Transcript Slide 1

Revalidation: What Is It?
New unified system of Reflective CPD & feedback to improve:
 Awareness of educational/professional needs
 Quality of care
 Confidence (patients, public, employers, colleagues)
 Addresses Current inconsistencies in re-mediation
 Incorporates relicenship & recertification
for all UK-licensed doctors
Revalidation: Why & When?
NHS Plan 2001
 Annual appraisal GMS
contractual obligation
 Scotland: compulsory since 2003
 +/- inclusion on Performer’s List
Now
Previously
 CPD + 360° feedback +/supervision
 NES led with local GP appraisers
 1-2h Formative session(i.e.
Feedback not Pass/Fail)
Current pilots
 Inc nPEP in Dundee
 Phased-in from April 2011
 Strengthen existing system
 Annual peer-led appraisal
 Continuous process
 Actioned every 5-year cycle
Key Documents
 “Trust, Assurance & Safety – The Regulation of Health Professionals in
the 21st Century” Feb 2007
 “Good Medical Practice for General Practitioners” 2008
 “Medical revalidation – Principles & Next Steps” 2008
 “GMC Licence to Practice” Nov 2009
 “RCGP Guide to Revalidation” Jan 2010
 “Revalidation: The Way Ahead. Consultation Document” March 2010
Good Medical Practice
GMC’s standards of Professional Duty for all doctors
4 domains, 12 attributes
Knowledge, Skills & Performance
 Maintain Professional Performance
 Apply Knowledge & Experience to
Practice
 Clear, accurate, legible records
Communication, Partnership,
Teamwork
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Communicate effectively
Works constructively / delegates
Partnerships with patients
Safety & Quality
 Systems to protect patients & improve care
 Respond to safety risks
 Protect others from risks of own health
Maintaining Trust
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Respect for patients
Treat others without discrimination
Act with honesty & integrity
Annual Appraisal
Over 5-year period with
local appraiser
Supporting Information:
• Colleague & Patient Feedback
• CPD records
• Clinical Audit
Medical Royal College / Faculty:
• Define standards for appraisal &
supporting information
• Providing speciality guidance &
advice for appraisers, appraisees and
Responsible Officers
Annual Appraisal
Over 5-year period with
local appraiser
Responsible Officer
Receives feedback on
appraisal
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Supporting Information:
• Colleague & Patient Feedback
• CPD records
• Clinical Audit
Medical Royal College / Faculty:
• Define standards for appraisal &
supporting information
• Providing speciality guidance &
advice for appraisers, appraisees and
Responsible Officers
New role [Health and Social Care Act 2008]
Senior doctor within healthcare organisation e.g. medical director
Supported by experienced GP adviser and trained lay person
Review supporting information submitted for several thousand doctors
Thus Appraiser has key-role in informing the Responsible Officer
Annual Appraisal
Over 5-year period with
local appraiser
Responsible Officer
Receives feedback on
appraisal
Responsible Officer
Makes revalidation
recommendation to GMC
GMC: Doctor Revalidated
Supporting Information:
• Colleague & Patient Feedback
• CPD records
• Clinical Audit
Medical Royal College / Faculty:
• Define standards for appraisal &
supporting information
• Providing speciality guidance &
advice for appraisers, appraisees and
Responsible Officers
Quality Assurance
• Royal Colleges
• System regulators (e.g. The
Care Quality Commission)
• GMC
GMC Revalidation:
“Single-process”
 Relicensure: license to practise on medical register (i.e. NHS doctor,
prescribe & death certification) in accordance with the GMC’s generic
standards [GMC driven]
 Recertification (re-accreditation): certificate confirms doctors meet
standards appropriate to be on GMC’s GP Register [RCGP driven]
 Support: As a backstop, to identify for further
investigation/remediation, doctors whose practice is/may be impaired
One-Process Revalidation
License
to Practise
5-Yearly Relicence
Certificate
to be on the GP register
5-Yearly Recertification
What do I need to do?
