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Objectives: The introduction of medical revalidation in 2012 has been a controversial and radical change to medical regulation in the UK. It involved changes to the way organizations manage medical performance, and to the relationships between doctors, their employers and the professional regulatory body. In this paper, we explore the implementation of medical revalidation, analysing the change process and its consequences for doctors and organizations. Methods: We conducted a qualitative investigation of the implementation of revalidation in 15 case study organizations in 2016–2017, collecting documents and undertaking a total of 80 interviews with medical and non-medical staff. We used Normalization Process Theory to frame and structure the analysis. Results: Revalidation reforms were largely implemented successfully within and across our case study organizations, with evidence of growing acceptance of the purpose and processes of revalidation. There was an emergent shift from securing doctors' compliance towards the use of revalidation to strengthen clinical governance, and towards evaluating revalidation processes and seeking to make them more effective. However, there was substantial variation in the implementation and impact of revalidation; it was still not fully understood by many doctors, and revalidation processes were highly reliant on a few key individuals in each organization. The changes brought about by revalidation have had consequences for the way in which doctors construct their identity and the way they relate to the organizations in which they work. Conclusion: Despite considerable early scepticism and overt opposition in the medical profession, revalidation has become gradually accepted, embedded and even valued over time. Its impact and effectiveness are still questioned by many stakeholders, and the focus of attention has now shifted towards revising and improving the way revalidation works in practice. [ABSTRACT FROM AUTHOR]

This article reflects on the value and outcomes of two projects commissioned by NHS England and Somerset Clinical Commissioning Group. The projects demonstrate how a robust strategy can empower practice nurses (PNs) to change practice and provide a sustainable way forward in appraisals, revalidation and continuous professional development. The project encompassed clinical supervision and its value for PN teams and contributions to appraisal. The projects trained a sufficient number of appraisers for PNs across the geographical areas involved to be able to access an appraiser local to them. The appraisal portfolio developed for the projects has been adopted by many PNs who want to use a system that is easy to access and is an alternative to online portfolios. [ABSTRACT FROM AUTHOR]

Background: The general practice (GP) workforce in England is in crisis, with declining morale and job satisfaction, increasing early retirement and declining interest in training to become a GP. We recently reported on factors that are influencing this, with appraisal and revalidation emerging as an unexpected finding; 28.6 % of GPs stating an intention to leave general practice within the next 5 years included this as 'very important' or 'important' to their decision. In this study we undertook a secondary analysis to identify how the experience of appraisal and revalidation might be influencing intentions to leave general practice. Methods: Qualitative analysis of free text comments made by GPs in a survey of career intentions. All comments that included mention of appraisal or revalidation were extracted. Emergent themes were identified and a coding framework devised. Results: Forty-two participants made comments that related to appraisal and revalidation. Compared to all 1192 participants who completed the main survey, they were older (76.2 % compared to 46.2 % aged 50 years and older), with more years' general practice experience (80.0 % compared to 48.0 % with >20 years' experience) and more likely to state an intention to retire within 5 years (72.2 % compared to 41.9 %). Key themes were appraisal and revalidation as: a bureaucratic, inflexible exercise that added to an already pressured workload; an activity that has little educational value, relevance to professional development or quality of care; and an issue that contributes to low morale, work-related distress and intentions to leave general practice. Revalidation was depicted as a cumbersome tick-box exercise that had little to do with quality of care or protecting patients. There were no comments that countered these negative views. Conclusions: While the representativeness of these comments to the experience of GPs as a whole cannot be judged, it is likely that that they reflect the concerns of GPs whose experience of appraisal and revalidation is influencing their intention to leave general practice. Through its impact on GP morale and burnout, the current appraisal and revalidation system in England appears to be contributing to the workforce crisis. The findings indicate that the appraisal system may be in urgent need of re-design to increase its relevance to individual GPs' experience and seniority, clinical activities being undertaken and professional development needs. [ABSTRACT FROM AUTHOR]

Background: GPs collect multisource feedback (MSF) about their professional practice and discuss it at appraisal. Appraisers use such information to identify concerns about a doctor's performance, and to guide the doctor's professional development plan (PDP).Aim: To investigate whether GP appraisers detect variation in doctors' MSF results, and the degree of consensus in appraisers' interpretations of this information.Design and Setting: Online study of GP appraisers in north-east England.Method: GP appraisers were invited to review eight anonymised doctors' MSF reports, which represented different patterns of scores on the UK General Medical Council's Patient and Colleague Questionnaires. Participants provided a structured assessment of each doctor's report, and recommended actions for their PDP. Appraiser ratings of each report were summarised descriptively. An 'agreement score' was calculated for each appraiser to determine whether their assessments were more lenient than those of other participants.Results: At least one report was assessed by 101/146 appraisers (69%). The pattern of appraisers' ratings suggested that they could detect variation in GPs' MSF results, and recommend reasonable actions for the doctors' PDP. Increasing appraiser age was associated with more favourable interpretations of MSF results.Conclusion: Although preliminary, the finding of broad consensus among GP appraisers in their assessment of MSF reports should be reassuring for GPs, appraisers, and employing organisations. However, if older appraisers are more lenient than younger appraisers in their interpretation of MSF and in the actions they suggest to their appraisees as a result, organisations need to consider what steps could be taken to address such differences. [ABSTRACT FROM AUTHOR]

