Transcript Peter Nightingale

THE ROYAL COLLEGE OF
ANAESTHETISTS
Revalidation
What, when and how
 What?
Responsibility of individual doctors (and
the GMC and Professional bodies)
 When?
Piloting in 2009, ready and delivered in
2010
 How?
Locally with RCoA support
Definition
 ‘Revalidation is a process where doctors will be
required to “periodically demonstrate their
continued fitness to practise … and for specialist
doctors, to demonstrate that they meet the
standards that apply to their particular medical
specialty (DH 2007: 6). If demonstration fails then
an evaluation (GMC guidance relating to Medical
Act, 2002) of evidence would be required,
progressing to assessment if it is deemed necessary’.
It is important to remember that …..
 The purpose of revalidation and medical regulation is not
solely to identify doctors whose performance is not of a
sufficiently high standard
 The vast majority of doctors are practicing medicine to a
high standard
 Revalidation should be a process that will support
continuous quality improvement in standards and practice
for both doctors and patients alike
What is it?
 A combined process of public
assurance about medical fitness to
practice
 Three elements:
Registration
Licensing
Certification
Registration
 Identified as a doctor
No rights
• To practice
• To prescribe
• To certify death
Licensing
 Identified on register to practice
General rights
(pays Fee)
No specialist recognition
Remains open after retirement
Renewed every 5 years
• Local process
Certification
 Identified as a specialist (or GP)
All non-training post holders
• Consultants / SAS + Trust posts
• Independent sector doctors
Renewed every 5 years
• Recommendation from RCoA to
GMC
• Linked to local process
Summary so far
 Registration
Able to be called a doctor
 License to practice
Can practice as a doctor
 Certification
Can practice as a specialist (anaesthetist)
When?
 2009
 All on GMC register issued a license to practice
 Clock starts
 2010
 Recertification starts
 Not across all specialities
 20% each year - who will it be?
 NB – no evidence older than 5 years is
admissible
How?
 Demonstration that we meet the
standards depends on a
cascade
Stage 1 provide evidence
>95%
Stage 2 may need evaluation <>5%
Stage 3 GMC assessment
<>1%
Demonstrating Practice – 5 years, 5 appraisals, 5 types of evidence
• Evidence required for Revalidation
1.
2.
3.
4.
Local Evidence – Clinical Governance information including recorded concerns , complaints and incidents.
Evidence of annual review and discussion at appraisal
MSF and Patient Survey – completion of 1 cycle (e.g. 2 MSFs)
CPD – 5 year cycle of 250 credits
Non-Clinical Evidence (if appropriate), e.g.
- Teaching Evaluations
- Published Research Papers
- Management Appraisals
5. Two Specialist Methods and Evidence which could include:
-
Clinical Audit (Completion of 1 cycle)
Peer Review
Case Based Discussion
Outcomes Data
Knowledge Assessment
Observation of Consultations / Procedures
Case Notes or Outpatient Letter Audit (1 cycle)
Involvement in Clinical Guideline Development (e.g. Participation on a NICE GDG)
Portfolio of
Evidence
CPD
Local Evidence –
Clinical
Governance
MSF and Patient
Survey
2 Specialty
Methods
Non-Clinical
Work
Demonstrating Practice – 5 years, 5 appraisals, 5 types of evidence
• Evidence required for Revalidation
1.
2.
3.
4.
Local Evidence – Clinical Governance information including recorded concerns , complaints and incidents.
Evidence of annual review and discussion at appraisal
MSF and Patient Survey – completion of 1 cycle (e.g. 2 MSFs)
CPD – 5 year cycle of 250 credits
Non-Clinical Evidence (if appropriate), e.g.
