Dr Anne Ramsay: Thank you for your time, Andy, I know you are busy.  Can I kick off by just asking what are you, as the RO, looking for from Appraisal and Revalidation?

Dr Andrew Russell: So for me for Revalidation, I am looking for the opportunity to assure the public - through the General Medical Council - that the doctors who work in our system of care work within the principles of good medical practice; and I am looking for a process of appraisal to allow us to do that.

Anne: Do you think that the appraisal process that we have achieves that aim?

Andrew: I think the appraisal process as it has developed and matured is getting us to the point that it allows us to do that.  I think the fact that the areas in which doctors are required to reflect upon their practice are areas that reflect things that now people do on a day-to-day basis, is now getting us to the point that we can be assured the processes are in keeping with good medical practice.

Anne: And by that do you mean Audits, and Significant Events Analysis, MSF, PSQ, that kind of thing?

Andrew: That type of thing. The reflection upon complaints, and the multisource feedback I think has been an integral part of allowing people to think very differently about themselves and the way that they interact with colleagues, particularly non-medical colleagues; and the importance of complaints and the way that we reflect upon complaints, I think it’s an important part of us maturing as professionals.

Anne: How can Appraisers best support you with this?

Andrew: I see Appraisers as being not only the mirror to reflect back to doctors, and the answers that they get given, and reflect back to them their practice - they are an opportunity to enthuse some of our clinical colleagues, because sometimes I wonder as we go through our day-to-day business if we realise how many things we are doing well, and part of the process of appraisal I think is celebrating what we are doing well.  It’s also to try and ensure that where perhaps people are not on track, that they are given appropriate support and appropriate direction around that.  I think the way in which the general medical practice has begun to change the nature of the assurances we are looking for, it’s appropriate that appraisers are in a position to offer a degree of direction and areas in which colleagues need to improve their portfolio.

Anne: How have revalidation and appraisal impacted on the workforce, if indeed they have?

Andrew: So, I think the process of appraisal which has been well established from a general practice point of view for a number of years now, and in many ways, many systems have been well established in Secondary Care, I think the standardisation of the conversation, the standardisation of the collection of evidence, and as I said the skilled support of the Appraisers in allowing colleagues to reflect upon that in a different way, has certainly brought to clinical practice a degree of reflection that people have not had the opportunity to provide in other ways.  And I think it very much complements the emerging and developing systems of clinical governance that we are seeing across organisations which do put reflections upon complaints, do put reflections upon significant events at the heart of looking to improve services.

Anne: Are there any areas of appraisal that you would like to see developed?

Andrew: As we look forward I think the expectations society levels, and certainly through the GMC, of what Revalidation will produce I think are going to get greater and greater, and I think our expectations of appraisal probably need to sit alongside that.  One of the areas where there’s perhaps been difficulty in the past has been for us to understand where the process of appraisal sits alongside the process of performance management of doctors, whether they are in primary or secondary care.  You would hope that any issues that emerge through appraisal can be supported through a supportive performance management arrangement within the organisation that they are part of.  As we look to develop our systems over the next two to three years and beyond, I think that interface between the process of appraisal and the broader performance management of doctors will become an integral part of our understanding of revalidation.

Anne: Regarding MSF, do you think, maybe as we get into the second cycle of revalidation, people will become a little bit more skilled at how they give their feedback, because as well as receiving it we are also providing it, and maybe it will become more useful, shall we say?

Andrew: I am very conscious that there’s a specific skillset required around supporting people in reflecting upon multisource feedback, because of all the things that are contained in appraisal - potentially it’s the most personally challenging area for all.  Whilst we have a well developed and mature set of Appraisers, I think the opportunity for the Appraisers to develop their skillset around that feedback would be an important part of the second cycle of MSF.

Anne: Any final observations about either appraisal or revalidation?

Andrew: I think the expectations of society, which are being reflected in the General Medical Council’s approach to organisations within which there are Responsible Officers, suggests that they are likely to get higher and higher with regard to revalidation; and my hope is as a system of care, particularly in Scotland, that we continue to be one step in front of those expectations so that there are not surprises for colleagues as they go through this.  If I was to look at where we’ve got to in Scotland, I think the thing we should be most pleased of is we have always been one step in front of what has been expected of us, and I think we‘ve got to continue to do that; because that will be the point where we will lose the profession if we are unable to continue to do it.

Anne: And of course, that will require ongoing resourcing and support.

Andrew: Absolutely.

If I was to look at where we’ve got to in Scotland, I think the thing we should be most pleased of is we have always been one step in front of what has been expected of us, and I think we‘ve got to continue to do that..."