All key documents referred to on the Revalidation Wales website can be downloaded here.
All Wales Medical Appraisal Policy
This high level policy document has been developed to support the implementation of local processes which are fit for purpose for revalidation, consistent and fair and add value in their own right.
View the completed Medical Appraisal Policy Equality Impact Assessment
A supplementary document has been developed by the Wales Revalidation and Appraisal Implementation Group (RAIG), which describes the operating standards to be achieved in order to deliver the policy, good practice guidance and templates.
Wales Medical Appraisal Toolkit - MARS
The WRDB decided in May 2013 that the Medical Appraisal Revalidation System (MARS) would be the only tool for appraisal for all NHS doctors in Wales from 1st April 2014.
MARS is designed to support organisations and individual doctors in ensuring that their current appraisal paperwork is fit for purpose in relation to GMC standards for revalidation.
Responsible Officers are given specific access to MARS to enable them to review appraisal and revalidation information for their doctors, this then enables Responsible Officers to make revalidation recommendations on GMC Connect.
Wales Appraisal Exceptions Management Protocol
The All Wales Appraisal Exceptions Management Protocol was agreed by the WRDB September 2014, it enables Designated Bodies to consistently manage doctors who do not engage in the appraisal process. The protocol outlines the key principles of the annual appraisal process in Wales, its links with revalidation and its management in this context. The document describes protocols which apply to a range of different exceptional situations. This will also be of interest to appraisers so they are aware of exceptional circumstances and how they will be managed and supported in Wales.
Making Revalidation Recommendations
The General Medical Council has published guidance to help Responsible Officers make revalidation recommendations about doctors.
The guidance - 'Making revalidation recommendations: the GMC responsible officer protocol' - explains what Responsible Officers should take into account when deciding what their recommendation should be.
Responsible Officers have the ability to make three types of recommendation at the point that a doctor's revalidation is due:
- a positive recommendation that a doctor should be revalidated
- a request for a doctor's revalidation date to be deferred (because the doctors needs more time to collect supporting information, for example)
- or a notification of "non-engagement".
Responsible Officers can make a revalidation recommendation to the GMC once the doctor is in the ‘Under Notice’ period which starts 4 months before their revalidation date.
The guidance is available to download from the GMC's website. It is aimed primarily at responsible officers but will be of interest to doctors, employers, and patients and the public.
Guidance on the wider role and functions of responsible officers was published by the Department of Health which can be found here.
Revalidation Advisory Groups
Health Boards within Wales generally hold regular revalidation advisory group meetings in order to collate and review all relevant revalidation information regarding a doctor because the Responsible Officer makes a revalidation recommendation, such as annual appraisal evidence and clinical governance information.
A pro-forma has been developed by RAIG to assist revalidation advisory groups in Wales in establishing whether all supporting information for revalidation is present, it also enables Health Boards to keep an audit trail of reasons for recommendations made by the Responsible Officer:
Revalidation Advisory Groups Terms of Reference - This document has been provided as guidance for designated bodies in Wales.
Designated Bodies are encouraged to be pro-active regarding reminding doctors to include all strands of required supporting information in their appraisals. A template letter has been approved by RAIG which can be sent out approximately 6 months before a doctor’s revalidation date to remind them of what is required:
The GMC outlines that nearly every doctor will have a prescribed connection to a designated body, for the majority of doctors this will be very straight forward. However some doctors may find it difficult to establish a prescribed connection with any existing designated body and should therefore contact the GMC for further guidance.
This document, Routes to Revalidation, provides guidance finding a prescribed connection in all circumstances.
For doctors who request to have a connection with a designated body or Responsible Officer, RAIG have developed a template letter which can be sent to the individual requesting further information, this can be used to establish whether there is a ‘connection’ between the doctor and the designated body:
If a doctor moves designated body it can be difficult for the new Responsible Officer to obtain enough information regarding that doctor for them to make a revalidation recommendation, particularly if the doctor moves fairly shortly before their revalidation date. A sub group of RAIG have developed a Responsible Officer Information Flow Form which needs to be completed by the doctor and the previous Responsible Officer. This form is then passed to the new Responsible Officer allowing them to become aware of any current issues etc.
