Transcript Slide 1

Appraisal and Revalidation 2012
September
Part of NEPCSA/northern deanery
revalidation roll out programme
Dr Paula Wright
GP tutor for Newcastle
Deanery lead for sessional GPs
Revalidation –the core
principles
Revalidation
1. demonstrates that you are up to date and fit to practise
2. should not be overly onerous on GPs but be sufficient
to provide confidence to the public
3. must take account of the different working lives of
GPs, the process must be objective, fair and
equitable
Don’t Panic !
You will be recommended for revalidation if you:
• Are are having an annual appraisal
• Providing the required Supporting Information
• Have no unresolved performance concerns
There is nothing more that you need to do beyond
continuing to engage in the appraisal process
What will the revalidation process
involve?
Revalidation
• is done by the GMC based on a recommendation by
your local Responsible Officer (every NHS organisation
will have one)
• recommendation based on appraisal record [from 1/4/12
unless unusual circumstances eg Maternity leave , Sick
leave etc]
• RO for North of Tyne is Mike Guy
When will revalidation be
introduced?
• ROs and appraisal leads will be revalidated
before April 2013
• all other doctors from April 2013
• GMC must give doctors at least 120 days notice
of their revalidation date
• Aim is for all doctors to get through the first cycle
of revalidation by 2016
• NE GPs will be revalidated in relation to their
birthday months
Revalidation schedule for NE GPs
Appraisal year
GP month of Birth Revalidation
2013-2014
May
1/7/13-30/9/13
August
1/10/13-/12/13
November
1/1/14-31/3/14
February
1/4/14-30/6/14
June
1/7/14-30/9/14
September
1/10/14-/12/14
December
1/1/15-31/3/15
March
1/4/15-30/6/15
April
1/7/15-30/9/15
July
1/10/15-1/12/15
October/January
1/1/16-31/3/16
2014-2015
2015-2016
The Revalidation Process- Options
for RO
1. recommendation for revalidation to the GMC
2. Defer if insufficient information [eg maty leave]
or performance concerns under active review
3. Administrative removal for non-engagement if
no documentation and no good reason for this
NB. Revalidation will be done electronically for all doctors.
You must register at GMC on-line- http://www.gmcuk.org/doctors/information_for_doctors/gmc_online.asp
What will happen to doctors who do not
revalidate?
• Aims is for early detection and support of “at
risk” drs
• A few doctors [??1-2 %] will not be
revalidated/ lose their licence to practise if
remediation fails-most are already known to
performance structures
• Remediation- recent agreement to provide
funding via NHSCB
What is appraisal for
revalidation ?
1. a supportive discussion between
two peers.
2. based on “Good Medical Practice”
by the GMC (new domains 4)
3. PDP is key (old and new one)
4. 5 “sign off” statements for appraiser
to agree or disagree
Good Medical Practice
Framework- new domains
1.Knowledge, Skills and Performance
2.Safety and Quality
3.Communication,
Teamwork and Partnership
4.Maintaining Trust
The domains and attributes of the GMC framework for Good
Medical Practice
Domain 1
Knowledge, skills and performance
Domain 3
Communication, Partnership and Teamwork
Attribute 1
Maintain your professional performance
Attribute 2
Apply knowledge and experience to practice
Attribute 3
Keep clear, accurate and legible records
Attribute 1
Communicate effectively
Attribute 2
Work constructively with colleagues and delegate
effectively
Attribute 3
Establish and maintain partnerships with patients
Domain 2
Safety and Quality
Domain 4
Maintaining Trust
Attribute 1
•Put into effect systems to protect patients
and improve care
•Attribute 2
Respond to risks to safety
Attribute 3
Protect patients from any risk posed by your
health
Attribute 1
Show respect for patients
Attribute 2
Treat patients and colleagues fairly and without
discrimination
Attribute 3
Act with honesty and integrity
Information required for appraisal
GENERAL INFORMATION
+
“SUPPORTING INFORMATION”
General information
• Personal details
• Scope of work –list of all the roles
undertaken (documents showing review of these
roles should be submitted to your appraiser )
• Record of previous annual appraisals
• Personal Development Plan and its review
• Probity and health declarations
Supporting Information
Is based on:
GMC “Supporting information for appraisal
and revalidation” (mandatory)
&
RCGP Guide To revalidation for GPs
(version7) (Advisory)
Supporting Information -GMC
guidance
General information, plus
–Evidence of Continuing Professional Development
–Quality improvement activity (e.g. Audit, case
reviews, review of teaching, QIP)
–Significant Event Audits (SUIs)
–Patient feedback
–Colleague feedback
–Complaints/compliments
–These must cover your “scope of practice”- ie all your roles
Summary of supporting information
RCGP version 6 October 2011
Evidence
Frequency
Significant Events
2 per year
Clinical audit
1 in 5 years [others options for some
Sessional GPs]
Colleague and
patient feedback
1 in 5 years
Complaints
All reviewed every year
PDP
Reviewed every year and new one
produced each year
CPD credits
50 per year- 250 over five years
Continuing Professional
Development
•CPD log must demonstrate at least 50 CREDITS
•1 hour=1 credit
•CPD should cover whole scope of practice-ie all
clinical and other roles
•Impact multiples hours by 2
•Record of educational activities [meetings,
conferences, reading etc] and core learning points
Supporting information: non
standard GPs
• peripatetic locums, OOHs doctors, rural remote GPs,
etc may have difficulty with some of these evidence
requirements , especially audit /SEA and MSF
• All GPs need to demonstrate that they regularly review
and evaluate the quality of their work .
