NHS appraisal is a formative process with which many GPs across the UK are already very familiar. In many ways, it’s similar to an annual car service, tuning up our performance to pretty much the best it can be. Servicing a car is generally time-consuming and expensive, and relatively subjective in that the quality of the service can vary between different garages. But there’s probably little variance in what most of us would recognise as a good service for our car. And continuing this analogy, revalidation is very similar to a yearly MOT – albeit every 5 years rather than annually. Just like an MOT, revalidation is a summative assessment – you pass or you fail – and is based on a well defined minimum set of requirements. With an MOT, each constituent criterion is also pass or fail. Broken indicator? Fail. Crack in windscreen 9mm in the A-zone? Pass. 10mm? Fail. It’s all very clear cut, and based on years and years of experience of how legislation has made for safer roads. But in that respect, NHS revalidation is very different. It’s extremely difficult, if not impossible, to quantify most of what GPs do. We are, after all, not machines, and neither are our patients. What we do, what we deal with, every day, is infinitely variable. Unlike the car – a simple machine designed 100 years ago by humans – human illness is the result of 4.5 billion years of evolution. We can’t even agree on the best management of a sore throat! A summative process based on something as subjective as the behaviour of ill people has never been done before (at least, not in any modern, democratic civilised country) and is based on criteria that in many, if not all, cases is incredibly subjective and is likely to change considerably over the course of just one revalidation cycle of 5 years.
Which all leaves many of us feeling frustrated and confused at having to participate in a scary new process that just doesn’t seem to be promising what it’s supposed to deliver. So, considering that not one single GP has officially been revalidated – how could they when it’s not yet even started? – what’s one to do?
Fortunately for us, NHS appraisal forms the basis of professional coaching to get as many of us through revalidation as possible. So, given that there are so many unknowns with revalidation, and that the people of this country, through government legislation, have demanded of us that we must take part in this process, we have little choice but to participate.