The role of appraisal in the regulation of doctors

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.

Next: Appraisal documentation >

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