See guidance from NEPCSA: on supporting
information for ‘non standard’ GPs.
Audit and sessional GPs
No Access to records outside of consulting time
Lack of Skills and help with in searches
No “specific clinical role” to audit;
No organisational influence
Mobility between practices if locum
Numbers with a single conditions seen by locum or parttime GP is very small
personally delivered care means “process” based for which
there is no evidence base (e.g. Record keeping)
“Key is to demonstrate reflection, learning and
improvement”-RCGP
Quality improvement activities
(GMC)
•
•
•
•
•
Clinical audit (1/5yr, or alternative)
Case review, (GMC)
Quality Improvement Plan [QUIP], (GMC)
Review of referrals, review of record keeping *
Review of 20 consultations in random surgery with
feedback from colleague *
• Prospective condition based review *
• Audit effectiveness of teaching or health policy
change (GMC)
Key is to demonstrate reflection, learning and improvement
*NEPCSA interpretation of RCGP statement above
Detailed guidance for sessional
Gps
Deanery Sessional GP page:
NEPCSA Guidance on Supporting Information for NonStandard GPs
http://northerndeanery.ncl.ac.uk/NorthernDeanery/primarycare/continuing-practice/retainer-scheme/information-forsessional-gps
Also
Career Break Advice December 2011
Significant events – ‘unexpected event
which could or did harm patient [s]’
• two SEAs each year [RCGP guidance]
• Personal to you (involvement in the care not just the
discussion meeting)
• Lessons learnt , areas for future learning and actions
taken as a result of SEA should also be discussed• SEAs can be discussed in a learning/study group if
practice meeting not accessible
Significant events – ‘unexpected event
which could or did harm patient [s]’
• SEAs are defined a bit differently in primary and
secondary care –SEA = SUI [serious untoward
incident ] in hospital context
• Unless your SEA has led to loss of life or serious
injury , include it under ‘Quality Improvement Activity ‘
section of the appraisal form
Patient and Colleague Feedback
• Formative and developmental –not pass fail
• Feedback should come from whole scope of practice [all the roles
eg clinical, academic etc]
• Will be needed for your first revalidation cycle however
short.
• Try and do this as close as possible to the date of your annual
appraisal [birthday month] so that you can discuss the
feedback with your appraiser soon after it is received.
• Your local GP tutor can also provide support
• Certain groups have different benchmarks (locums/
sessionals)
Patient and Colleague
Feedback-how to collect it
• The surveys must be independently collected/analysed
• You need to choose a commercial provider of feedback tools
approved by the RCGP include- NE discount prices here
• CFEP –approx £105 –give code DJ8482 when you apply
• http://www.cfepsurveys.co.uk/products/general-practice/360.aspx
• Edgecumbe –approx £75 – code is nucapf
http://www.edgecumbehealth.co.uk/edgecumbe-doctor-360.php
• Please read the FAQs recently circulated to help guide you in the
collection and interpretation of this feedback
Complaints
•All patient complaints must be discussed each year at
appraisal, reflection using NEPCSA template
•Learning points and actions must be recorded
•Compliments can be listed in this section
Scope of work –an example
Area of work
Detail
Qualifications
/experience
Length of
time
Organisation
Clinical
Regular
GP
MRCGP
20 yrs
Surgery
Ad hoc
OOH
MRCGP
10 years
NDUC
Education
Regular
Trainer
Dip MEduc 5 years
VTS
Ad hoc
Managerial
Regular
CCG lead
1 year
CCG
Ad hoc
Appraiser
7 years
PCSA
Other roles
Team GP
5 years
Falcons
Ad hoc
Mandatory training- NEPCSA
CPR certification up date every 18 months
Safeguarding children =GPs must achieve competence at
LEVEL 3 which means over 3 year period
One approved IT module
One session of single agency training –[ health
care staff only]-approx 2 hours
One session of multi-agency training -usually
one day (organised by LSCB)
Sign Off statements for the
appraiser
1. An appraisal has taken place that reflects the doctor’s scope of
work and addresses the principles and values set out in Good
Medical Practice.
