REVALIDATION AND PUBLIC HEALTH PROFESSIONAL APPRAISAL

INTRODUCTION

• Purpose of Revalidation/Professional Appraisal • Revalidation/ORSA standards • RO/Designated Bodies • Appraisal standards/ supporting information • Recent RO guidance • East Midlands approach

The Purpose of Revalidation

• To provide patients, public, employers and other health care professionals with the assurance that licensed doctors (RST) are up to date and fit to practise

The Purpose of Medical/Professional Appraisal

• Enable doctors to discuss their practice and demonstrate they continue to meet GMP/GPH practice and inform RO’s recommendation to GMC • Enable doctors to improve their quality of work and PDP • Consider their own needs for PDP • In line with employers priorities

GMC or UKPHR?

• Revalidation is not a FPH process • It is a process of the GMC and UKPHR for people who want to retain their license to practise

Revalidation Process

• GMC requires local systems of professional appraisal and clinical governance to effectively and fairly distinguish between satisfactory and poor performance • Responsible officers (RO) appointed for employers (Designated Bodies) to oversee local systems and make recommendations to GMC on whether each doctor should continue to practise

Revalidation Process cont.

• Doctors to be revalidated every 5 years and provide a portfolio of supporting information at annual professional appraisal • Launch nationally in late 2012

ORSA – Organisational Readiness Self-Assessment

• New standards are identified by ORSA • ORSA – developed by the DH Revalidation Support Team (RST) • Standards apply to Designated Bodies • New systems to be set up during 2011/12 and 2012/13 and functioning (with evidence) by March 2013

Who is my RO? - GMC

• Laid down in law – no choice (prescribed connection) • Usually Medical Director of employer • GMC will write to you but find out now… • GMC on-line account (GMC homepage – click on “GMC online for doctors”)

Designated Bodies

1.

2.

3.

4.

5.

6.

7.

Primary Care Trusts Local Health Boards National Health Service Trusts NHS Foundation Trusts Strategic Health Authorities Health Boards The Department of Health 8.

9.

The Scottish Ministers The Welsh Ministers 10. Postgraduate medical deaneries in England and Wales 11. Any Scottish training governance body 12. The Royal Navy 13. The regular army within the meaning of section 374 of the Armed Forces Act 2006 14. The Royal Air Force

Designated Bodies

15. 16. 17. 18. 19. Special Health Boards Special Health Authorities The Common Services Agency for the Scottish Health Service Bodies which provide independent health care services within the meaning of section 2(5) of the Regulation of Care (Scotland) Act 2001(2) A Government department or any executive agency of a Government department The following locum agencies: (a) limited companies with shares owned wholly by the Secretary of State for Health, which are concerned with the contracting of locum doctors(3); and (b) locum agencies in England and Wales which are participants in the NHS Purchasing and Supply Agency’s national framework agreement for the supply of medical locums(4) 20. 21. A non-departmental public body Any body whose principal office is located in the United Kingdom and whose President or Dean is a member of the Academy of Medical Royal Colleges (e.g. FPH)

Overall Aim of UKPHR

To ensure a system of revalidation that is • rigorous • timely • effective • affordable • appropriate to its multidisciplinary and multi-professional membership • equivalent where possible to those in public health being revalidated by other, mainly statutory, regulators, such as the GMC

UKPHR Key Issues

• Many of the definitions can be adapted and used • Aim is for the majority of registrants to be revalidated through their employer with recommendation to UKPHR • RO system is likely to be implemented – need to consider the options • Ambition is to have the system starting end of December • Need public health specialists to be trained as appraisers

Employed by a Local Authority?

• Many PH consultants in England will be employed by local authorities • DH has proposed that local authorities in England will be ‘designated bodies’ (results of consultation due in Autumn) • Arrangements for academics with honorary PCT contracts and CCGs tbc as above

Dual Specialties

• ‘Work in progress’ - being pursued nationally • You only have one RO, who must make a recommendation to the GMC about the totality of your work • One session per week of GP (on a 'performers list') trumps a further nine sessions in public health (discuss with your RO)

What if I can’t be bothered?

Failure to engage

Will affect

Fitness to practise

and RO recommendation

Fitness to Practise

Issues that will impact on fitness to practise include: • Patient safety concerns • Failure to engage in revalidation • Undermine confidence in the profession • Conduct (which includes fraud and dishonesty among many other factors) • Performance • Health

ORSA New Appraisal Standards

• Formal Professional Appraisal Policy agreed by relevant organisations • Appraisal Lead in place • Accredited training for appraisers (and appraisees) • Appraiser Support Network ( at least annual)

ORSA New Appraisal Standards

• New eligibility criteria for appraisers • Been through at least 3 appraisal • cycles as appraisee Received accredited appraiser training • Academic colleagues covered by organisation holding honorary contract

ORSA New Appraisal Standards

• Increased quality assurance process • Consultant database - centralised • Central Storage of appraisal papers meeting information governance standards • Formal appraiser feedback via appraisee questionnaires and aggregation of appraiser development needs • • 3 yearly appraisal of appraisers Complaints process

