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
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
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
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
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
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