2.
Appropriate supporting information has been presented in
accordance with the Good Medical Practice Framework for
appraisal and revalidation and this reflects the nature and scope of
the doctor’s work.
3.
A review that demonstrates appropriate progress against last
year’s personal development plan has taken place.
4.
An agreement has been reached with the doctor about a new
personal development plan and any associated actions for the
coming year.
5.
No information has been presented or discussed in the appraisal
that raises a concern about the doctor’s fitness to practise.
Sign Off statements for the
appraiser
– Not signing one of the statements does
NOT mean the doctor wont revalidate –it
serves to signpost what additional work
needs to be done for the following year
PDP- definition (RCGP)
a formal agreement, between the appraisee and
appraiser, on the learning and development needs
of the appraisee, identified at the appraisal
interview, with an outcome based learning plan for
the subsequent year
PDPs - What Goes Into Them
Personal development
Targeted learning
Practice development
OK if also involves personal learning
Professional goals
Professional or career development
Producing supporting information
Capture scope of practice
Personal Development aims best practice
1.
2.
3.
4.
Meet SMART criteria
Reflect appraisee’s approach to learning
Link to improving patient care
needs identified through reflection on
practice, SEAs, case reviews , audit etc
5. aspirations identified by the appraisee
6. Gaps in supporting information
Career breaks
RCGP talks about “minimum portfolio” if out of practice for a
significant period:
• 3 out of 5 appraisals
• 200 clinical sessions (of which 100 should be undertaken
in the 2 years prior to revalidation).
• 150 credits
All yet to be tested in real life
Appraisal Checklist- identifying
problems early
1. Appraiser complete checklist of supporting
information for RO
2. significant gaps – put in next year’s PDP
3. Range of actions available to appraiser is they
have concerns:
1. Second sign off by GP tutor to check appropriate
actions
2. Signposting for support (tutors, occ health, deanery
etc)
3. Flag up for close scrutiny by RO
Booking your appraisal
• 200 appraisers covering North east and 2500 Gps.
• Appraisals by birthday month
• Must book via new website being launched 2012
www.gpappraisalsne.nhs.uk
• Booking early means more choice
• Select appraiser according to their availability that month
• Website has Bio/profile on the appraiser
• Maternity leave, Sabbaticals, Sick leave etc –apply for
deferment via website
• Admin will no longer allocate if you are delayed. Its all
up to you !
Collecting information for
your annual appraisal
FREE Options
• The new Medical Appraisal Guide [MAG] Form
• GP tools set up by a GP https://www.gptools.org/
SUBSCRIPTION BASED OPTIONS
• The RCGP Revalidation e-portfolio
• Clarity Appraisal toolkit [previously NHS toolkit]
It’s a matter of appraisee choice, however…
Things to consider when choosing
toolkits
Must use new GMC domains (all do except RCGP eportfolio)
Must :
• comply with NEPCSA checklist
• use NEPCSA templates for SEA/Audit/case
review/ complaints etc.
No requirements for appraisers to log onto an online
toolkit to see your evidence (discretionary)
Be prepared to extract your information from your chosen
website and email to your appraiser
MAG form
1. Writable PDF with facility to store uploaded supporting
information (NEPCSA templates)
2. Need latest ADOBE reader
3. Also has place for writing the appraisal summary (form4)
4. after summary agreed appraisers does lock down
which cannot be reversed
5. After this “open new year” creates new year and keeps
only summary and pdp (all supporting information
removed)- this version goes to PCT.
Guidance from your appraisal lead
You should be getting updates and guidance directly from
your PCt admin lead.
if you are not it means they dont have your email address
and you are not in their system.
[email protected]
Where to get advice
Always refer to PCSA web-based booking
site https://gpappraisals.nepcsa.nhs.uk/
Also
• Your appraiser
• Your tutor (Paula Wright)
• GP tutor for Sessional Gps:
• Paula Wright [email protected]
• Steve Blades [email protected]
• Appraisal lead- Di Jelley (specially if career breaks,
deferments)
Useful websites for further
information
• PCSA web-based booking site
https://gpappraisals.nepcsa.nhs.uk/
• UK Revalidation Support Team
http://www.revalidationsupport.co.uk/
• Royal College of General Practitioners
http://www.rcgp.org.uk/revalidation.aspx
• General Medical Council
• http://www.gmc-uk.org/