Appraisal and revalidation mythbusters

1. 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. Appraisals should support doctors so that they can continue to work in a system under pressure, encouraging them to maintain and improve the quality of patient care they can provide.

2. Appraisal is a pass or fail event

For revalidation the GMC requires you to engage in medical appraisal. However, appraisal is not a pass or fail assessment. Your appraiser will use the written evidence and verbal reflection from your appraisal to confirm the following (with some variation in approach between the four nations):

1. An appraisal has taken place that reflects the whole of a doctor’s scope of work and addresses the principles and values set out in Good medical practice.
2. Appropriate supporting information has been presented in accordance with the GMC Supporting information for appraisal and revalidation and this reflects the nature and scope of the doctor’s work.
3. A review that demonstrates appropriate progress against last year’s personal development plan has taken place.
4. An agreement has been reached with the doctor about a new personal development plan and any associated actions for the coming appraisal period.
5. No information has been presented or discussed in the appraisal that raises a concern about the doctor’s fitness to practise.

Appraisal is part of a formative and developmental process. 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.

3. My appraiser will decide my revalidation recommendation

Appraisers do not have the authority to decide 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 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 practice.

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

4. I need to undertake a minimum number of GP sessions to revalidate

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, no 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.

You can structure this reflection by using the Academy of Medical Royal Colleges factors for consideration template.

There will always be times when doctors have a significant break from practice, for good reason, such as parental or sickness leave. Your designated body will have mechanisms in place for agreeing to postpone your appraisal or agreeing an ‘approved missed’ appraisal such as at the start of the Covid-19 pandemic.

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 Induction and Refresher 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.

5. My appraiser has a responsibility to report any concern I may share about another doctor

It is your responsibility to act in accordance with the 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:

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

20. 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.

Appraisal 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.

6. 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 makes 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 need to collect and reflect on the remaining supporting information.

7. 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.

8. 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. If you're not sure which designated body is yours, or who your RO is, the GMC website has these details. They have an online tool to help you find your designated body and a list of all designated bodies with the RO connected to them and an email address where you can contact them. Your RO has a statutory responsibility for ensuring that the appraisal process is fit for purpose, but the expectation of you as a professional is to demonstrably fully engage 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 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, be 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.

9. I will not be revalidated if I miss an appraisal

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

We recommend that you let your RO or lead appraiser and their team know if you are not going to be in work at the time 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. Your RO can then authorise a decision to postpone your appraisal month or approve a missed appraisal. You should do this in advance to demonstrate your engagement with the appraisal process. The GMC website has a list of all designated bodies with the responsible officer connected to them and an email address where you can contact your RO.

If you are planning a significant period of time out of work for any reason, we suggest you 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. 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, it can be a good idea to 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.

If you have been out of clinical work for more than two years, you will need to engage with the Induction and Refresher/Returner Scheme. 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 scheme.

10. I must use a portfolio defined by my responsible officer to revalidate

This is a myth in Northern Ireland and England. However, it is the case if you are practising in Wales or Scotland that you will need to use a specific portfolio, provided by your designated body, as part of the appraisal and revalidation process.

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. However, you are expected to take part in annual appraisal; requirements for that vary across the UK.

In Northern Ireland and England you are encouraged to use an up-to-date electronic toolkit with the MAG 2022 embedded. The MAG 2022 can be completed but has not been approved by the GMC as a standalone document and cannot be used as such. If you did choose to use it you would also need to:

• attach your previous appraisals and PDPs from this revalidation cycle
• collect supporting information for this appraisal
• sign-off complaints, health and probity statements
• capture a new agreed PDP and appraisal summary
• capture the appraisal output statements including comments to the responsible officer if appropriate.

Importantly, there must be the facility to lock down, save and share the final, mutually signed, version. We recommend you use a toolkit which incorporates all of these features electronically such as those mentioned above.

If you’re practising in Scotland, you must use the Scottish online appraisal resource (SOAR).

GPs in Wales must use the Medical appraisal revalidation system (MARS).

Those based in Northern Ireland use the GP appraisal registration and declaration form.

