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Revalidation in Wales

Constraints

There is a section entitled constraints in the appraisal information section on MARS and this is there for the doctor to highlight any potential personal, practice or service level challenges they have come across.

A constraint is a factor in a doctor’s environment, personal or professional life that is impacting on their development or performance. MARS enables doctors to record constraints in three sections; Personal, Service and Practice/Hospital.

The purposes of constraints being identified at appraisal are multiple:

At a personal level:

  1. To allow discussion with the Appraiser and to see if there are any steps that can be taken to mitigate the issue
  2. To record issues getting in the way of development which may be relevant in a revalidation decision
  3. To explain why something is less than perfect e.g. NICE guidance cannot be implemented due to service constraints

At a service or hospital level:

  1. Health boards have access to aggregated reports on constraints to enable them to compare trends with the national picture

Whilst constraints are recorded and brought to appraisal for discussion with an Appraiser, they remain the responsibility of the doctor as an individual. If a constraint is raised which involves a potential patient safety issue this must be reported via the correct reporting procedure as outlined within the Duties of a Doctor GMC guidance.