- Teaching Evaluations
- Published Research Papers
- Management Appraisals
5. Two Specialist Methods and Evidence which could include:
-
Clinical Audit (Completion of 1 cycle)
Peer Review
Case Based Discussion
Outcomes Data
Knowledge Assessment
Observation of Consultations / Procedures
Case Notes or Outpatient Letter Audit (1 cycle)
Involvement in Clinical Guideline Development (e.g. Participation on a NICE GDG)
Portfolio of
Evidence
CPD
Local Evidence –
Clinical
Governance
MSF and Patient
Survey
2 Specialty
Methods
Non-Clinical
Work
Colleges and Faculties: Roles and Responsibilities
1. Set Standards
•
•
Specialist Recertification
Specialty Service Provision and potentially Accreditation
2. Develop Specialty Tools and Methods
3. Train Appraisers in Specialty Standards and Methods
4. College/Faculty Role in Revalidation Recommendation
•
•
Quality assure local systems and processes leading to the Recommendation
Provide College Representatives to work at the Local level with the LRO to review appraisals and
evidence throughout the 5 year cycle and jointly confirm the Recommendation and send a
Statement of Assurance to GMC
•
•
•
•
College Regional Advisors?
Larger Colleges may need additional representatives in the larger regions
Review all evidence portfolios and confirm Recommendation from LRO to GMC
Audit a proportion of evidence portfolios for quality assurance
5. Provide remediation support or advice for doctors identified as in need
Appraisal / assessment
 We are well into the 5 year cycle
The evidence has to match the
current GMC Domains of Good
Medical Practice (4 not initial 7)
Probity and health are for local
use only
Specialist Standards for
re-certification
4 Domains adapted from Good
Medical Practice
 Domain 1 - Knowledge, skills and
performance
 Domain 2 - Safety and quality
 Domain 3 - Communication, partnership and
teamwork
 Domain 4 – Maintaining Trust
Work Streams
 These all interlink:
CPD
E-portfolio
Non-clinical activity
MSF
Remediation
Departmental accreditation
CPD
 Core topics are essential for all
Primarily a knowledge based process
Largely ‘internal’ process
 Higher levels of CPD are necessary to
demonstrate currency of practice
External process is likely to be necessary
CPD Process
 Appropriate
 Recordable
 Verifiable
The ‘levels’ of CPD will vary
The content of CPD will vary
Definitions of CPD
 Core topics
Essential knowledge for all practitioners
Redefined from core topics agreed by
UEMS
 Level 1
Essential for safe practice when on call
Hospital specific
• May be evidenced by clinical activity or external
CPD
Advanced CPD
 Job planned clinical activity
The content of this specialised clinical work
has been defined by the relevant specialist
societies
• It will be published on the CPD web-site
• It will be used for evaluation if necessary
• It will be a largely external process
Multi-source feedback
 Two systems
The precise nature will vary across
specialities
• There is a minimum number of returns necessary
• There is a maximum number of questions
 Patient feedback
Not yet clearly defined for anaesthesia
 Peer / team
Many commercial systems exist
Anaesthesia
 Team systems
These must inform the GMC
Good Medical Practice domains
• They are often part of a Trust-wide
process
• Most are poorly validated
Remedial process must be in
place
Non-clinical activity
 A process for identifying
activity for the ‘wider’ NHS
Teaching / training
Research
College / AAGBI work
Audit
Writing / editing
Non-Clinical Activity
 This will be considered as part of
revalidation
Evidence from the appraisal process
related to that activity will be used
Non-clinical activity does not replace the
CPD requirements for full-time practitioners
E-portfolio
 This should underpin the entire
process
Provides the easiest method of
completing appraisal
• Expensive
• High security demands
• Multi-speciality
Not likely to be fully functional on
time
E-portfolio
 More than a revalidation tool
Personal documents
Linked to e-CPD system
Secure
Learning / reflective diary
Logbook data
Teaching / training activity
Departmental
Accreditation
 Part of healthcare regulation
The context for assessing
performance in revalidation
• Evaluation of a doctor’s performance has to
include the environment in which they work
• Local CPD activity may be recognised only
from accredited departments in the future
What should you do?
 Today!
Review your appraisals
Identify any gaps in CPD
Check with your CD about
opportunities to ‘catch up’
Start / continue to record logbook
data or identify systems that can
Planning
 Find and organise the box-files
One folder for each year
• Identify appraisals
• Identify ‘themes’ from appraisals
• Log praise / complaints
• Collate CPD
• Pilot / complete MSF
Where is the information
 Links :
 http://aomrc.org.uk/revalidation.aspx
 http://www.gmc.uk.org/about/reform/index.asp
 http://www.rcoa.ac.uk/index.asp?SectionID=3