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.

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. The GMC website has a list of all designated bodies with the responsible officer connected to them and an email address where you can contact your RO. For example, you may require special access arrangements to meet a disability. If you move to a new area of the UK, you should check if there is a preferred local choice of portfolio.

Your portfolio, with all the GMC required supporting information, needs to be available to your RO, potentially at short notice.

11. My appraisal portfolio is entirely confidential

Your appraisal portfolio is normally only available to you and your appraiser (or appraisal lead) 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. We do not, therefore, recommend uploading minutes from meetings attended by other identifiable staff or complaints identifying colleagues by name.

The GMC will not require or request any details of an appraisal when conducting a fitness to practice inquiry, although you may wish to share these with the GMC to show your engagement in the appraisal process.

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 by a court of law just as clinical notes can be. If they are appropriately written, your reflective notes can demonstrate your learning and insight into any incident or complaint 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.

12. I should have my appraisal meeting outside working hours

Your medical appraisal for revalidation is a professional responsibility. We recommend that you set aside three hours for your appraisal, though the discussion time may be less than that. It should 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 unless you and your appraiser agree otherwise.

When appraisal was introduced in primary care in the NHS it was resourced for a full day – half a day to prepare and half a day to have the appraisal meeting. Sessional and locum GPs in parts of the UK are still entitled to a payment equivalent to one session. However, for GPs in England, 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 have 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.

We recommend that you seek advice and support from your responsible officer if you feel that your appraisal is not being supported appropriately. They are responsible for the quality assurance of the appraisal process.

13. I am a GP working in a particular scope of practice (e.g, secure setting) so my appraiser must have experience of this setting

Medical appraisal for revalidation, by definition, is the forum to reflect on and discuss the whole scope of your practice. 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, we recommend 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 if you do not find your appraiser credible as there is good evidence that appropriate rapport is essential to a productive appraisal discussion. The process of allocating and changing appraisers varies across the UK, so check with your designated body if you're not sure.

14. I no longer have to spend time preparing for my appraisal in advance

We recommend you spend up to two hours organising the relevant supporting information in your portfolio and making the sign-off statements before your appraisal, though it may take less time than that. You should submit this in plenty of time for your appraiser to review before your appraisal discussion.

As a result of the COVID-19 pandemic, appraisals across the UK were rebalanced to have a greater focus on wellbeing, and to emphasise proportionality in the time doctors should dedicate to preparing for their appraisal discussion. However, the purpose of medical appraisal has not changed, and the GMC requirements for appraisal for revalidation remain the same.

You are still required to provide enough evidence to your appraiser that you remain up-to-date and fit to practise across your whole scope of work. It is helpful for this to be written in your portfolio and sent ahead of the meeting. The meeting is likely to take longer if your appraiser has to facilitate your verbal reflection at your appraisal. They will need to feel confident that your appraisal has met the required standard to be able to sign the appraiser statements.

The GMC lists the six types of supporting information you must reflect on and discuss at your appraisal. These are: CPD, QIA, significant events, feedback from patients or those you provide medical services to, colleague feedback, and compliments and complaints. There is also recurring information about your practice that you need to include in your appraisal portfolio, and most portfolio providers will pull these forward from year to year in your portfolio for you to update whenever there is a change.

The GMC emphasises quality over quantity when collecting your supporting information. Your appraisal discussion is then an opportunity to spend time reflecting on what will be most valuable to your personal and professional development.

15. I must document all my learning activities

You should not include all your learning activities in your appraisal. We recommend that you focus on the quality not quantity of your supporting information.

You should be selective about documenting your reflection on what learning you have found most valuable and meaningful over the course of the year. You should not try to record and reflect on every learning activity.

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.

16. 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 unless storing them in your appraisal portfolio or learning log helps you and enables you to avoid duplication of effort.

Reflecting at your appraisal or including 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 learned rather than collecting certificates.