- GMC Supporting Information
- This guidance sets out the supporting information that you will need to provide at your annual appraisal and the frequency with which it should be provided. It also gives further details on how the information can be used or discussed during appraisal.
- GMP Framework for Appraisal and Revalidation
- The framework sets out the broad areas which should be covered in medical appraisal and on which recommendation to revalidated doctors will be based.
Resources for Employers & Responsible Officers
- Managing conflicts of interest between doctors and ROs in Wales
- This document outlines how to manage conflicts of interest between a doctor and an RO in the context of Revalidation.
- Quality Management Framework Template
- Effective Quality Management is crucial to the on-going success of medical appraisal in Wales, and its contribution to other quality improvement and governance processes including revalidation. The document has been developed by a sub-group of RAIG and distributed to DBs, this should enable DBs to evaluate the robustness of existing arrangements and assess the extent to which these are fit for purpose.
- Appraiser Standards Framework
- An overview of quality assurance indicators relating to the selection, training and performance management of medical appraisers.
A handbook for boards and governing bodies
5 Annual Appraisals
Guidance for short term or locum doctors
Appraisal and Revalidation guidance for short terms or locum doctors in Wales.
- Validating Supporting Information Outside the Appraisal Process
- Occasionally, in the last year of a revalidation cycle, a doctor may find that one or other of the six strands has not been validated in that cycle. This document explains the processes in place in Wales to enable validation of that information.
Whole Practice Appraisal
With the advent of revalidation the GMC requires a doctor to present supporting information covering all aspects of their professional duties. To support doctors in Wales in meeting Whole Practice Appraisal requirements, the following guidance has been developed.
Revalidation for Trainees
- Information for Doctors in Training
- The GMC has recently published a leaflet on 'How doctors in training will revalidate', read it to find out more about the process.
Patient and Colleague Feedback
All doctors working in NHS Wales have access to the Equiniti patient and colleague feedback tool. For most doctors this will provide the route to obtaining the minimum requirement of 1 colleague and 1 patient feedback exercise every 5 years.
It is good practice to obtain your feedback in the first two years of your revalidation cycle as, if changes are needed, you may choose to run the feedback again to demonstrate development.
How does the Equiniti system work?
- Your Health Board has completed a spreadsheet for all doctors detailing when they should have access to the Equiniti system
- Equiniti issue invitations to doctors to participate in line with schedule
- You complete a self-questionnaire, nominate 15 colleague raters (medical, nursing, administrative etc) and a Supportive Medical Colleague (SMC). The SMC will be a doctor who knows you and is willing to support you through the process.
For GPs, the SMC is not normally your appraiser. You will need to contact the Appraiser to ascertain whether they are willing to be your SMC. This doctor should not be related to you but may be your partner or someone else with whom you work closely.
For all other doctors, the SMC can be your appraiser. This doctor should not be related to you but may be someone else with whom you work closely.
Guidance for avoiding Conflicts of Interest re: SMC's
The role of the Supportive Medical Colleague in the process, is to help the doctor make sense of, and reflect on, their feedback - both good and bad. A relative may find it difficult to be objective and balanced in their approach, and, as a consequence the doctor might not get as much out of the process of reflection as they otherwise would.
For this reason, it would suggest that it would be best practice for the SMC to not be a relative wherever that is possible. The same advice would apply to a relative who is considering the appropriateness of being a colleague rater, where it might be appropriate to consider requesting additional patient questionnaires to be completed.
In both situations, it is a requirement of Good Medical Practice that the doctor declares that there is the potential for a conflict of interest.
- The SMC approves the rater list and will act as the recipient of the completed report.
- Equiniti then emails all selected raters to invite them to complete the online questionnaire
- You will receive a pack of 30 patient feedback forms with sealable envelopes and you should make arrangements to distribute these in a manner compliant with GMC guidance. (i.e. distribution and collection is independent of you– this may be your receptionist or clinic clerk etc)
- Once you have obtained 20 completed patient feedback forms you then mail them back to Equiniti as one batch still within the sealed envelopes. These are processed by Equiniti and released to the SMC – a process that may take up to two weeks.
