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Reviewing Revalidation

In January 2017 Sir Keith Pearson published his report assessing the first 5 years of Revalidation. For me there were two key messages that stood out. Firstly, to keep Appraisal and Revalidation requirements simple - it was felt that some organisations and Responsible Officers were placing additional requirements onto Revalidation adding to the perceived burden. Secondly, that doctors should seek patient feedback more frequently. It is this second point that I wish to concentrate on here.

Currently, for Revalidation the minimum standard requires asking 34 patients for feedback every 5 years. Patient representatives and Sir Keith Pearson feel this should be more and I think that is reasonable. We don’t want to increase the burden of Revalidation, however, and I don’t think that just repeating the existing patient feedback exercise more frequently is the answer. In fact Sir Keith Pearson mentioned an aspiration of patient feedback becoming a more fluent and continuous process. This is where iWantGreatCare seems to me to fit very neatly indeed.

To perform a colleague feedback exercise once every 5 years feels about right to me. That time period comes round surprisingly quickly. I am of course generalising but I think unless circumstances change the answers are likely to be similar if it is repeated more frequently. (This is not to say that it might not be useful to repeat the feedback exercise after reflection and intervention but that is different from requiring it).


iWantGreatCare is the world's largest independent patient data and insights platform - think TripAdvisor for health and you are on the right track. As a GP and LMC Medical Director, my assumption was that iWantGreatCare is essentially a private version of NHS Choices - it’s not. I think many of us have negative experiences of reviews on NHS Choices from patients with an apparent axe to grind and a feeling that the solutions to try and respond or correct this was inadequate. Getting to know iWantGreatCare has made me realise that they recognise these fears and have taken steps to alleviate them. They seem to balance the role of patient advocate and professional service nimbly. In essence, they are not NHS Choices.

Dealing with malicious feedback

Since 2008 they have had almost 5 million reviews and they use a combination of human, automated and statistical monitoring at each stage of the process to spot and disallow malicious reviews. If a clinician or practice reports an inappropriate review they respond and act professionally. Another reservation is that we are impotent to respond because we might breach confidentiality. In fact, consistently any negative comments on IWGC do not concern confidential clinical issues instead process and communication problems to which doctors feel they can respond without compromising confidentiality.

A patient can leave feedback on any doctor or practice in the UK currently. Where the real value for the practice and the doctor lies though, is if the doctor or practice registers and starts to take ownership of the feedback. This means they can set up notifications, respond to comments and even encourage patients to feedback with personalised prompt cards or links. Why on earth would we want to encourage this I hear you ask? 100% of doctors using the service felt that the majority of feedback received was positive and 77% reported improved morale1 - something desperately needed now more than ever. We are lucky in General Practice that we have that continued doctor-patient relationship to get positive feedback. There are still many patients that we may not see frequently between episodes for follow up though and with the changing face of the workforce in General Practice this may also be less common.

Consumer feedback culture

We now live in an age where service user feedback is the norm. I don’t make purchases without checking Amazon reviews, holidays or restaurants we check TripAdvisor. We may fear a TripAdvisor for health becoming commonplace because we worry that bad reviews will reflect poorly on us but there are few doctors that won’t have predominantly positive reviews and if not then perhaps all the more reason to get frequent feedback. We are perfectionists who are motivated by trying to help all our patients, therefore, a single bad review can have understandable disproportionate emotional responses. If this is balanced though with frequent positive responses a different perspective is attained. Also using the Amazon analogy I think most of us are now comfortable spotting reviews where the reviewer obviously had their own issues that were most likely out of control of the subject of the review, why should this be any different for our patients.

The aspiration of continuous patient feedback is that it will drive up standards. It is also an easy way to gain valuable feedback from patients in addition to the required Revalidation patient feedback.

FourteenFish and iWantGreatCare integration

We worked with iWantGreatCare so any feedback you receive can be reflected on and transferred into your appraisal at the click of a button. This provides an easy way to capture quality, ongoing patient feedback and the only additional step is registering with iWantGreatCare if you haven’t already.

What’s in it for me?

Doctors using iWantGreatCare recognise that it requires a leap of faith to get started but once using it provides a straightforward way to gain supporting information for your appraisal and great evidence for CQC for the Practice.

This may just sound like a sales pitch for iWantGreatCare but after meeting and talking to iWantGreatCare I feel enthusiastic that we can use their approach to lead on how Sir Keith Pearson’s wishes can be delivered for Revalidation. At FourteenFish we are driven by providing solutions that add value to the processes that they support, for example, an easy to use Appraisal Toolkit means the appraisee and appraiser spend less time fumbling their way through the IT and have more time for the positive affirming, reflecting and planning aspects of appraisal. iWantGreatCare synchronised with FourteenFish to me seems to provide a simple, value-added system for collecting more frequent and quality patient feedback.


1. Why doctors want to be rated by patients: feedback increases empathy and boosts morale C.M. Rees, R.M. Thompson, M.Carter, O.J. Warren, V.J. Gokani, N. Bacon 2015


Dr Duncan Walling
Founder, FourteenFish

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