Since 1 April 2016, UK nurses and midwives have been required to undertake revalidation to maintain their registration with the Nursing and Midwifery Council. This article reports the results of a service evaluation to identify the revalidation preparation experiences of nurses and midwives at University College London Hospitals NHS Foundation Trust (UCLH). Findings suggest that the revalidation preparation process at UCLH supports staff to seek opportunities continually for practice feedback, reflect on their everyday experiences and link their learning to ongoing professional development. [ABSTRACT FROM AUTHOR]

Background: Revalidation for UK doctors is expected to be introduced from late 2012. For general practitioners (GPs), this entails collecting supporting information to be submitted and assessed in a revalidation portfolio every five years. The aim of this study was to explore the feasibility of GPs working in secure environments to collect supporting information for the Royal College of General Practitioners' (RCGP) proposed revalidation portfolio. Methods: We invited GPs working in secure environments in England to submit items of supporting information collected during the previous 12 months using criteria and standards required for the proposed RCGP revalidation portfolio and complete a GP issues log. Initial focus groups and initial and follow-up semi-structured face-to-face and telephone interviews were held to explore GPs' views of this process. Quantitative and qualitative data were analysed using descriptive statistics and identifying themes respectively. Results: Of the 50 GPs who consented to participate in the study, 20 submitted a portfolio. Thirty-eight GPs participated in an initial interview, nine took part in a follow-up interview and 17 completed a GP issues log. GPs reported difficulty in collecting supporting information for valid patient feedback, full-cycle clinical audits and evidence for their extended practice role(s) as sessional practitioners in the high population turnover custodial environment. Peripatetic practitioners experienced more difficulty than their institution based counterparts collating this evidence. Conclusions: GPs working in secure environments may experience difficulties in collecting the newer types of supporting information for the proposed RCGP revalidation portfolio primarily due to their employment status within a non-medical environment and characteristics of the detainee population. Increased support from secure environment service commissioners and employers will be a prerequisite for these practitioners to enable them to re-license using the RCGP revalidation proposals. [ABSTRACT FROM AUTHOR]

Revalidation will be introduced in 2010; it will require general practitioners (GPs) to demonstrate they are fit to practise according to standards set by the Royal College of General Practitioners (RCGP). This will include the requirement to achieve 50 continuing professional development (CPD) credits per year. There has been no published analysis of GPs' current CPD. This paper describes a retrospective analysis of the learning logs kept by 71 practising GPs undertaking the interim Membership by Assessment of Performance (iMAP) programme, considering quantity of recorded learning, evidence of reflection on outcome and spread of content across the domains of the General Medical Council's Good Medical Practice (GMP). The average GP iMAP candidate undertook 87 hours of CPD over the year (range 21.5 hours to 293.5 hours); 16 (22.5%) undertook less than 50 hours while 22 recorded more than 100 hours. The GPs averaged five different types of CPD and 31 recorded outcomes across the year. Most GPs recorded outcomes in each domain of GMP. Those who logged more activities were also those more likely to record a wider spread of learning across the RCGP's curriculum. These results suggest that the RCGP's proposed managed CPD scheme is feasible based on the current CPD activity of this self-selected group. [ABSTRACT FROM AUTHOR]

Background Appraisal is a relatively new process for doctors and evaluation serves to inform its future development. Aim To evaluate the experience of, attitudes to, and impact of, appraisal for general practitioners. Design of study A qualitative survey. Setting Three strategic health authorities in England. Methods Semi-structured telephone interview with PCT appraisal leads, appraisers and appraisees, selected by a process of invitation. Results Participants found the appraisal process well designed, and appreciated the support, encouragement and opportunity to reflect on professional practice that it allows. Appraisees felt it gave structure and focus to their professional development. However, difficulties were highlighted in making time for appraisal in busy professional lives. There was some confusion amongst appraisees about the purpose of appraisal. The potential for change as a result of appraisal was identified, but the perceived likely impact on practice was less clear at this early stage of the process. Conclusion In this study evaluating appraisal of general practitioners, the need to reiterate the purpose of appraisal, ongoing commitment to development of the process, and the need for quality assurance were highlighted. Further research is needed to identify and quantify changes in professional practice arising from appraisal. [ABSTRACT FROM AUTHOR]

