While appraisal and revalidation will be largely based on the same sources of information, the objectives of the two processes are distinct and complementary. Appraisal is concerned with the doctor’s professional development within his or her working environment.

Revalidation involves an assessment against a standard of fitness to practise, in line with the basic framework of the GMC's guidance Good Medical Practice. It will allow a doctor's licence to practice to be renewed.

The 2007 English Department of Health White Paper Trust Assurance and Safety confirmed that revalidation will be comprised of re-licensing (Assessment of performance based on evidence from the work place, comprising: Appraisal, Local clinical governance sign-off, 360 degree / multi-source feedback) and re-certification (Assessment of knowledge and skills, assessment methodologies to be developed by the Royal College).

Re-licensing and ‘enhanced appraisal’

In order to reliably inform re-licensing as described above, appraisal must be robust, standardised and quality assured. In this context the White Paper describes a system of ‘enhanced appraisal’ which will be based on existing good practice in terms of appraisal systems but further developed to include both formative and summative components. These are described as follows:

• Summative assessment looks back to assess whether performance has met specific standards.
• Formative assessment looks forwards to any changes that might need to be made.

The appraisal system in Wales

In Wales, we are well placed to build on the opportunities offered by the White Paper . Our system of GP appraisal is well established, and widely recognised as making a valuable contribution to the wider clinical governance and CPD spectrum. We are continuously working to improve our appraisal process, based on quality assurance reviews and feedback from appraisers and GPs across Wales. We have also updated our Quality Management Strategy for 2008 to ensure effective quality assurance is undertaken in line with the White Paper.
To ensure our system will be able to meet the requirements of enhanced appraisal as described by the White Paper we have undertaken work over the last year to define an essential evidence set to for appraisal. This evidence set will clarify for GPs the evidence they are required to provide for their appraisals over a five year cycle, and describe how the evidence will be reviewed by the appraisers. We have been liaising closely with the Royal College of GPs to ensure this work is consistent with the standards they are developing for appraisal. This work is still in pilot format and will be the subject of extensive consultation and piloting during 2008-09.
We continue to work with our appraisal and CPD networks to ensure they will be well placed to provide support and guidance to all GPs as appraisal is further developed and processes to support revalidation are developed, tested and introduced.

Working with the GMC

In 2007 we were invited to jointly manage with the General Medical Council (GMC) a project to evaluate the readiness of clinical governance and appraisal systems in general practice in Wales to support revalidation. The GMC hope that where robust systems of appraisal and clinical governance are in place and quality assured, these can be relied upon to provide information about individual doctors working within those systems.
We have been working closely with the GMC and with the LHBs in Wales to develop an assessment tool which will provide the LHBs with feedback on the readiness of their clinical governance and appraisal systems to support revalidation. This project is one of a series of projects the GMC will be undertaking in order to develop the re-licensing process. This is an excellent opportunity for us in Wales to develop those processes and ensure they build on the effective systems we already have in place.