Transcript Revalidation and anaesthesia - The Royal College of Anaesthetists
Revalidation for anaesthetists
Liam Brennan
Council member & revalidation lead
Royal College of Anaesthetists
Update - June 2012
Introduction Appraisal for revalidation Timetable for revalidation & transitional arrangements Supporting information CPD Review of clinical outcomes Patient & colleague feedback Doctors in training Remediation Obtaining advice
Why do we need Revalidation?
Revalidation: is it really going to happen?
• • Andrew Lansley’s letter to GMC, June 2010 Full support for revalidation Extend piloting for a further year • House of Commons Health Select Committee, Feb 2011 GMC required to ensure ‘no further delays to late 2012 implementation of revalidation ’ • House of Commons Health Select Committee, March 2012 ‘’In the light of the importance of this process to the quality of services delivered to patients, and of the status of the GMC as an independent regulator, the Committee looks to the GMC to give early and public notice if it concludes that delivery of this timetable is at risk.”
What is Revalidation?
It’s about providing assurance that all doctors with a GMC license are up to date and fit to practice
What is Revalidation?
It’s about providing assurance that all doctors with a licence are up to date and fit to practice Based on continuing evaluation of
current
context of everyday working environment practice in the Based on local systems of annual appraisal that are based on the GMC core guidance Good Medical Practice*
It is not
a “point in time” assessment of knowledge & skills
* http://www.gmc-uk.org/guidance/good_medical_practice.asp
What is Revalidation?
It’s about providing assurance that all doctors with a licence are up to date and fit to practice
Based on continuing evaluation of
current
context of everyday working environment practice in the Based on local systems of annual appraisal that are based on the GMC core guidance Good Medical Practice
It is not
a “point in time” assessment of knowledge & skills
A five year process NOT a fifth year event !
Appraisal/revalidation …..a continuing cycle
One revalidation cycle Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Second revalidation cycle Appraisal Appraisal Appraisal Appraisal
Appraisal/revalidation …..a continuing cycle
One revalidation cycle Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Second revalidation cycle Appraisal Appraisal Appraisal Appraisal …..for each and all our professional lifetimes!
GMC revalidation model
Portfolio of Supporting Information Five x yearly appraisals Employer liaison service Specialty-specific advice Recommend revalidation Responsible Officer Request deferral Failure to engage
General Medical Council
What is appraisal?
“A professional process of constructive dialogue, in which the doctor being appraised has a formal structured opportunity to reflect on his/her work and consider how his/her effectiveness might be improved” “A positive process to give someone feedback on their performance, to chart their continuing progress and to identify developmental needs. It is a forward looking process, essential for the development and educational planning needs of the individual”
DH December 2002
Appraisal: for revalidation
Existing appraisal practice
Clinical and non-clinical aspects mapped to GMP CPD reviewed against
Core topics Job plan
Match job plan to Trust needs Increased use of MSF PDP taking account of the above
Appraisal for revalidation
Clinical and non-clinical mapped
to four domains of GMP Judgements on:
Adequacy of supporting information including:
CPD Audit MSF
Clinical risks/safety Progress towards revalidation
Match job plan to Trust needs PDP taking account of the above
Appraisal remains largely a formative process but with summative components
www.revalidationsupport.nhs.uk
Revalidation: anticipated timetable
May/June 2012 Summer 2012
Sept/Oct 2012
By end of 2012 By 31 March 2013 By 31 March 2014 By 31 March 2016 By 31 March 2018 Final organisational state of readiness assessment (ORSA) Assessment of readiness and business case prepared for Ministers
Ministerial decision
Enablement of necessary legislation All ROs to have revalidated ~20% of doctors to have revalidated The ‘vast majority’ of doctors to have revalidated All remaining doctors revalidated • • Challenge of non-affiliated doctors GMC ‘ making your connection’ campaign
Transitional arrangements
GMC aim to revalidate all doctors by March 2018 One appraisal minimum requirement Procedure for selecting doctors for revalidation yet to be announced; process may vary across the UK Minimum of three months notice anticipated All designated bodies expected to make some recommendations in first year GMC revalidation readiness statement (June 2012 ) available at: http://www.gmc-uk.org/doctors/revalidation/13282.asp
Specialty specific supporting information
www.rcoa.ac.uk/docs/Revali dation_doh_pilots.pdf
Final version published late summer 2012
Supporting information
General information -