The NHS Constitution (Department of Health (DH), 2013a) sets out the principles and values of the NHS in England: care should be planned and provided in partnership with service users and their families and this patient-focused approach should be of a consistently high quality with respect, dignity, compassion and care as core values. The newly updated Code (Nursing and Midwifery Council (NMC), 2015) concurs with this philosophy by stating the interests of service users must come first by ensuring their privacy, dignity and confidentiality are preserved and their needs are recognised, assessed and met. Furthermore, the introduction of revalidation (NMC, 2015) to replace the post-registration education and practice (Prep) standards (NMC, 2011) includes the requirement for midwives to demonstrate to the NMC on a regular basis that they continue to remain fit to practise. This will, in part, be evidenced by written reflective accounts, based on the requirements of the Code, using feedback from service users, patients, relatives, colleagues and others (NMC, 2015). This article will provide a definition of a service user in the context of maternity services and outline current policy and professional body requirements in relation to service user involvement in care. It will assess the literature with regards to service user expectations of 'a good midwife' and the Friends and Family Test (FFT) (NHS England, 2015) to consider the relationship between policy, practice and service user experiences and expectations. [ABSTRACT FROM AUTHOR]

The article discusses the impact of the medical appraisal and revalidation on the patient care system in Great Britain. It is mentioned that medical appraisal was implemented on all the doctors in the country form December 2012, earlier it was used on the National Health Services. Also, the appraisal and revalidation can help in increasing the quality of medical care provided to the patients by introducing professional development of the doctors.

Background: Until recently, processes of professional regulation and organisational clinical governance in the UK have been largely separate. However, the introduction of medical revalidation in 2012 means that all doctors have to demonstrate periodically to the regulator that they are up to date and fit to practise, and as part of this process doctors must engage with clinical governance activities in the organisations in which they work., Objective: To explore how the recent implementation of medical revalidation has affected the arrangements for clinical governance in healthcare organisations in England., Design: Thematic analysis of interviews with 62 senior clinicians and non-clinicians in management or senior administrative roles, from a range of healthcare organisations in England., Results: Revalidation has engendered changes to clinical governance systems, resulting in: increased doctor engagement with clinical governance activities; new or improved systems for access to clinical governance data for doctors and leaders within healthcare organisations; and more leverage - through the Responsible Officer role - to enforce engagement with clinical governance. Organisational context has been an important mediator of the impact of revalidation on clinical governance., Conclusion: Revalidation has increased alignment between systems for organisational and professional oversight and accountability, resulting in increased scrutiny of clinical practice. However, it is still a matter of conjecture whether this will in turn lead to improvements in medical performance., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Renewal of healthcare registration or license to practise is becomingly increasingly common, worldwide. Evidence regarding the experience of nursing and midwifery revalidation in the United Kingdom is limited. Preparation of students for the process has not yet been considered in the literature., Objectives: To explore registrants' experiences of undertaking or supporting colleagues through revalidation. To consider preparation of pre-registration students for this future professional requirement., Design: A descriptive exploratory study comprising an on-line survey., Setting: A university in the southwest of England and associated clinical placements., Participants: Nursing and Midwifery Council registrants, comprising 40 university staff and 40 clinicians; 36 pre-registration nursing and midwifery students., Methods: Participation in an anonymous on-line survey was invited via university databases. Descriptive statistical analysis of quantitative data used a combination of software and manual methods. Qualitative data were manually coded and categorised into themes through inductive reasoning., Findings: Most experiences of revalidation were positive. Reflective discussions resulted in mutual learning, particularly if partners were chosen by the registrant. External scrutiny was welcomed. Some registrants questioned involvement of line managers and alignment with performance review, seeking to avoid a 'tick-box exercise' and conflicts of interest. University staff felt better prepared and more positive than clinicians. Pre-registration curriculum activities preparing students included writing reflections, maintaining portfolios, practice assessment and discussions about the revalidation process. Midwifery students seemed better prepared than nursing peers. Key themes of 'Professional values', 'Preparation', 'Process' and 'Purpose' and a range of positive influences and potential hazards informed development of a conceptual model., Conclusions: The purpose and process of revalidation is enhanced if confirmation is undertaken by a registered nurse or midwife of the individual's choice. Preparation of students for future revalidation is facilitated by role-modelling of positive attitudes and explicitly linking relevant pre-registration curriculum activities to this process and purpose., (Copyright © 2019 Elsevier Ltd. All rights reserved.)