Revalidation of Doctors - Health Committee Contents

Written evidence from the Royal College of Paediatrics and Child Health (REV 13)

The Royal College of Paediatrics and Child Health (RCPCH) represents paediatricians in career grade posts (consultants and specialty, staff and associate specialist grade (SSASG) doctors) and paediatricians in training.

We support the evidence presented to the Health Select Committee by the Academy of Medical Royal Colleges but have additional evidence to present.

The information presented draws from data formally collected from the RCPCH membership between late 2008 and mid 2010 by means of surveys, focus groups and consultations, and informally from discussions at paediatric meetings and conferences.


The RCPCH supports the recent GMC decision to simplify the process of revalidation. We present evidence from paediatrics to support the general principles that the first steps of the process should be to ensure that all the workforce:

  • Undertakes a process of strengthened appraisal;
  • Undertakes peer multisource feedback (with a validated tool selected by their organisation);
  • Undertakes patient/carer feedback with a tool validated/selected by the specialty (in the case of paediatricians by the RCPCH);
  • Should have the process of revalidation properly audited (to seek out false positive and false negative results) by a robust quality assurance process.


1.  The RCPCH supports the introduction of medical revalidation, and within the newly GMC announced timetable by 2012.

2.  We believe that paediatricians are generally in agreement with, and compliant with, current procedures within their organisations and are not outliers in the current process, which makes the evidence presented here more relevant and robust.


3.  We support the introduction of a structured review of a doctor's practice via a process of strengthened appraisal. However a RCPCH survey suggests that approximately 70% of all paediatricians have had appraisals and that availability of appraisal systems and processes for paediatricians is not UK-wide. (More than 30% of SSASG doctors have not had an appraisal).

4.  There is a lack of clarity around how doctors on the GMC register working outside the UK will be supported through appraisal and ultimately revalidation. This is especially relevant to a number of paediatricians. There is anecdotal evidence that a significant number of these doctors wish to remain GMC registered with a licence to practice. More work is needed.

5.  Consistency of appraisal is essential to effect robust revalidation outcomes, and there is a recognition of the need for appraiser training, both to cover generic expectations of GMC and Colleges. However there is currently no intention to provide a national appraiser training scheme, supplemented by speciality additions as needed.


6.  Even with clear guidance, an appraiser will need to exercise judgement to determine whether the content of supporting information demonstrates fulfilment of an attribute. This can be reduced by discussion and interdisciplinary exchange of concepts and ideas. Appraiser training nationally is essential to ensure consistency of judgements made.


7.  Paediatricians support a range of supporting information types as part of revalidation including MSF, patient feedback, CPD, audit, and case based discussion. But to ensure revalidation is manageable, the types of supporting information required at the outset may need to be restricted.

8.  The level of assessment remains to be clarified - assessment should be at the level of "fit to practise" rather than expecting standards of excellence, however attractive these standards may seem in terms of presentation.


9.  Paediatricians are generally supportive of revalidation. However, fewer than 50% of paediatricians have undertaken a peer-based MSF in their organisation. The majority of paediatricians who have undertaken MSF indicated it was worthwhile. Implementing this as a core component of revalidation is a priority.

10.  NHS Trusts which have undertaken multisource feedback for their consultants have usually chosen to run one model which fits all specialties. Specialty-based models, though attractive, are more expensive and potentially more complex to process, understand and incorporate into the revalidation process in a standard way.

11.  Specialty patient feedback tools are required. The RCPCH has developed a paediatric carers of children feedback tool (PaedCCF) to cover this gap. Our current analysis shows that 25 parent/carer feedback forms per doctor are needed to provide a reliable measure. While this may set a standard for patient and carer feedback tools, there are also major resource implications.

12.  Not all doctors will be able to obtain patient feedback through questionnaires however e.g. those working in safeguarding, and alternative methods should be allowed.


13.  CPD as a core component of revalidation is supported by paediatricians, but evidence shows that not all paediatricians can meet current College CPD scheme requirements. Workplace restrictions may currently affect doctors' abilities to access CPD e.g. lack of time, funding or opportunities. In addition, GMC principles for CPD include a focus on demonstrating reflection and learning outcomes, which are challenging for many doctors to capture and quantify.


14.  Careful consideration is needed for this. A range of support is required (from self help to support by national organisations) but the current focus as part of revalidation appears to be on more in depth support. The aim must be to address issues before they become serious concerns that will affect a revalidation recommendation.


15.  Quality assurance of revalidation must cover both process and outcomes e.g. revalidation decisions. Quality assurance of outcomes needs to include an audit of all those who fail the revalidation process and a sampling of those who have passed.

16.  Paediatricians would expect to be involved in quality assurance with the GMC to ensure decisions are made fairly and equitably within the specialty.


17.  The RCPCH agrees there is a need for a fully functioning electronic revalidation system to support data storing, content reflection, sharing and review by appraisees, appraisers, Responsible Officers and quality assurance bodies. The system must be secure and meet patient confidentiality protocols.

18.  Central support is needed to avoid implementing untested IT systems.


19.  Paediatricians are clear that the cost and time required to implement revalidation must not be to the detriment of patient care and frontline services.

20.  Systems and processes must be put in place to ensure the system is effective, low in bureaucracy and not just a tick-box exercise. Anecdotal evidence from pilot sites suggests that information-gathering is time consuming, current IT systems intended to simplify this process are instead prolonging and complicating the process. Untested requirements e.g. MSF may further increase time and cost factors. Ongoing funding to develop and support revalidation is not as yet clear.

November 2010

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