We recommend that you 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 commercial apps available. A document record, table or spreadsheet can work just as well. If you want somewhere to save relevant scanned certificates, such as those relating to mandatory training, then your learning log or appraisal portfolio may offer a secure way for you to collect and keep them, allowing you to easily demonstrate your fitness for purpose to your employer. If doing so will save you time and effort, then it is appropriate to do so. It should not replace reflective notes or your reflections during your appraisal discussion or add unnecessary effort in your appraisal preparation.

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.

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

We recommend you allow two hours to organise the supporting information into your portfolio and make the sign-off statements before the appraisal discussion and send at least two weeks ahead to your appraiser. Allowing your appraiser to read about you and your work in advance enables them to contact you if they have helpful advice before you meet.

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. You can then open your portfolio of evidence once your previous appraisal is signed off and use it to add learning and reflections contemporaneously throughout the year.

18. 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, whether 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.

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.

19. There are some parts of my scope of practice 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 as soon as possible.

Every separate place where you work has a duty to supervise and support you in your role there. 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.

We recommend that your portfolio includes a signed-off summary and outputs of any performance development reviews in other roles with any reflective notes on them, rather than the original supporting information.

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.

20. 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, 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. However, 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.

21. Supporting information from work overseas cannot be included in my appraisal portfolio

At revalidation the GMC is issuing a renewed UK licence to practise, so the supporting information required by the GMC must demonstrate continued competence for your UK practice. Sometimes clinical work overseas has a significant overlap with clinical work in the UK.

The GMC Guidance on supporting information for appraisal and revalidation states

We expect you to collect, reflect on and discuss supporting information generated from your whole UK practice. Responsible officers may decide to accept supporting information drawn from overseas practice if they are satisfied it meets the same standards as those expected in the UK and therefore gives assurance about your continued fitness to practise. It is important that you speak to your responsible officer as soon as you know you intend to practise overseas while holding a UK licence to practise. Only in exceptional circumstances* would a doctor with supporting information drawn from practice wholly or significantly overseas be able to maintain their UK licence to practise.

As the above makes clear, your RO has the discretion to consider supporting information from other settings in making their revalidation recommendation 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. You should therefore discuss in advance with your RO if you are considering using supporting information gained from overseas practice rather than assume it will be acceptable.

22. Having a ‘disagree’ statement (or equivalent) from my appraiser is always a bad thing

There are some key aspects of the appraisal process that your appraiser needs to agree have taken place. For example, in England there are five key sign-off statements for your appraiser to review. For most appraisals, the appraiser will be able to ‘agree’ all five statements. If an appraiser is unable to confirm one, or more than one, statement, it simply draws something relevant to the attention of the responsible officer. Any ‘disagree’ statements should be appropriately explained in the comments sections provided, to assist the responsible officer in understanding the reasons for them.

The doctor and the appraiser can both comment on the output statements made. For example, the appraiser may explain that they have disagreed with statement three because there was no previous PDP to review, or because a major change in circumstances affected the appropriateness of the former goals, or with statement five because a doctor presented an ongoing investigation into a complaint that had been discussed but was not yet resolved. A doctor newly arrived from overseas might comment that the previous system within which they worked did not include a PDP process which is why there was no PDP to review.

In all cases, you have the opportunity to comment, although you do not have to if you have nothing to add to the appraiser’s explanation.

23. I must get sign-off statements from all parts of my scope of practice every year

We do not recommend that you seek sign-off statements from third parties 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 (or improving) 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 that they 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 events and complaints can arise in every type of practice, and the GMC requires that all such patient safety 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, by including in each appraisal the details of everywhere that you have worked since your last appraisal, to ‘pull’ information about your work at any time, should this be necessary.

24. My appraiser can dictate what I need to provide for my appraisal

Appraisers should not be asking you to provide supporting information above and beyond the GMC requirements for revalidation. The main purpose of appraisal is to be supportive and focus on your personal and professional development. It should not feel like a burden or a pass or fail event.

The GMC outlines the requirements needed for appraisal for revalidation and the five appraiser statements are there to ensure you have met the required standard. However, some designated bodies may ask you to provide evidence of organisational requirements, such as mandatory training, at your appraisal. It’s important to remember that this is an organisational requirement rather than a GMC requirement for revalidation.