- Once 15 colleague raters have completed the online questionnaire the colleague report is released to the nominated SMC.
- The SMC has to provide feedback and release the report to you (on line in downloadable PDF format).
- You will then be able to upload to MARS and complete the appropriate reflective entry.
- If less than 15 Raters have responded you can nominate more raters by contacting the Equiniti helpdesk.
If you have any further questions please contact: firstname.lastname@example.org
In order to meet revalidation requirements the feedback must be taken to appraisal. If however your revalidation date falls between your Patient and/or Colleague feedback and your next appraisal, you should inform your RO.
Being a Supportive Medical Colleague in the Feedback Process
How to analyse the report
In most instances scores are very high. However, no quick assumptions or conclusions should be drawn from low scores until reasons have been explored. Below is a list of possible reasons for low scores.
These have been provided for discussion and reflection. There may well be many other reasons for low scores not included in this list, but many of the more common reasons have been included.
Possible Reasons for Low Scores
|These are listed with no particular weighting:|
|Team/Trust failure||Suitability of selected raters|
|Personality clashes||Personal problems / illness|
|Patient case load||Lack of training|
|Lack of skills/knowledge||Lack of information|
|Lack of feedback||Lack of awareness|
|Keeping up to date||Job structure/job role|
|Communication skills||Awareness of own limitations|
Supportive Medical Colleague (SMC) Feedback Notes
Feeding back the contents of the 360 report to your colleague
Introduce the feedback session and describe your role as a SMC to encourage reflection and personal development planning. If appropriate, consider setting some ground rules, such as confidentiality. The feedback interview should be held in private, avoiding interruptions.
Seek doctor's views first - Ask questions rather than make statements
If your colleague has low scores in a particular area, do not make assumptions. There are many reasons for low scores some of which are detailed above. Low scores may be a result of workload or staff shortages. Of course, low scores may also be due to personal factors.
If there are clusters of raters scoring 'I have concerns/ below expectations', the appraiser should seek advice from their appraisal lead.
You could ask:
- What went well and why?
- What didn't go so well? and why?
- What changes would you like to see in the future?
- How will these changes be implemented?
- What will happen to reassess / monitor improvements?
- Concentrate on specific areas which cause most concern e.g. high variance between self and colleagues assessments.
Then focus on specific items of behaviour.
Compliment on the areas where the individual scored highly as well as address areas for improvement. Encourage the individual to build on their strengths. The graphic quantitative feedback report allows you to discuss current, sensitive issues in a direct manner. The feedback interview should be held in private, avoiding interruptions.
Stick to the facts and always avoid becoming emotional or using emotional language. For example, if a doctors has a low score in communication skills you might say 'you have some lower ratings in the communication skills element, why do you think that might be?' instead of "you didn't do very well in communication skills did you?"
If in doubt about how to approach this feedback please contact the Appraisal Lead in your organisation or the available designated individual. If you are unaware who this is please contact the Responsible Officer for advice.
For further guidance please visit the Equiniti website.
- Workaround Template
- If a doctor has had their final appraisal prior to their revalidation date but have not completed the patient and/or colleague feedback, the Responsible Officer (RO) will need to be informed that the feedback has occurred and that they've have reflected on the content. This must be discussed with a Supportive Medical Colleague. Both should then fill in this template and forward to the RO before the date for revalidation as communicated by the GMC.
- Quality Indicators for Appraisal Documentation to Support Revalidation in Wales
- A set of quality indicators have been devised to guide both doctors and appraisers in ensuring the quality of that supporting information is sufficient.
- Appraisal Discussion Assessment Method (ADAM)
- The Wales Deanery has developed a tool for analysing recorded appraisal discussions. This is a formative tool used to assess the quality of the appraisal discussion that might also be used to self-assess or to provide feedback to appraisers to improve appraisal discussion skills. ADAM was developed as a tool to improve appraisal discussion skills and is applicable to both primary and secondary care for use in initial training and the development of more experienced appraisers.