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Revalidation in Wales

Low Clinical Workload

There is no generally agreed definition of low clinical workload and it is probably unhelpful to count the number of sessions worked over a year.

In Wales we have taken the view that it would be up to the individual Doctor to recognise low volume of clinical contact, as it forms part of their professional responsibility  to recognise and consider whether they can continue to meet the GMC’s Good Medical Practice standards.  MARS asks you to declare your clinical work across your whole practice and as such the appraisal discussion may include this as part of the reflective discussion.

There are many ways that an individual could identify the need for attention to competencies in an area of work e.g., a surgeon undertaking a particular procedure infrequently – they may be able to demonstrate that they remain competent in that skill through means other than direct patient contact (simulation training for example). A GP may only see one case of GCA every 2 years but has read and retained the NICE guidance on the topic.

When considering low clinical workload, it is not just a question of considering whether you are seeing patients.  For example, GPs are increasingly taking on other roles such as managing blood results, managing letters from hospital, or taking on the specific elements of work such as direct enhanced services e.g., nursing home reviews. The GP may be being employed by the practice to perform the specific tasks e.g., coil insertion.

It is a professional obligation from the GMC to ensure that you:

  • make the care of your patient your first concern
  • be competent and keep your professional knowledge and skills up to date
  • take prompt action if you think patient safety is being compromised
  • establish and maintain good partnerships with your patients and colleagues
  • maintain trust in you and the profession by being open, honest, and acting with integrity (GMC good medical practice).

It is important to reflect on whether you feel you have the knowledge and skills to undertake the roles that you are doing.

In hospital practice many specialties have split in to subspecialties and demonstrating the skills and knowledge to know when to utilise other teams/practitioners would satisfy the GMC requirements

The low volume of work in a specialty may be balanced by other clinical work in similar settings such as working in a casualty department or in medical assessment unit. In this instance the Doctor is using their medical skills a lot of the time and generally, there will be less concern about them staying up to date. There will however be some situations where they may be undertaking less clinically orientated activities such as being a medical director for the health board et cetera.

The GMC state clearly that every Doctor in the UK must have an annual appraisal and every licensed Doctor must undergo revalidation. The GMC provide useful advice on how to stay registered and who should undertake your appraisal

If you are working minimal part time the revalidation requirements in relation to your role is the same as those for another Doctor who is working eight or 10 sessions a week. The requirements are:

Annually you must:

  • provide general information about what you do in all aspects of your work
  • demonstrate continuing professional development
  • reflect on significant events or if you have none the process that you would use
  • reflect on complaints or complements
  • at least once in the 5-year revalidation cycle you must collect and reflect on patient and colleague feedback which should come from all of your UK practice
  • at least once in the 5-year revalidation cycle you should undertake a quality improvement activity based on your UK practice.

Your Appraiser will be able to discuss with you how you can do this if you have an unusual work pattern.

The Doctor therefore needs to think carefully about how to provide evidence in relation to their clinical practice. They may find it helpful to reflect on the following:

  • how confident do I feel about my current clinical practice?
  • how does my performance compare to my peers?
  • is my knowledge and understanding of the area of care that I'm undertaking up to date?
  • how would I manage unpredictable encounters e.g., a sudden patient collapse?
  • have I got appropriate defence union cover?
  • do I have enough evidence of my clinical learning and development within my portfolio?
  • how does my appraisal help me plan my learning needs?

In summary you can use your appraisal preparation and discussion to help you assess your appraisal needs in relation to your revalidation requirements and your GMC obligations to help you ensure you remain fit to practise across the range your whole professional work.

A self-reflective template called ‘Low Volume Clinical Work’ is included within the Whole Practice Appraisal Supporting Information category on MARS to support Doctors that may be undertaking low volume of clinical work in preparing for their appraisal.

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