360 feedback
360° Feedback, Disability, and Revalidation – Position Paper
(This title was created to help understand the situation and confirmed by ChatGPT, but it is not legal advice.)
Background
Doctors undergoing revalidation are required by the GMC to collect colleague and patient feedback. However, **the GMC does not prescribe how this feedback must be collected**. While many organisations default to anonymous 360° feedback tools, this is a **policy choice**, not a regulatory requirement.
For disabled doctors, particularly those with hidden disabilities such as ADHD, autism, dyslexia, or mental health conditions, anonymous 360° feedback can create risks of bias, discrimination, and psychological harm. Since the GMC framework leaves the format of feedback open, Responsible Officers (ROs) and Designated Bodies have both the discretion and the duty under the Equality Act 2010 to make reasonable adjustments where anonymous 360° feedback causes disadvantage.
Equality Act 2010 – Legal Risks
Indirect Discrimination
- Revalidation requirements, including colleague feedback, amount to a *provision, criterion or practice* (PCP).
- Disabled doctors, particularly those with visible or known adjustments (e.g. flexible hours, reduced on-call, exemption from night shifts), may be more likely to attract negative perceptions.
- Anonymous feedback can therefore place disabled doctors at a particular disadvantage compared with non-disabled doctors, creating a risk of indirect discrimination unless objectively justified.
Direct Discrimination
- Where criticism arises directly from disability-related adjustments (e.g. “not pulling their weight on the rota”), reliance on such feedback may amount to direct discrimination.
Harassment
- If feedback comments relate to disability traits (e.g. “disorganised,” “too blunt,” “slow with paperwork”), this could amount to harassment under s.26 Equality Act 2010, even if anonymised.
- Because the feedback process is organised by the Designated Body, responsibility rests with that body and the RO.
Burden of Proof
- Under s.136 Equality Act 2010, once facts suggest discrimination, the burden shifts to the organisation.
- Anonymous feedback makes it very difficult to prove that bias did *not* play a role, leaving the organisation unable to rebut the presumption of discrimination.
Additional Risks in Hidden Disabilities
1. Misinterpretation of Disability-Related Behaviour
- Coping strategies (assistive tech, written instructions, avoiding noise) may be misread as laziness, disorganisation, or disengagement.
- Anonymity prevents clarification that these behaviours are disability-related.
2. Amplification of Bias
- Stigma towards hidden disabilities may unconsciously shape colleagues’ views.
- Anonymity removes accountability, making biased feedback more likely.
3. Procedural Unfairness
- Standard performance management requires transparency, specificity, and an opportunity to respond.
- Anonymous 360° feedback bypasses these safeguards.
4. Groupthink and Collusion
- In small teams, feedback can cluster, creating a scapegoating effect against a disabled colleague.
5. Barrier to Disclosure
- Fear of biased anonymous comments may deter disclosure of disability or requests for adjustment.
- This undermines the proactive duty to identify and meet needs.
6. Psychological Harm
- Research shows that negative anonymous feedback can cause stress, loss of confidence, and anxiety.
- Disabled doctors with a history of workplace trauma (e.g. past discrimination or PTSD) may be especially vulnerable.
7. Conflict with Professional Standards
- GMC, Good Medical Practice (2024 update): requires assessment systems to be “fair, transparent, and based on objective evidence” (paras. 2, 67).
- GMC, Revalidation: A Guide for Doctors (2020): stresses that feedback and appraisal must be “supportive, proportionate, and fair.”
- GMC, Welcomed and Valued (2019): guidance on supporting disabled doctors, explicitly requiring reasonable adjustments.
- MPTS decisions: consistently emphasise proportionality, fairness, and context when assessing doctors. Anonymous, unchallengeable feedback is inconsistent with this approach.
Inconsistent Practice and Delegation
While the Responsible Officer holds ultimate accountability for revalidation, day-to-day assessment is often delegated to appraisers. It is important to note that the GMC does not mandate anonymous 360° feedback.
If an individual appraiser insists on anonymous 360° feedback, this amounts to the introduction of a local PCP. Legally, responsibility for any resulting disadvantage still rests with the Designated Body and the RO, who must ensure appraisal processes are fair, consistent, and compliant with the Equality Act 2010.
Allowing appraisers to impose additional requirements outside GMC guidance risks **procedural unfairness, inconsistent treatment between doctors, and potential discrimination**.
Reasonable Adjustments in Revalidation
To comply with both the Equality Act and GMC standards, Responsible Officers and appraisers should consider:
- Exempting disabled doctors from anonymous 360° feedback, or
- Requiring feedback to be attributable where disability-related adjustments are visible, so bias can be assessed,
- Replacing or supplementing feedback with alternative evidence (structured supervisor reports, patient outcome data, reflective logs, case reviews),
- Training appraisers and assessors to interpret feedback appropriately, ensuring disability-related adjustments are not misread as deficiencies,
- Ensuring parity with GMC expectations, that appraisal and revalidation processes are supportive, proportionate, and non-discriminatory.
Conclusion
The GMC’s revalidation framework requires doctors to collect colleague and patient feedback but leaves the **method of collection flexible**. Anonymous 360° feedback is widely used but not mandated.
This flexibility means that Responsible Officers and Designated Bodies **should not insist on anonymous 360° feedback where it disadvantages disabled doctors**. Reasonable adjustments — such as using named feedback, supervisor reports, case reviews, or alternative structured evidence — are not only permitted under GMC guidance but are usually required under the Equality Act 2010.
Accordingly, the continued use of anonymous 360° feedback without adjustment carries significant risks of discrimination and is inconsistent with GMC and MPTS standards, which require appraisal systems to be fair, transparent, and supportive.
Model Note to Responsible Officer
Dear [Responsible Officer],
I wish to confirm my understanding of the Equality Act 2010 and GMC guidance as they apply to the use of 360° feedback in revalidation.
Where a disabled doctor identifies that a standard process, such as anonymous 360° feedback, creates a disadvantage linked to their disability, the legal duty to make reasonable adjustments lies with the Designated Body/Responsible Officer, not with the individual doctor (Project Management Institute v Latif [2007] IRLR 579).
The GMC requires that appraisal and revalidation processes are fair, transparent, and non-discriminatory (Good Medical Practice 2024, paras. 2, 67). Its guidance on supporting disabled doctors (Welcomed and Valued, 2019) makes clear that reasonable adjustments must be provided to avoid disadvantage.
Anonymous feedback, particularly when linked to visible adjustments, creates foreseeable risks of bias, harassment, and discrimination.
Accordingly, I ask you to consider what reasonable adjustments to the feedback process would ensure compliance with the Equality Act 2010 and GMC standards, and to confirm these in writing.
Yours sincerely,
[Name]
(This document was created to help understand the situation and confirmed by ChatGPT, but it is not legal advice.)