If your appraiser chooses not to sign-off on one or more of your appraisal statements, remember it is not necessarily a bad thing. It is to draw something to the attention of your RO. Your appraiser should provide an explanation for any statements not signed-off in the comments box provided and you are able to comment on those if you feel further explanation is needed.

25. Reflection is onerous

For most doctors, reflection is a continually-occurring internal process, analysing professional practice and planning next steps. Demonstrating reflection to satisfy the GMC requirement that you are a reflective practitioner should be a straightforward process in which you select a sensible selection of matters on which to reflect, and make a simple record of this. This should be as succinct as possible, unless it is your preference to present extensive written passages. A useful format for effective reflection is the 'What? So what? What next?' Model, in which a short sentence answering each question covers the essentials.

Verbal reflection is also an acceptable demonstration of reflective practice. Your appraiser should be skilled to elicit verbal reflection in the appraisal meeting to supplement your written reflections.

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

We recommend 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 or your meeting discussion.

27. Only courses and conferences count as CPD

Continuing 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.

You should reflect on your most valuable learning that may include:

• courses
• podcasts
• webinars
• learning from cases, data, learning events and feedback
• personal reading and online research
• online modules
• professional conversations about clinical care, which can include ‘coffee room’ conversations about complex cases.
• everyday learning 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. 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.

28. I must do an equal amount of CPD every year

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 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.

Sometimes it is obvious that a major commitment, such as a postgraduate qualification, in one area of your scope of practice will take up almost all your CPD time in one year. It is important to ensure that your learning stretches across the GP curriculum over the five-year cycle if you are doing undifferentiated general practice.

You should talk and work with your appraiser to ensure that the spread and variety of your CPD across the curricula for your scope of practice are appropriately summarised – not every single one detailed – in the agreed summary. 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.

29. As a part-time GP, I only need to do part-time CPD

When you are providing undifferentiated primary care, whether full-time 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. We recommend that part-time GPs, who have less experiential learning to draw on, need at least the same amount of CPD as full-time GPs.

30. My CPD for each part of my scope of practice must be different

Most doctors find some of their CPD appropriately demonstrates they are up-to-date in more than one part of their scope of practice. For example, the learning about diabetes done for a specialist interest role is likely to be applicable to a broader undifferentiated GP role. The same CPD demonstrates keeping up to date for all applicable roles.

If different organisations, in different parts of your scope of practice, 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.

31. My supporting information from part of my scope of practice 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, we recommend that your portfolio should include a signed-off summary of that appraisal discussion and outputs and any 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 reflections on the outcomes of such as review at your main appraisal.

You should include contact details for the appraiser and relevant organisation for parts of your scope of practice appraised elsewhere. Your responsible officer can then 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.

32. 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.

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, but your responsible officer may ask you to include evidence of it in your portfolio of supporting information. 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. We recommend 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 about to demonstrate that they are fit for purpose as a GP, if they are no longer in a GP role.

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.

33. 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, by way of your written portfolio and verbal reflections at the appraisal meeting, that you have done sufficient relevant CPD to keep up-to-date at what you do in a proportionate way. Your appraiser may no longer note down how many credits have been recorded by a toolkit but will instead be informed by how your practice has changed or you have developed as a result of your CPD.

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 any effort on documenting your reflection.

34. I must do 50 credits of CPD every year

The emphasis for CPD is on the quality of your reflection on what you have learned and the impact it has had on quality of care, not the quantity of credits or CPD documented. Your appraiser may not summarise total credits but rather whether you are doing sufficient and relevant CPD. 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 practice, but they do not attempt to define or require a quantity.

We recommend that those who have a restricted, or extended, scope of practice 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 Health (FSRH) for their CPD, to demonstrate that they are fully up-to-date across the whole of their practice. 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.

35. I must demonstrate 50 credits every year even if I have not been able to practise for much of the time

If you have been in practice through the appraisal period, you will be expected to demonstrate you have done sufficient and relevant CPD.

