early stage. Where the method that will generate the most meaningful feedback is not fully GMC compliant, it is wise to agree that it is appropriate for your circumstances with your appraiser and your RO before undertaking the survey.

Myth: I must do a patient survey every year 

You only have to do one fully GMC compliant patient survey in the five-year revalidation cycle, like all other doctors. GPs are not required to do additional GMC compliant solicited patient surveys for revalidation.

There are many other sources of feedback from patients. The RCGP recommends that you reflect on any feedback you have had and your relationship with your patients during every appraisal. This is not about formally collecting additional feedback. This is about reflecting on feedback that is available about you.

Myth: I must find other ways to get feedback from patients every year 

We recommend that GPs, who have many patient contacts every day, should reflect on their relationship with their patients during every appraisal. You are not required to do additional patient surveys or actively seek feedback every year but we recommend that you consider the feedback that you already have. 

Patients have told us that they expect you to reflect on all the sources of feedback that already exist, not that you should do more surveys than other doctors. You should take the opportunity once a year at your appraisal to discuss your reflections on your relationship with your patients and any feedback that you have had during the year. This can be from:

• informal unsolicited comments or cards
• formal feedback from 'Friends and Family' or the national patient survey 
• complaints or compliments.

You are not expected to do any extra work in actively seeking additional feedback, unless you want to seek targeted feedback on a specific area.

Myth: There are RCGP approved colleague and patient feedback questionnaires

The RCGP stopped recommending any particular questionnaires several years ago.

In the past, there was an attempt to collate a list of questionnaires that met the GMC standards and were appropriate for GPs to seek feedback on their performance. It proved impossible to keep up with the development of more and more questionnaires, or to avoid the appearance of bias, and so this has not been maintained for some time.

The GMC are clear that it is important to choose a tool that is appropriate for the type of feedback that you are seeking and the people that you are asking and set out some principles for the choice of questionnaire. The review by Sir Keith Pearson points out how essential it is to reach the 'hard to reach' groups and to seek meaningful feedback from all patients, including those who cannot access written forms.

We recommend that you choose the most appropriate colleague and patient feedback tools for your circumstances. You are advised to review the GMC standards for such tools and agree, in advance, with your appraiser or responsible officer that they are happy to accept your choice.

Myth: I can use patient and colleague feedback from overseas 

The GMC issues a UK licence to practise. Your revalidation recommendation will depend on supporting information that relates to your work in the UK. Although your RO has discretion to additionally consider supporting information from overseas, where the relevance to your UK practice is clear, your main patient and colleague feedback should be gathered from work in the UK.

Designing SMART goals for PDPs to support changes that make a difference.

Myth: My personal development plan must include… 

There is nothing that the GMC requires your personal development plan (PDP) to include. 

Your goals should be taken from your appraisal as an individual and your specific needs. The GMC requires you to make progress with your PDP each year or explain why that has not been possible. They require you to reach agreement with your appraiser on a PDP for the coming year based on your appraisal portfolio and discussion. Your PDP should be:

• personal
• developmental
• a plan for the future 

It should meet your needs in the context within which you work. We recommend that you develop SMART (Specific, Measurable, Achievable, Relevant and Timely) goals with your appraiser. It often helps to work out how you can demonstrate that a change you plan as one of your PDP goals has made a difference by considering what the impact on patients will be.

Performance objectives should be part of job planning and not necessarily part of your appraisal and revalidation PDP unless you wish to include them.

Myth: My personal development plan cannot include… 

The only PDP goals that are inappropriate are ones that are flippant, not specific to you, or irrelevant to your needs. 

Your appraiser is trained to help you work out how to write your PDP so that it is a professional record of your personal development planning for your needs. The PDP goals should be balanced across the five-year cycle and across your whole scope of practice.

Goals around being a good role model for patients and maintaining your personal health and wellbeing in a period of great pressures on the healthcare system are entirely appropriate. It is important to use the PDP to capture those high importance goals that are essential for the coming year if there is something that you need to achieve. For example, if you need to do your colleague feedback in the coming year, spending some time planning who to ask and how to do it and including it in your PDP acts as an aide memoire to yourself and to your next appraiser.

It is not appropriate to include non-specific goals in your PDP that could apply to any doctor and do not apply to your personal needs. Your goals should not normally be part of what everyone is required to do to be fit to practice. For example, 'keep up-to-date' is not a sufficiently SMART goal. These goals should be re-framed and described in more specific terms so that you can demonstrate: 

• where they have arisen
• why they apply to you now
• how you will achieve them
• how you will demonstrate that your goal has been met
• that achieving the goal will make a difference.

