Licensing and registration

All doctors practising medicine in the UK are required by law to have a licence to practise and to be registered with the GMC. This requirement applies whether the doctor works full-time, part-time, as a locum, privately or in the NHS, or whether they are employed or self-employed. At the start of the revalidation process all doctors who were entitled to hold a licence were contacted by the GMC. Subsequently, doctors have been licensed at qualification. The licence is generic and does not apply to any particular specialty.

The GP Register was introduced by the GMC in 2006. Since 1st April 2006 all doctors working in general practice in the NHS, including locums but excluding GP registrars, have to be on the GP Register. There is an equivalent Specialist Register for consultants.^[3] 

Doctors no longer in clinical practice do not need a licence but may choose to remain registered with the GMC. Such registration allows them to sign passports and retain the title of doctor but they cannot sign prescriptions or official documents. It may benefit Individuals applying for non-clinical posts to confirm that they are 'in good standing with the GMC'.

Revalidation

Revalidation is a process by which licensed doctors have to demonstrate that they are up-to-date and fit to practise. Its purpose is to reassure patients that doctors are regularly checked by their employer/contracted authority and the GMC.

Appraisals are intended to be a formative, supportive process in which the doctor reviews his/her overall work content with the appraiser. The evidence-gathering process is of necessity similar to that for revalidation but the outcome is the construction of a personal development plan as opposed to a relicensing process. There is a separate article on Appraisals.

Whilst there are variations in the appraisals process, all the UK countries have signed up to the same revalidation process.^[4] 

Responsible Officers

The Medical Profession (Responsible Officers) Regulations 2010 required all NHS organisations ('designated bodies') to appoint Responsible Officers by 1st January 2011. Among other obligations, they are responsible for local revalidation arrangements and will inform the GMC when a doctor is ready for revalidation and when that revalidation has occurred.^[5]

For doctors who do not have a regular contractor/employee relationship with a designated body, the GMC has agreed that a 'suitable person' can make the revalidation recommendation.^[6] 

The revalidation process

The GMC aimed to inform all doctors of their revalidation date by January 2013. Regular appraisals will be the cornerstone of the revalidation process. Information gathered for appraisals should now be structured with a view to presenting a portfolio for revalidation. This should show how the doctor is meeting the professional values set out in the GMC's Handbook 'Good Medical Practice' (GMP). For doctors who have engaged with the appraisal process and had regular appraisal, revalidation will be straightforward.

It should be noted that the 2006 version of GMP was revised in April 2013 and evidence from this point on should be organised according to the latest edition. Although the standards are very similar they are organised into different categories ('domains'). Guidance on how the new domains apply to the revalidation process has recently been published by the GMC.^[7] Revalidation is intended to occur in a five-year cycle. Information that will be reviewed will include previous appraisals and personal development plans.

Six types of supporting information will be required:

1. Continuing professional development (CPD): the GMC has not specified any particular number of hours or credits required, or the way in which a doctor should keep up-to-date. Meetings, journals, web-based learning,individual consultations and case histories and the Patient's Unmet Needs (PUNs)/Doctor's Educational Needs (DENs) system are are all possible methods. It is important that evidence should be presented in a way which can be related to the domains of GMP. The doctor should also seek to demonstrate whether the learning experience has resulted in any changes to his/her practice.
2. Quality improvement activity (examples quoted by the GMC include clinical audit, review of clinical outcomes and case review).
3. Significant events.
4. Feedback from colleagues.
5. Feedback from patients.
6. Review of complaints and compliments.

Doctors will be familiar with much of this information which has been part of the appraisal process since its inception. However, feedback from colleagues and feedback from patients are innovations specific to the revalidation process. The GMC expects this feedback to be obtained according to a standardised framework. Various questionnaires have been produced for use by GPs: these have recently been reviewed by the Royal College of General Practitioners which has endorsed those it considers fit for purpose.^[8] 

The GMC has recently published separate guidance on information required for appraisals and revalidation.^[9] Additional specialty-specific guidance is available from the website of the Academy of Royal Colleges.^[10] There is also separate guidance for foundation and specialty doctors in training.^[11]

Doctors will not be in attendance when they revalidate. Providing all the appraisal statements have been agreed and there are no other outstanding performance issues, the RO will simply endorse the revalidation.

Remediation

It is likely that the revalidation process will identify a number of doctors who require remediation, although it is predicted that this number is likely to be small. Funding for remediation has been a thorn in the side of the BMA since revalidation was first mooted. However, in September 2012 the NHS Commissioning Board agreed to establish funding for this purpose. Further work needs to be done to clarify the finer details of how the funding will be distributed, who will provide the remediation and how it will be accessed.^[12]