ORSA New Appraisal Standards

• • • • Managed exemption process Exception audit (for appraisals not completed within 28 days) Annual report and Action plan Aggregation of regional CPD needs via Summary Appraisal (Form 4) and PDP audit

The Process of Medical Appraisal

Appraisal covers the whole of the doctor’s practice I N P U T S Personal information Scope and nature of work Supporting information Review of last year’s personal development plan Achievements, challenges and aspirations Confidential appraisal discussion O U T P U T S Doctor’s personal development plan Summary of appraisal Appraiser’s statements Post-appraisal sign-off by doctor and appraiser

What’s New about Appraisal for Revalidation - Processes

• Includes whole scope of work • RO will use • Appraisal outcome • Plus other information (clinical governance) • Appraiser/Appraisee: • Sign off statements • Engagement • Portfolio/supporting information • Progress since last appraisal • Health/probity • New Summary and PDP

Revalidation: a five year cycle

Levels of supporting information

Personal Aspirations

Supporting information that promotes reflection , may be about the current working environment or areas for future growth and development

Professional development

Mandatory requirements may be made contractually by the employing organisation

Supporting information defined by the employing organisation or specialist body (Fitness for purpose)

GMC guidance is the essential basis for all revalidation decisions

Supporting information defined by the General Medical Council (Fitness to practise)

Good Medical/Public Health Practise – GMC Domains/Attributes Supporting Information 1. Knowledge, skills and performance Attribute 1

Maintain your professional development

Attribute 2

Apply knowledge and experience to practise

Attribute 3

Keep clear, accurate and legible records

3. Communication, partnership and teamwork Attribute 1

Communication skills

Attribute 2

Work constructively with colleagues and delegation

Attribute 3

Establish and maintain partnerships with patients

2. Safety and Quality Attribute 1

Systems to protect patients and improve care

Attribute 2

Respond to risks to patient safety

Attribute 3

Protect patients from risks posed by your health

4. Maintaining Trust Attribute 1

Show respect for patients

Attribute 2

Treat patients fairly and without discrimination

Attribute 3

Act with honesty and integrity

Summary of GMC supporting information requirements

There are six types of supporting information:

1. Continuing professional development 2. Quality improvement activity 3. Significant events 4. Feedback from colleagues 5. Feedback from patients (where applicable) 6. Review of complaints and compliments

So:-

• • • • • • Keep up to date Review and improve your practise Demonstrate learning/reflection PH Audit Get feedback MSF/360 ° Appraisal

Public Health Audit

• FPH has developed examples of audit and case review (see Faculty website) Examples : • DPH annual report • Commissioning reports and impact • Screening annual reports • Health Equality Impact Assessments • Case Review/Reflection • SUI involvement

Feedback

• Colleague • Supervision / training feedback • Formal Complaints • Patient feedback only required for those who have direct patient contact • Multi source feedback – At least once in the revalidation cycle – What tool to use? – RO decision

GMC Timeline

July 12 Sept 12 GMC/ROs confirm their doctors GMC/ROs confirm doctors recommendation dates Sept – Nov 12 GMC confirms submission dates Dec 12 GMC issue first notices to doctors and ROs (9 months notice)

Implementation Years

1

2 3

Year Dates

0

Who

April 12 – March 13 RO’s, ? Doctors in leadership April 13 – March 14 20% all doctors April 14 – March 15 60% all doctors April 15 – March 16 100% all doctors

Year 1 – Selection Process

• Random selection or Local criteria • RO decision

RO Recommendations

• Positive recommendation – continue to license • Deferral request • Notification of non-engagement

Deferral Request

• Engaged but insufficient evidence, gaps identified, anticipate able to make informed recommendation once collected • Engaged, but participating in on-going process (HR, remediation, investigation) anticipate able to make informed recommendation once concluded • Length of deferral: – 3-6 months – 6-9 months – 9-12 months – More than 12 months

Notification of Non-Engagement

• Not engaged • Does not meet deferral criteria • Doctor had sufficient opportunity and support • All local processes exhausted

Current East Midlands PH Appraisal System

• In place since 2002/03 • Recognised by Faculty of PH as example of good practise • Includes all PH Consultants – regardless of background • Includes those on UKPHR but not in consultant post • Covers PCTs, SHA, Universities • HPA has own system • Co-ordinated annually Sept-Mar

East Midlands Approach/Framework

• • • • • • • Systematic /structured/QA approach Meets all ORSA standards QA central database Appraiser training/network Allocation/choice of appraiser MDS – submissions/RO link Evaluation/Feedback

East Midlands Framework – Resource Pack

• • • • • • • National guidance Local guidance/policies/processes Portfolio checklist Structured Line Manager letter Outline agenda for appraisal interview Handling difficult appraisal guidance MDS for central database

SUMMARY

Revalidation

• • • • GMC/UKPHR process 5 year cycle Find your RO RO uses appraisal plus other information

SUMMARY

Appraisal

• • • • • Do engage annual enhanced appraisal by approved appraiser Systematic/QA’d process Quality supporting information/portfolio is paramount Demonstrate learning/reflection Sensible PDP