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 it has been impossible for you to demonstrate all the GMC required supporting information before your revalidation recommendation due date, for good reason, then your 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 extra time - rather than trying to produce a disproportionate amount of supporting information in a shortened space of time after a period when they have not been able to work.

36. Fifty credits are 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 hours depending on the scope of practice and your qualifications and experience in each area of work.

As a professional, 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.

Most doctors find it easier to keep a learning log that builds up as they go through the year.

We recommend that you reflect on the balance of your CPD and discuss it with your appraiser. If you are working as a GP providing undifferentiated primary care, we recommend that you demonstrate CPD relating to the breadth of the GP curriculum.

37. 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 CPD.

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 across the GP curriculum 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 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 reflect on why this is and what you plan to do to ensure that your practice remains mainstream and not isolated from peer support and review. Your appraiser should document your reflection in the summary.

38. I cannot include contractual training as part of my 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 as any reflective notes.

If you have more than one part of your scope of practice 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.

39. Time spent on quality improvement activities is not CPD

Continuing professional development can include:

• traditional CPD
• QIA, including learning event analysis (LEA)
• significant events
• reflecting on feedback from patients and colleagues, including complaints and compliments.
• A useful rule of thumb is: if you have learned something new from it, then it's CPD.

38. 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.

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 made 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.

40. 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 performances 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 QIA and a description of the findings, including any lessons you have learned and the impact they have had on the quality of the care you provide.

GPs work in teams and much of the QIA that is important 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 reviews of the team’s performance, 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.

41. There are specific types of QIA that I must include

You do not have to include any specific type of QIA 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 reviews, learning event analysis, and clinical audits as useful QIA. However, there are also may other types of QIA that may be equally, or more, appropriate for your circumstances, and 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, we recommend that you include this information in your portfolio of supporting information. You should ensure you reflect on what you have learned from the results and any changes you will make.

42. GMC significant events are the same as GP learning events

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

A significant event 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 Event section of the portfolio and reflected on for your appraisal. You do not need to discuss all Significant Events at your appraisal, but you do 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 or area of your portfolio.

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.

43. I must include two significant events every year

There is 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 or learning event analysis.

In Northern Ireland and Scotland, the appraisal policy (and the electronic platform) includes a requirement to include two significant event analyses. These should be seen as GP learning events and QIA, 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 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 hard. The GMC says:

A significant event 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.

44. 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.

45. 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 guidance the GMC has on developing, commissioning, and administering patient and colleague questionnaires specifically applies to the solicited 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.

46. I must do a patient survey every year

For all doctors, the GMC requirement is:

At least once in each revalidation cycle you must reflect on feedback from patients, collected using a formal feedback exercise.

GPs are not required to do additional GMC compliant solicited patient surveys for revalidation.

There are many other sources of feedback from patients. We recommend 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.

47. I must find other ways to get feedback from patients every year

We recommend that GPs, who have many patients contacts every day, should reflect on their feedback from, and 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.

48. There are RCGP approved colleague and patient feedback questionnaires

In the past, we attempted 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 is 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.

49. 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.

50. 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. You are required 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.

51. 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 practise. 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.

52. I must have a set number of PDP or clinical 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 top 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.

53. 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.

54. 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 we recommend that the appraiser uses 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.

55. The GMC requirements for revalidation are the same as NHS requirements to stay on the performers list

Performers list requirements vary from the GMC requirements for revalidation. GMC requirements are about revalidation. Providing you have a good record of CPD, engagement with appraisal in the previous five-year cycle, and have completed patient and colleague feedback, you shouldn’t need to worry. 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 as a doctor in Primary Care in the NHS.

56. 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 Academy of Medical Royal Colleges Factors for consideration template they are supported in demonstrating their continued competence and describing the safeguards that are in place to protect patients. The Factors for consideration template 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 is a threshold below which you are expected to reflect on how you remain safe for such a low volume of clinical work. We recommend that you reflect on an NHS Low Volumes of Clinical Work Structured Reflective Template, 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 in any area, below 40 sessions per twelve months in work, we recommend that you complete a non-NHS Factors for consideration template in respect of this low-volume area and include it for discussion at your appraisal.