Intended for healthcare professionals


Appraisal and revalidation for UK doctors—time to assess the evidence

BMJ 2020; 370 doi: (Published 09 September 2020) Cite this as: BMJ 2020;370:m3415
  1. Victoria Tzortziou Brown1,
  2. Margaret McCartney, general practitioner2,
  3. Carl Heneghan, director3
  1. 1Institute of Population Health Sciences, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2Department of Primary Care, University of St Andrews, St Andrews, UK
  3. 3Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
  1. Correspondence to: V Tzortziou Brown V.TzortziouBrown{at}

The pause in appraisal and revalidation during the covid pandemic offers an opportunity to reflect on their value and consider their future argue Victoria Tzortziou Brown and colleagues

The General Medical Council adopted a more flexible approach to regulation at the start of the covid-19 pandemic, with revalidation and appraisals largely suspended to allow doctors to focus on clinical safety and workload.1 With reinstatement planned, we argue for urgent clarification of their purpose, an evidence based approach for their implementation, and ongoing evaluation.

Medical revalidation and appraisal

No consensus exists on the definition, mechanisms, and appropriate design of revalidation, and practices vary widely.2 Some countries have no formal process in place 3 while others rely heavily on evidence of continuing medical education.2

The GMC is the first regulator to implement a compulsory and comprehensive revalidation process4 and has over 335 000 doctors on its register.5 According to the GMC, revalidation “gives your patients confidence that you’re up to date.”6 A cost-benefit analysis in 2012 showed that, in England alone, revalidation would cost the NHS nearly £1bn over 10 years.7 The expected benefits included increased public trust and confidence in doctors, improved patient safety and quality of care, reduced costs of support for underperforming doctors, reduced malpractice and litigation costs, better information about care quality, and positive cultural change in the medical profession,8 but there is no evidence these have materialised.

Appraisal is the only route to revalidation and must contain supporting information under six defined categories: continuing professional development, quality improvement activity, significant events, feedback from patients and colleagues, and complaints and compliments.9 Most doctors (97%) revalidate through annual appraisals and a five yearly recommendation to the GMC from their responsible officer, based on the outputs from their appraisals.9

Disagreement remains about whether the mode …

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