 Supporting Evidence
 CPD credits
 Personal Development
Plans
 Appraisal
Portfolio: 13 evidence areas
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Profession Role
Special Circumstances
Annual Appraisals Review
PDP
PDP Reviews
Continuing Education
Multi-Source Feedback
Patient Feedback
Formal Complaint Review
Significant Event Audits
Clinical Audits
Probity/Health
+/- Extended Practice
description of work
e.g. maternity/sick/sabbatical, job change
signed-off
PDP for each annual appraisal
≥50 learning credits/year
2 x MSF every 5 years
2 x PSQs every 5 years / 1 + video-analysis
if any
5 x SEA every 5 years
2 x full-cycle audits every 5 years
e.g. OOH, GPwSI, teaching/research
Revalidation ePortfolio
 “Supporting information” (evidence) used for annual appraisal
 RCGP College Revalidation ePortfolio
 Most GPs will include information from April 2009
 Easy, intuitive data entry to allow easy review of progress
 Structured to encourage reflection
 Traffic-light-coded ‘dashboard’ summary
 Integrate other online-tools
 Essential Knowledge Update (EKU): scenario-based learning
 Essential Knowledge Challenge (EKC): multiple-choice, voluntary
 PEP, e-GP, RCGP trainee ePortfolio, NHS appraisal toolkit
The
Early
Years
Learning Credits
 All colleges agree - record continuing education in the form of learning credits
 At least 50/year = 250 over a full 5-year revalidation cycle
RCGP:
 1 credit = 1 hr education (learning, planning, reflecting)
 Self-assessed then reviewed at appraisal
IMPACT FACTOR
 Each hour of education that can been shown to lead to improvement in
care or practice will qualify for 2 credits
 Impact on
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Patients e.g. Implement new guideline / initiate new drug
Individual e.g. new / further developing skill
Service e.g. new service / becoming training practice
Others e.g. Teaching, training, NHS services
1 credit
HF Meeting (1h)
Impact Factor x 2
Dr A:
 Logs learning (knowledge & relevance)
Dr B:
 As Dr A
 2 case studies of appropriate B-blockers use in HF
Dr C:
 As Dr A + plans an audit (1h) + discusses findings (1h)
 Change implemented & 2nd cycle demonstrates change
1 credit
2 credits
6 credits
Personal Development Plan
RCGP Guide to the Revalidation of GPs. Jan 2010. version 3.0
Special Consideration
 Maternity leave
 Work Abroad
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Sessional GPs
GPs in remote or small practices
GPs in Forces / Prison Service
GPs in training
Non-clinical (medical managers)
 ? re-entry portfolio
Career Breaks RCGP Video May 2010
Ordinary Portfolio requirements (within 5 year period)
 Appraisal ≥3 years
 Kept up-to-date (CPD) ≥ 3 years
 Clinical Activity ≥ 200 half-day clinical sessions
 Otherwise Responsible Officer may d/w RCGP / GMC
Out-of-practice at time licence up for revalidation...
 License may not be continued
 Can re-apply when ready to go back
 If “sustained” period of time will need “re-orientation”
 Assessment
 Re-entry course
Drawbacks
“Unfair”
 Punitive process for wholly independent practice
 Older GPs & electronic record and reflective practice
 Locums (paper record prescribing, referrals, feedback)
“Bureaucracy”
 More political form-filling
 Wasted time away from clinical care
 Costs (implementing, carrying out, remediation)
 Uncertainty
 DoH terminating contracts of underperforming practices
BJGP (July 2009:476)
 Most doctors see revalidation as a focus for CPD to bring regulation
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and education together
Some GPs the process seems like a bureaucratic nightmare and an
inefficient way to weed out villains of the profession
Need to move away from this idea if revalidation is to reach its
potential (improve care, reassure public/profession, support)
Society wants doctors to be more accountable
Collecting evidence of what we do is significant part of profession
Needs to be properly resourced to avoid “squeezing it in” around
“proper work”
Public Interest
 Increasing climate of general loss
of public trust & increased
awareness of medical error
 Bristol enquiry, Shipman, etc
 GMC figures April 2010
 2,300 patients
 14 % not confident in last Dr seen
 71% felt revalidation would boost
confidence
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Inc 2/3 those quite/very confident
“Information for Patients”
 Tell doctors when care is good
 Thank you letters, compliments
 Say when care is not as good as expected
 Talk, letter, formal
 Report when things go wrong
 Give views when asked
Appraisal Performance
“Central document underpinning revalidation & supporting GPs through it”
Performance
 GMP Objectives =
Appraisal Standards
3 phases:
 Preparation of evidence
 Submission &
Assessment
 Relicense/Remediate
Standards
The Excellent, Good & Unacceptable Dr
 Clinical Care
 Keeping Up To Date
 Record keeping
 Training & Assessing
 Access, Availability,
 Dr-Pt Relationship
OOH
 Resources
 Access to Medical Care
 Emergency Treatment
 Team-work
 Probity
 Health
“A doctor’s certificate and
registration cannot be
restricted or removed, except
through due process, under
the GMC’s fitness to practise
rules and where there is
evidence of impaired
practice”
Remediation
Small minority
 Early identification of concerns
 Follow up local support /action
 RCGP National Adjudication
Panel after 2 unsatisfactory
appraisals
Next stop GMC (can appeal)
 May defer decision to allow Dr to
fill gaps in supporting info
 Outcome based on local,
National Clinical Assessment
Service or GMC process
 Re-entry portfolio
 Resourcing is key concern
Other Countries
Formal revalidation
 Germany
 Netherlands
Netherlands
 ‘Herregistratie’
(recertification) 2001
 OOH mandatory, thus older
GPs felt discriminated against
 Initially required GPs
complete whole 3 y of GPtraining again
 2002 1-year programme
started 4 days/week
supervised work + 1 day
education
Summary
Aims to continually improve:
 Professional accountability
 Standards of Care
 Faith in doctors
Accumulate evidence:
 Annual appraisals
 Audits / SEA / Complaints
 Record learning hours
Taking into account
 Standards
 Clinical guidelines
 Good Medical Practice
 Feedback
 Patients & Colleagues
 Responsible officer review
 Every 5 years