providing context about what you do in all aspects of your professional work
Personal details Scope of whole practice (inc NHS, independent, voluntary)
Anaesthetic/ICM/pain medicine caseload data
Data on complex procedures e.g. central access, regional blocks Probity statement
Personal declaration of disciplinary, criminal or regulatory sanctions
Competing interests e.g. financial or other Any declarations of professional conduct/performance of others Personal health declaration
Self-declaration of health issues that could pose a risk to patients
Supporting information
Keeping up to date-
your professional work
Maintaining and enhancing the quality of Continuing professional development (CPD)
Review of your clinical practice -
the quality of your professional work
Evaluating and improving Clinical audit
personal, local, national Participation in at least one complete audit in a 5 year cycle Not everyone has to lead an audit but ‘active engagement’ by all Significant untoward events
Personal reflection and lessons learnt by dept/ whole organisation Clinical outcome measures
Supporting information
Feedback on your practice –
of your professional practice how others perceive the quality
Colleague multi-source feedback (MSF) Patient/carer MSF Feedback from clinical supervision, teaching & training Formal complaints Compliments
Continuing Professional Development (CPD)
GMC principles of CPD
• • • • • •
Responsibility for personal learning
Personal responsibility for identifying your CPD needs, planning how they should be addressed and undertaking CPD that will support professional development and practice
Reflection
Good Medical Practice requires you to reflect regularly on your standards of medical practice
Scope of practice
You must remain competent and up-to-date in all areas of your practice
Individual and team learning
CPD activities should aim to maintain and improve the standards of your practice and teams in which you work
Identification of needs
CPD activities should be shaped by assessment of your professional needs and the needs of the service and the people who use it
Outcomes
You must reflect on what you have learnt through your CPD and record any impact or expected impact on your performance and practice GMC Guidance on CPD (June 2012) www. gmc-uk.org/education/continuing_professional_development.asp
How much CPD is required?
Minimum of 50 credits per year; 250 credits in 5 year revalidation cycle is recommended
Internal
Minimum 20 credits (NB at least 10 from local clinical governance meetings)
External
Minimum 20 credits RCoA encourages wide range of CPD activities to reflect your whole practice Full details of RCoA CPD guidance available at: http://www.rcoa.ac.uk/document-store/guidelines-continuing- professional- development
RCoA CPD matrix
Resource to assist in planning CPD needs Regard as a menu rather than a tick box list
Level 1
Core knowledge expected of all who received their base training as anaesthetists Easily achievable by review of clinical activity, local meetings, e-learning; some topics included in mandatory training
Level 2
Knowledge & skills relevant to an anaesthetist’s whole practice (inc on call, independent/voluntary practice) Achievable via local meetings, e-learning & some external CPD activity
Level 3
Knowledge & skills required for a ‘special interest’ area of practice* Will rely heavily on external CPD activity Suggestions via relevant Faculty/specialist society website
*Special interest areas are as defined in advanced level CCT curriculum although other clinical & non-clinical areas may be suitable for Level 3 CPD
CPD & appraisal
• • • Achievable amount of CPD from relevant matrix levels agreed at appraisal Include CPD goals as part of PDP Review evidence of completion at next appraisal & sign off
RCoA Online CPD system
• • • • • • • • Users Searchable database of approved events CPD diary & reflective review Personal development plan Breakdown of CPD credits Integration to eLA Depository for CPD certificates End of year CPD activity report Free to Fellows & Members • • • • • Providers Submit applications for CPD approval Dedicated help line for providers Addition of event to database Link to event website for more information & booking Learning outcomes review by users www.cpd.rcoa.ac.uk
Clinical outcomes
Review of clinical outcomes
National
NAP projects ♯ NOF network Laparotomy network ICNARC
Local
RCoA audit recipe book may be key (new edition published June 2012) One or two audits per year in each anaesthetic department Review areas of core clinical outcome
e.g. post op pain relief, PONV, line related sepsis, ICU readmission
Benchmark personal practice against national/local standards whenever possible New initiative - national ‘sprint’ audits
Patient & colleague feedback
Patient & colleague feedback
www.rcoa.ac.uk/docs/peer_ patFeedback2011.pdf
wwwgmcuk.org/doctors/revalidation/colleague patient_feedback_resources.asp
