UK Medical Appraisals and Revalidation for Doctors Working Outside the UK.
An article by guest writer Dr Mark Golder PhD FRCS, Independent Medical Appraiser
Revalidation: An Essential Process for All Doctors
Every doctor registered with the General Medical Council (GMC) in the United Kingdom (UK) who practises medicine in a general or specialist capacity must revalidate regularly, usually once every 5 years. This includes all doctors who are registered with the GMC, but currently working outside the UK.
The purpose of revalidation is to ensure that the doctor is fit to practise in accordance with the standard of the GMC. In the words of the GMC “Revalidation supports you to develop your practise, drives improvements in clinical governance and gives your patients confidence that you are up to date”.
The Three pathways to Revalidation
- Designated Body and Responsible Officer: You are connected to a Designated Body. You will need to have an annual appraisal. The associated Responsible Officer will monitor your yearly appraisals and will make a Revalidation Recommendation about you to the GMC, at the time of your Revalidation Submission date.
- Suitable Person: You are not connected to a Designated Body, but you are connected to a Suitable Person. You will need to have an annual appraisal. The Suitable Person will monitor your yearly appraisals and will make a Revalidation Recommendation about you to the GMC, at the time of your Revalidation Submission date.
- Annual Appraisal: You are not connected to either a Responsible Officer or a Suitable Person. You will need to have an annual appraisal, plus submit a direct Annual Return to the GMC [REV11 and REV 12 forms]. Towards the end of the 5 year cycle, you will be required to sit a Revalidation Assessment at the GMC, in Manchester, after which the GMC will make a decision as to whether or not you maintain your licence to practise.
Further information is provided on the GMC website:
Relinquishing Your GMC Licence to Practise
Prior to relinquishing your licence to practise, it is important that you discuss your individual situation with the GMC. The current GMC recommendation for doctors working outside the UK and who are NOT connected to Designated Body or Suitable Person, is that they should consider relinquishing their GMC licence to practise. This means remaining on the GMC resister, without a licence to practise. This recommendation is primarily for those doctors who do not plan to return to the UK to work within the next 6 months.
The reason the GMC gives for this recommendation, is that if the doctor does not relinquish their licence, they will need to submit an Annual Return. The supporting information provided in that Annual Return will need to be UK based. This is clearly not possible, if one is working outside the UK.
Those doctors who are working outside the UK, who DO have a connection to Designated Body / Responsible Officer or Suitable Person, should discuss with them about whether they would recommend that they voluntarily give up their licence to practise.
Restoring Your Licence to Practise After You Have Previously Relinquished Your Licence
It is important you discuss your individual situation with the GMC, prior to an application to restore your licence to practise. Currently, the application process includes providing the GMC with documents which include:
- A “Provision Of Medical Services Statement” form [from your employer]
- A certificate of good standing from the Medical Regulatory Authority where you are currently based
- A work history
- ID check / photo ID
Medical Appraisal Process for Doctors Working Outside the UK
If you choose not to relinquish your GMC licence to practise, as you plan to work in the UK within the next 6 months [and you are not / will not be connected to a Designated Body / Responsible Officer or Suitable Person], you will be required to submit an Annual Return to the GMC. This includes the completion and submission of a REV 11 form to the GMC and then the undertaking of an annual appraisal with an Independent Medical Appraiser. This can easily be conducted by video link. Following the Appraisal, your appraiser will complete the REV 12 and MAG [appraisal form] and will email these to you. You then provide these documents to the GMC.
The Appraisal (MAG) Form
The Appraisal [MAG] form can be downloaded from: https://www.england.nhs.uk/medical-revalidation/appraisers/mag-mod/
You then complete sections 3-17 of the MAG form. For an overview of the key steps in completing the MAG form, read below.
The Key Steps for The Appraisal (MAG) Form:
Add your personal details, Revalidation date and qualifications [Section 3 MAG]
Define your current scope [s] of practise [section 4 MAG]
Attach previous year's appraisal outputs, if any [section 5 MAG]
Provide evidence of 50 hours of CME over past 12 months [add certificates to Section 7 MAG]
Make Written reflections on 4 Topics of CME over the past 12 months [add to section 7 MAG]
Provide evidence of Quality Improvement Activities over the past 12 months (4 case discussions or an audit) [add to section 8 MAG]
Provide evidence of and written reflections on any Significant Events (serious incidents) over the past 12 months [add to section 9 MAG ]
Provide evidence of any UK colleague and patient feedback you have collected within this Revalidation cycle [add to section 10 MAG]
Make written reflections on the results of any UK colleague and patient feedback within this Revalidation cycle [add to section 10 MAG]
Provide reference letter[s] from posts held over the past 12 months [add to section 10 MAG]
Provide evidence and written reflections on any compliments and or complaints received over the past 12 months [add to section 11 MAG]
Complete section 16, after reading GMC Good Medical Practice guide
Email completed MAG form to Appraiser
Set a time for your appraisal
GMC Guidelines on Written Reflections
The GMC has provided guidelines on reflection as part of the annual appraisal process:
Mark Golder's Top Tips for Reflection, as an Independent Medical Appraiser
A. CME Reflection
Write the CME reflections in section 7 of the MAG form
- Choose 4 topics of education you have undertaken over the previous 12 months
- Write a few paragraphs on what you have learnt on each topic
- Define what IMPACT that learning has had, or will have, on your practice
B. Case Based Discussions
Write up the 4 cases in section 8 of the MAG form, using a “structured clinical reasoning” approach:
- Clinical examination findings
- Summary paragraph of case with list of problems
- A list of differential diagnoses
- A plan
- Results of investigations
- A working diagnosis
- What IMPACT the discussion has had, or will have, on the team’s future management of such a case [this is the quality improvement aspect].
Write up the audit in section 8 of the MAG form, using the standard approach:
- Recommendations for change
D. Significant Events and Complaints
Write the reflections in sections 9 or 11 of the MAG form
You may consider a detailed personal Systematic Practice Review (with 360 degree reflection) of your Risk Management in relation to [Significant Event / Complaint].
This will include:
- What are the potential associated risks?
- What are the magnitudes of the risks?
- What strategies do I employ to minimise those risks?
- What are the potential barriers to risk reduction and how could I overcome them?
The review may include any relevant: Clinician factors | patient factors | team factors | communication factors | system factors | management factors | IT factors | equipment factors | protocol / guidelines factors | resource factors | care pathway factors.
This is not a test of performance, but instead will provide an opportunity to facilitate reflection, to reaffirm and consolidate areas of good practice, to identify areas for potential development, to identify challenges that one faces in the implementation of risk reduction strategies and to develop plans to overcome any such barriers.
E. Colleague and Patient Feedback Reflection
Write the reflections in section 10 of the MAG form, using the “what”, “why”, and “how” technique
For each of the colleague and patient feedback results:
- What were my strengths and what were the areas where I could get even better?
- Why is it important to maintain these high levels of performance or to get even better in other areas [context to practice and motivation for change]?
- How will I maintain high levels of performance or get even better?
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