Myth: I must have a set number of PDP or clinical PDP goals

The GMC requires you to agree a new PDP each year that reflects your needs as defined by the portfolio of supporting information and the appraisal discussion. This is a matter for agreement between you and your appraiser. 

There is no GMC requirement about the number of PDP goals you should include or if those goals are clinical or non-clinical. Some doctors like to record lots of PDP items; it is your PDP. Most doctors find three or four PDP items are sufficient to capture their priority goals. You could have one very big objective that you have broken down into separate interim or smaller goals.

There is no GMC requirement to include some clinical goals. If, for example, your main goal was becoming a GP trainer there might be no clinical objectives in a particular year. However, under normal circumstances, it would be unusual not to include any clinical goals and you should consider reflecting on why you have not chosen to include any with your appraiser. Your PDP can be a particularly useful place to plan your quality improvement activity for the coming year.

Myth: My appraiser should tell me what to put in my PDP

Your Personal Development Plan should be owned by you. You are the doctor who will have to make progress with it. While it should be formed from your needs and priorities as they arise from the appraisal portfolio and discussion, it should never be imposed on you and your appraiser should not tell you what to put in it. Your appraiser may help you to define your needs and priorities more clearly, but your PDP should remain personal, developmental and form a plan for the future that is valuable to you. 

The RCGP recommends that you put some thought into what your priorities for the coming year might be before your appraisal discussion so that you already have some ideas about what an appropriate PDP might be, although your top priorities may change as a result of the discussion.

Myth: I do not have a PDP because I have just finished my training

All GPs in training in the UK must have a PDP for their final ARCP (Annual Review of Competence Progression) and this is the PDP that should be brought forward to their first medical appraisal for revalidation.

It is possible that some doctors arriving from overseas may not have been part of any managed system that would generate a PDP. In such cases the RCGP recommend that the appraiser should use a "disagree" statement as one of the outputs of appraisal and explain in the comments that there has been no progress with the previous PDP because there was no previous PDP.

Requirements for staying on the performers list.

Myth: The GMC requirements for revalidation are the same as NHS requirements to stay on the performers list

GMC requirements are about revalidation. Meeting the GMC requirements provides a positive affirmation of the demonstration of continued competence for any doctor, whatever their scope of practice, whether private or NHS or voluntary. Doctors must demonstrate that they are up-to-date and fit to practise across their whole scope of practice to revalidate successfully. 

The national performers list requirements vary slightly between NHS England, Scotland, Wales and Northern Ireland and are about being fit for purpose to work in the NHS. They vary from the GMC requirements for revalidation. Responsible officers and suitable persons are expected to be very clear about the difference between the two. 

Myth: I cannot stay on the performers list if I work fewer than 40 clinical sessions for the NHS

Doctors who do low volumes of clinical work are often providing very valuable services to patients but need to be confident that they can demonstrate that they remain up-to-date and fit to practise at what they do when they have a relative lack of experiential learning. By working through the series of factors in a Low Volume of Clinical Work Structured Reflective Template (LVCW SRT) they are supported in demonstrating their continued competence and describing the safeguards that are in place to protect patients. The LVCW SRT is based on the idea that how much clinical work you need to do to remain clinically up-to-date and fit to practise is variable and depends on several factors, including:

• your prior knowledge and experience
• how recently you reduced your volume of clinical work
• your scope of practice in the role
• how well supported you are and the governance arrangements for your role
• the CPD and QIA you are able to do in your role
• your engagement in annual appraisal
• other medical activities you are doing which may provide overlapping experience

It is structured as a tool to help you think through how these factors apply in your circumstances. Many GPs report relief and reassurance after working through the template and realising that their practice is well protected.

If you do some NHS clinical work every year, and fulfil the requirement to have an annual appraisal, you will (under current legislation) remain connected to the NHS responsible officer in the area where you do the majority of your NHS clinical work. There is no minimum amount of NHS clinical work required, but 40 sessions per twelve months in work are a threshold below which you are expected to reflect on how you remain safe for such a low volume of clinical work. The RCGP, BMA and NHS England recommend that you reflect on an NHS LVCW SRT, include it as a quality improvement activity in your supporting information and discuss any issues at your appraisal. You are asked to think about the factors that ensure that you remain up-to-date and safe for what you do in your NHS clinical work and to put safeguards in place as part of your PDP if you identify any risk to yourself or to patients.

Similarly, if you do not work for the NHS, but do a low volume of clinical work, below 40 sessions per twelve months in work, the RCGP recommends that you complete a non-NHS LVCW SRT and include it for discussion at your appraisal.