The GMP framework for appraisal and revalidation (General Medical Council 2014) sets out four broad domain areas which should be covered in a doctor’s appraisal and on which the recommendations to revalidate doctors should be based. As Chapter Two discusses, these domains also set the basis from which revalidation can be evaluated as a quality assurance tool.

Domain 1 – Knowledge, skills and performance

Maintain your professional performance

• • Maintain knowledge of the law and other regulation relevant to your work

• • Keep knowledge and skills about your current work up to date

• • Participate in professional development and educational activities

• • Take part in and respond constructively to the outcome of systematic quality improvement activities (eg audit), appraisals and performance reviews

Apply knowledge and experience to practise

• • Recognise and work within the limits of your competence

• • If you work in research, follow appropriate national research governance guidelines

• • If you are a teacher/trainer, apply the skills, attitudes and practice of a competent teacher/trainer

• • If you are a manager, work effectively as a manager

• • Support patients in caring for themselves

• • If you are in a clinical role:

• – Adequately assess the patient’s conditions

• – Provide or arrange advice, investigations or treatment where necessary

• – Prescribe drugs or treatment, including repeat prescriptions, safely and appropriately

• – Provide effective treatments based on the best available evidence

• – Take steps to alleviate pain and distress whether or not a cure may be possible

• – Consult colleagues, or refer patients to colleagues, when this is in the patient’s best interests

Ensure that all documentation (including clinical records) formally recording your work is clear, accurate and legible

• • Make and/or review records at the same time as the events are documented or as soon as possible afterwards

• • Ensure that any documentation that records your findings, decisions, information given to patients, drugs prescribed and other information or treatment is up to date and accurate

• • Implement and comply with systems to protect patient confidentiality

Domain 2 – Safety and quality

Contribute to and comply with systems to protect patients

• • Take part in systems of quality assurance and quality improvement

• • Comply with risk management and clinical governance procedures

• • Cooperate with legitimate requests for information from organisations monitoring public health

• • Provide information for confidential inquiries, significant event reporting

• • Make sure that all staff for whose performance you are responsible, including locums and students, are properly supervised

• • Report suspected adverse reactions

• • Ensure arrangements are made for the continuing care of the patient where necessary

• • Ensure systems are in place for colleagues to raise concerns about risks to patients