Mental Health Awareness Week: Supporting Doctors Through Revalidation
Posted on: Wednesday 13 May 2026
The current narrative is that the UK is in the grip of a mental health crisis. Around one in four adults experience a mental health issue in any given year and referrals to mental health services in the UK are up 38% on 2019. In our NHS, a doctor takes his or her own life every three weeks.
Doctors in the NHS have particular and well documented challenges: high workload, rota gaps, administrative burden and moral injury; the stress of being unable to provide the care that patients deserve.
But pharmaceutical physicians themselves have significant stressors.
Many of us work in an environment of chronic cognitive and ethical load. We carry responsibility for complex benefit-risk decisions with high consequences of error for patients, regulators, the company and our own careers.
In more commercial roles, there is the added pressure of ensuring we do the right thing while keeping patients at the centre of our thinking. In recent times in particular, balancing reimbursement drivers versus patient access. Not always easy, and over time, that quiet ethical tension can take a toll.
Layered onto this are boundary issues, presenteeism and job insecurity. Many of our roles are global, stretching across time zones and tied to tight regulatory or launch timelines, which encourages long hours and an “always on” culture.
Corporate environments can also make it harder to talk openly about distress, especially where senior roles are few, performance is closely monitored, and competition for progression is strong. In that context, doctors may fear that admitting to depression, anxiety or burnout will jeopardise promotion or key responsibilities, echoing the broader evidence that stigma leads clinicians to delay seeking help.
And of course there are our own intrinsic issues. Mental health challenges at home can make engagement at work, or dealing with the pressures of work, even greater.
I’m going to overshare a little in this post. Because I’ve learned for me that it’s helpful. But it’s not for everyone; we’ll get to that.
In the early 1970s, my grandmother died by suicide. My mum wasn’t quite twenty, still navigating university. In the jaws of this event she married my dad, out of the blue as my dad now describes it, and just a few years later she gave birth to me. I’ll never really be sure of her motivation to plunge into marriage and then parenthood so quickly and at such a young age (she was just 25) after such a significant trauma. But she struggled with being a mum.
My mum was recently diagnosed with dementia, in 2023, and I found myself struggling with depression. I finally had to face the consequences of a difficult childhood, the effect it had on me today and the fact that I’d now never be able to discuss it with my mum. Although what would I say if I discussed it with her? And would it help? Who knows; but what I do know is that a death by suicide 55 years before still cast the longest of long shadows. It took my GP, two very different counsellors and a lot of my own hard work to get to where I am today. And there is no doubt that throughout some of those more difficult times, dealing with pressures at work was harder.
Okay, all that said, what do we do about it?
Mental health challenges at home can make engagement at work, or dealing with the pressures of work, even greater.
I was delighted to be asked to take on the role of Responsible Officer at FPM last year after a competitive process. I saw it as a real opportunity to try and use revalidation for the benefit of our mental health, not as an additional stressor. Or, at the very least ensure that we run a supportive system that doesn’t make things worse!
Appraisal and revalidation are seen by many as an added stressor at difficult times. The broader literature on professionals living with a disability or mental illness highlights some recurring themes:
- Professionals with medical conditions report that illness, impairment and workplace discrimination can make it harder to meet and document revalidation requirements. (Disabled Doctors Network)
- Doctors experiencing mental ill‑health often worry that disclosure will lead to negative judgements about their “fitness to practise”, loss of opportunities or more scrutiny than support. (Source)
- Occupational health and employers do not always understand or fulfil their duties around reasonable adjustments, which can effectively penalise doctors who are already struggling. (Source)
For a doctor living with depression or anxiety, the revalidation portfolio can feel like a magnifying glass held over their most vulnerable areas. The fear is not only about failing to meet a standard, but about being seen as ‘unsafe’ or ‘unreliable’ if they admit to struggling.
For a doctor living with depression or anxiety, the revalidation portfolio can feel like a magnifying glass held over their most vulnerable areas.
Declaring mental health conditions at appraisal
What actually happens when you declare a problem?
Revalidation in the UK is based on annual appraisal plus a five‑yearly recommendation from a responsible officer (me!) to the GMC about whether you are fit to practise and can retain your licence.
During appraisal, doctors are expected to complete a health and probity declaration and to discuss any issues that could affect their work, including mental health.
Responsible officers are explicitly tasked with ensuring that support and remediation are provided where a doctor’s practice falls below the required standard, not simply with “passing” or “failing” people.
Declaring a mental health condition is not, in itself, a bar to revalidation; the focus is on current impact on practice and whether appropriate support and mitigation are in place. In my experience, failing to declare and seek support can cause more problems as people struggle to engage with the process and complete a portfolio.
If a doctor is under the care of a GP or psychiatrist, has engaged with occupational health, and is following agreed adjustments, this is usually seen as a positive, proactive step rather than a risk signal.
If there are significant current concerns about safety, the outcome is more likely to be a structured plan (e.g. closer supervision, phased return, agreed adjustments) than immediate loss of licence.
If a doctor is under the care of a GP or psychiatrist, has engaged with occupational health, and is following agreed adjustments, this is usually seen as a positive, proactive step rather than a risk signal.
Reasonable adjustments and time out of work
This is a little harder for FPM as a non-employing designated body since we don’t have direct power over your workload. But we can definitely help when it comes to appraisal. If you’re worried about the appraisal process, speak early to your appraiser or responsible officer (again, me!) about how time away will be documented and how gaps in practice hours, CPD or feedback can be managed.
We have a number of tools at our disposal, including light touch appraisal, delayed or approved missed appraisals where appropriate, and even temporary relinquishing of licence to practice if you don’t have a patient-facing role.
Support is available
Responsible officers and designated bodies are meant to ensure systems are in place to support doctors through revalidation and to provide remediation where needed.
Many regions now have specific support for doctors in difficulty, including occupational health, practitioner health services, mentoring, coaching and “return to work” schemes and there are a number of charities and professional bodies (including BMA charities and mental health organisations) who can offer financial help, confidential advice, and guidance about workplace adjustments.
Indeed, our next formal appraisal training programme will be conducted by the charity Doctors in Distress who are going to give our appraisers some additional tools and resources.
Thinking of appraisals as a positive support structure
In summary, we’re here to help.
- Use the appraisal as a structured opportunity to reflect honestly on your mental wellbeing, not just your portfolio.
- Go into appraisal with a brief written reflection on “what helps me stay well at work” and “what gets in the way”; this can make it easier to discuss adjustments.
- Normalise asking for help by framing it as part of professional responsibility and patient safety, not as a personal failing.
- If you are an appraiser or senior doctor, explicitly invite discussion of mental health, model non‑stigmatising language, and signpost to support.
I’d like to finish with a positive experience. During the last few years, when things were difficult, I had an amazing appraiser who asked questions, took his time to understand what was going on and was infinitely supportive. It was like an annual structured therapy/coaching session. While I’ll not name him here lest he get flooded with requests to appraise people, he knows who he is and I want to say thank you again to him for the tremendous support and encouragement he gave me during a difficult time.
If you’re struggling with your mental health, do open up to your appraiser or reach out to me directly at ROrevalidation@fpm.org.uk. It’s what we’re here for.