Health Service Focus

The role of patient feedback in revalidation

NHE hears from Katherine Murphy, Patients Association chief executive, on revalidation.

Patient groups have welcomed the official start of revalidation, but there is a worry that patient involvement remains tokenistic rather than embedded in the process.

Katherine Murphy, Patients Association chief executive, said the GMC is taking patient concerns seriously, but added: “We’ve worked with the GMC to push revalidation through, and have consistently campaigned for as much patient involvement as possible – both patient feedback and real-time involvement in the revalidation process. We think they are going down that route. But it’s not a perfect process by any means: the level of patient involvement still isn’t high enough.

“We know from our Helpline and research that patients want to be part of shared decision making about their care. Communication is absolutely key and where it falls short, measures should be taken to improve these crucial conversations. The Patients Association want to make sure that we do everything to protect patients so they can access high quality care provided by competent, highly skilled staff.

“The importance put on patient feedback isn’t high enough in the process, in our opinion. We are concerned it is going to get ‘crowded out’ by peer review and similar things, with patient views coming last. We see revalidation as a really good step forward, but it’s only a step, and there’s got to be further steps before we get to a really robust system.”

Fears of the consequences of raising concerns

The GMC is helping GP practices in the way they collect patient feedback, which will often be through a standardised form (see panel), though Murphy said: “With revalidation and in a lot of other areas, such as the Friends & Family test, we have concerns about using patient views on tests carried out by the providers themselves.

“There are also other issues; for example, the extent to which patients feel comfortable giving their honest views about their GPs’ performance. Indeed, recent research we have conducted shows a small but notable number of patients are being deregistered without a reasonable explanation. The fear for patients is that there may be consequences to raising concerns. There also must be a robust plan in place to ensure feedback is followed up; that not only does listening take place, but also learning and action follows.”

Feedback needs to go both ways – hearing from patients, but also patients getting to hear about the results of revalidation, such as if their doctor is in some kind of remediation process.

Murphy explained: “That’s somewhere where the system is falling down at the moment.

“The GMC always argue that their statutory duty is to ‘manage the list’, and if you’re fit to practice, you’re fit to practice.

“We, obviously, as patient representatives would like to see more than that.

“That information should be given out responsibly – GPs have the right to privacy we all expect in our day-to-day working lives – but patients should have the right to know the extent of concern about GPs, or about things that come out during the revalidation process (especially if the concerns are about attitudes to patients or similar communication issues).”

The new NHS structure after April is also a concern. Patients can currently raise concerns with PCTs, but it is not yet clear what happens next. Murphy told us: “There is a real concern that patients will have more limited ability for redress, once PCTs are fully dismantled. Should a patient be removed from a GPs’ list, for example, which we know does happen, who do they raise this with?

“Some of the public are only now getting familiar with PCTs and their functions.”

GMC guidance to doctors on patient feedback

Feedback from colleagues and patients will usually be collected using standard questionnaires that comply with GMC guidance. The purpose of the exercise is to provide you with information about your work through the eyes of those you work with and treat, and is intended to help inform further development.

Seeking feedback in this way enables colleagues and patient views about a doctor’s behaviour to be gathered in a more systematic way. It provides the opportunity for patients, non-medical co-workers (including other health professionals, managers and administrators) and medical colleagues (including trainees and juniors) to reflect on the professional skills and behaviour of a doctor.

Frequency: At least once per revalidation cycle, normally every five years.

One of the principles of revalidation is that patient feedback should be at the heart of doctors’ professional development. You should assume that you do have to collect patient feedback, and consider how you can do so. We recommend that you think broadly about who can give you this sort of feedback. For instance, you might want to collect views from people who are not conventional patients but have a similar role, like families and carers, students, or even suppliers or customers.

The GMC has developed colleague and patient questionnaires that any doctor can use, although we would expect that any questionnaire will be administered independently of the doctor and the appraiser.

(Source: ‘Ready for revalidation: Supporting information for appraisal and revalidation’, GMC)

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