The difficulties encountered by independent practitioners in the pathway to revalidation.

The revalidation pathway for independent practitioners can seem a lonely and daunting prospect. As an independent practitioner you are largely responsible for your own direction and supervision that is consistent with your licence to practice.  You will not normally be connected to a designated body.

Confusion. Inaccurate Information. Conflicting advice. Time constraints.

A designated body is an organisation that provides regular appraisals, clinical governance and support with revalidation for its employees.  The designated body is responsible for ensuring that all their doctors are up to date and fit to practise and are able to meet the requirements of revalidation, and for this purpose, must appoint a responsible officer to support the process.  The designated body is also responsible for reporting figures on a quarterly basis to NHS England and for implementing a full suite of policies and procedures to embed quality assurance throughout the appraisal and revalidation process and clinical governance systems.  Appraisals are required yearly as part of the revalidation process.  Non engagement with the appraisal process will most certainly cause problems  and damage your ability to undergo revalidation.

The demands upon independent practitioners are different from those working in paid employment, and pose various challenges in terms of maintaining professional standards, ethics and competence.


- Medical appraiser = important professional role
- Trained in the appropriate skills and knowledge of medical appraisal
- Understand the context, scope and nature of work that you do
- Must undertake continuing professional development as an appraiser and attend peer networking sessions
- Be formally accountable to a responsible officer
- Be free of conflict of interest or bias in order to perform your appraisal
- Must be subject to ongoing review of appraisal outputs as part of a quality assurance programme
- Be subject to regular feedback

If you are not connected to a designated body?

The GMC provides a tool on their website in order to assist you to find a connection – if you do not have a designated body the process for revalidation via the GMC can be laborious in terms of having to complete an appraisal, an annual return and an assessment,  so that the GMC has assurance that you are fit to practise.

You must ensure that your appraiser complies with the GMC and NHS England criteria and requirements.  To satisfy yourself, you should ask to view a copy of their training certificate, which should be renewed every 3 years with annual refresher updates and regular peer review and network meetings.

The appraiser must hold GMC registration with a licence to practice and have a prescribed connection to a designated body or suitable person.  They also must have, within the last 12 months, performed at least 5 appraisals before carrying out your appraisal. Without this information how can you assure the quality of your appraisal or make sure that you are receiving a good service? The GMC will want a report on your appraisal, fully completed, signed and dated by your appraiser as part of your annual return.  The GMC may as part of their verification process, contact the appraiser to ensure that all the information and conditions have been met.

Revalidation without a responsible officer or suitable person.

Revalidation is normally recommended by your responsible officer to the GMC – without a responsible officer or suitable person, the GMC will ask you to take an assessment, usually within the year that you are due to revalidate.

You must book your assessment within the timeframe that they give you and take the assessment on the date you have booked, and meet the required standard in the assessment.  The assessment is designed to test minimum competence.  Failure to not book the assessment in time to meet the revalidation requirements, or not meeting the required standard, may result in the process of your licence to practice withdrawal by the GMC.  The revalidation assessment is a multiple choice exam of 120 questions which lasts for 2 hours.  There are 12 of these assessments based on the respective colleges core curriculums and you will be required to choose the assessment that matches your speciality area the closest.  There is a fee currently of £1,127.00 and the assessment takes place in Manchester.

What else is involved in the revalidation process?

- Multi source feedback

- Statistical analysis report

- Self-assessment

- Concerns

- Compliments

- Deferral

- Case based discussions

- Significant events

- Reflection


- Administration

You need to balance your responsibilities to comply with the appraisal and revalidation process with your duty of care and responsibilities to your patients.  Of course, remaining up to date and fit to practise forms an enormous part of that duty of care.

Appraisal should not be seen as a burden or a punishment.  It should be positive, supportive and encouraging you to improve and maintain quality patient care provision.  Appraisal is the opportunity to reflect with your qualified appraiser and discuss your development, goals and aspirations.  It is not a pass or fail matter.  Your appraiser’s role is to facilitate your development and help you to maintain a portfolio of documentation that supports your evidence of fitness to practise.  The appraiser is not there to make a decision about your revalidation recommendation.  Their purpose is to summarise comprehensively your evidence to present to the responsible officer and show that you comply with the revalidation requirements.

Your responsible officer is the person who has the statutory responsibility to make the revalidation recommendation to the GMC and, only he or she can decide if your revalidation date should be deferred.

Do Not Despair

There is a plethora of help available on the GMC website and other organisations such as the Royal Colleges and independent providers who are available to provide support, guidance and advice.  It doesn’t have to be a seemingly impossible mountain to climb.  The key to successful appraisal and revalidation is clear understanding of what exactly is required of you and how you can manage the process as part of your daily routine so that it does not become burdensome and stressful for you.

Written by Kate Lewis & Darren Wiggins of ACI Training & Consultancy Ltd., specialists in revalidation and appraisal services.

Responsible Officer Professor Rehan Kazi.  MBBS, MS, DNB, DLORCS, DOHNS, FRCS, PhD;  and Lead Appraiser Doctor Imran Mushtaq, MBBS, FRCPCH, MRCPsych, DCH, Dip-Child Health, PG Dip-CAMH; along with a qualified team of medical appraisers who are all doctors and a fully trained administration team headed up by Trish Morgan and Claire James.