• • Patient & colleague MSF should be collected at least once in each revalidation cycle Several validated MSF tools • GMC,RCoA & FICM guidance available
Patient & colleague feedback
www.rcoa.ac.uk/docs/REV-Statement-03.02.12.pdf
Patient & colleague feedback
GMC commissioned survey for feedback showed: Colleague MSF straightforward Patient feedback more difficult for perioperative anaesthetist 51% >21 questionnaires 75% >14 questionnaires Difficulties with timing, distribution & collection of patient feedback Further work by RCoA with patient groups to consider: Logistical difficulties of patient MSF Quality of care Despite difficulties RCoA recommend engaging with patient MSF
Doctors in training
Doctors in training
All trainees will need to revalidate Postgraduate deaneries in England or equivalent in devolved nations will be the ‘designated body’ Recommendation to revalidate based on participation in ARCP/RITA process Most supporting information already be part of training portfolio Some new documentation likely Pilot exercise completed and will report soon Timing: five years after full registration or at add award of CCT whichever is sooner
Remediation
Remediation
Revalidation likely to identify increased numbers of doctors with fitness to practice issues ~ 1000 remediation cases in progress in England 2,800 (~2%) of all doctors in England subjected to investigation annually Remediation provision will need to be enhanced & increased DH report on remediation published Dec 2011
Remediation: what is meant?
‘The overall process agreed with the practitioner to redress identified aspects of underperformance. Remediation is a broad concept varying from informal agreements to carrying out some re-skilling, to more formal programmes including supervised remediation and/or rehabilitation.’
Remediation: DH report 2011
Highlights lack of: consistency in how organisations tackle doctors with performance issues clarity about where a PDP stops and remediation starts clarity as to who has responsibility for the remediation process clarity on what constitutes acceptable clinical competence and capability clarity about when the remediation process is complete and successful clarity about when the doctor’s clinical capability is not remediable capacity to deal with the remediation process
Remediation: DH report
Key recommendations: Wherever possible, performance problems including clinical competence and capability issues, should be managed locally Local processes need to be strengthened to try and avoid performance problems occurring and reduce their severity at the point of identification The capacity of staff within organisations to deal with performance concerns needs to be increased with access to external expertise as required A single organisation is required to advise and, when necessary, to co ordinate the remediation process and case management so as to improve consistency across the service
Remediation: DH report
Key recommendations (cont’d):
The medical royal colleges should produce guidance and also provide assessment and specialist input into remediation programmes
Postgraduate deaneries and all those involved in training and assessment need to assure their assessment processes so that any problems arising during training are fully addressed
Remediation: Clinical Directors view
Much should be managed locally College should be involved ‘ A supportive rather than driving role’ Setting standards - consistency Providing advice on assessment and processes Help make it happen Concerns about funding of remediation programmes
Remediation: Regional advisors view
College should be involved in: Setting standards and establishing framework Assessment: both advice and doing Helping make it happen – organise external placements Training for specialty needs
Remediation: General consensus
Preferable to identify performance concerns early Ensure robust local appraisal and clinical governance processes are in place Act on information obtained Majority of issues should be manageable locally Work with national organisations e.g. NCAS Work with Academy of Medical Royal Colleges to produce consistent approach across the profession
Obtaining information & advice
Sources of information & advice
GMC website http://www.gmc-uk.org/doctors/revalidation.asp
RCoA & FICM website http://www.rcoa.ac.uk/revalidation-cpd http://www.ficm.ac.uk/cpd-and-revalidation RCoA Bulletin articles http://www.rcoa.ac.uk/bulletin Specialty advisors
Revalidation specialty advice
• • Common model for delivery of specialty advice agreed by AoMRC Central contact point for all specialty advice via the College:
[email protected]
Revalidation specialty advice
• • • • • Demand for specialty advice for anaesthesia unclear Requests likely from all revalidation stakeholders Uncomplicated process queries dealt with by College staff Commence with a small (15-20) team of advisors Membership includes representation from: • FICM & FPM • • • All home nations • All major sub-specialties SAS grade Retired/ independent practice • All advisors will receive appropriate training