Transcript Revalidation Update

Revalidation Update
Ros Crowder & Maggie Woods
Primary Care CPD Tutors, Oxford
Deanery/NHS Berkshire West
Objectives for session
By the end of this session you should be confident about:
• The structure of strengthened medical appraisal
• What’s new for revalidation
• What you need to do now:
– Collecting supporting information
– Recording CPD
• Anything else?
What is Revalidation for?
Ensuring that doctors are:
• Up to date
• Fit to practise
Setting an absolute minimum standard that every
doctor who wishes to keep their license to practise
must meet.
Most doctors will easily meet and exceed this
baseline
Revalidation – the current position
• Good Medical practice – new framework
• GMC consultation on ‘Revalidation: The Way Ahead’
closed in June. Report due in the autumn
• Royal Colleges have developed specialty standards
• Revalidation proposals are currently being piloted in 10
sites (including NHS South Central & Berkshire West)
• Health Secretary’s letter to GMC supports revalidation &
extends piloting for second year
• Indications are that revalidation will be streamlined –
pilots will help to determine how
• Responsible Officer regulations laid before Parliament in
July 2010, will come into force 1 January 2011
The initial
proposed
model
Revalidation
Re-Licensing
Re-Certification
Is this doctor fit to practice as
a medical practitioner in the
UK?
Is this doctor fit to practice as
a specialist or generalist?
General Medical Council
Royal Colleges & Faculties
Local Responsible Officer
General Medical Council
Revalidation – current thinking
• Licence to Practice issued to every doctor who
requested one, October 2009
• The GP and Specialist Registers are a record of
historical achievement; once on it the doctor will
stay on it
• The Licence will reflect what a doctor is
revalidated for and relicensing will be the main
output from revalidation
General Medical Council
GMC
Affiliate
Professional
Board
Royal Colleges &
Faculties
Lay
Local
Responsible
Officer
Specialty
Specific
Assessments
Local Processes
Strengthened
Appraisal
Job Planning
Performance
Management
Clinical Audit
Clinical
Governance
‘r’ - low level
remedial support
‘R’ - high level
remedial support
Local Responsible Officer
Appraisal x 5
Portfolio of Evidence
Satisfactory
College/Faculty Quality Assurance
(audit of sample)
Query
College/Faculty (full
evidence review)
Satisfactory
Positive Statement of Assurance
Regulator
General Medical Council
Informal Support
College/Faculty Plus Local
Responsible Officer
Self-Help
Strengthened medical appraisal is
a key part of revalidation
• Common quality framework for appraisal:
– Trained appraisers
– Supporting information
– Speciality standards
• Mapping of supporting information to Good
Medical Practice
• Effective local clinical governance systems
The Appraisal
Balance
Challenge
Support
Personal
Development
Balancing support and challenge
Challenge
Feeling
Exposed
Awareness
Too Comfortable
Support
Portfolio of supporting information
• Reflection on achievements since last
year’s appraisal
• Reflection on last year’s Personal
Development Plan
• Mapping of supporting information to the
attributes of Good Medical Practice
• Self assessment of performance against
each GMP attribute
• Identification of items for next year’s PDP
RCGP Proposed Essential Information June 10
Type of Information
Min. Required in 5
Years
Comments
1
Significant Event Review/Case Review
5
Minimum 1 per year
2
Review of Complaints
All
Audit (of which some may be less
formal data review)
2 completed cycles (or
one satisfactory one plus
a quality improvement
project)
Minimum 2 in 5 years
4
Patient Feedback Survey and Review
2 (or one satisfactory one
plus a consultation skills
review)
To be presented no later
than years 2 and 5
5
Colleague Feedback Survey and
Review
2
To be presented no later
than years 2 and 5
6
New PDP and Review of Previous
Year’s PDP
5
Annually
7
CPD Completion
5
Annually
8
Health Self Declaration and Review
5
Annually
9
Probity Self-Declaration and Review
5
Annually
3
Good Medical Practice
Domains & Attributes
GMC, 2005
4 Domains
12 Attributes
70+ ‘standards’
Domain 1
Knowledge, Skills & Performance
Attribute
Maintain your
professional
performance
Apply knowledge and
experience to practice
Keep clear, accurate
and legible records
Standards
Standards
Standards
Domain 1 - Knowledge, Skills and Performance
Numbers following generic standards in this framework refer to paragraph numbers in Good Medical Practice,
except where preceded by MfD which refers to our booklet Management for Doctors; or Research which refers to
Research: the role and responsibilities of doctors.
Attributes
Generic Standards
Maintain your
professional
performance
All doctors
• Maintain knowledge of the law and other regulation relevant to practice (13)
• Keep knowledge and skills up to date (13)
• Participate in professional development and educational activities (12)
• Take part in regular and systematic audit (14)
Apply
knowledge and
experience to
practice
All doctors
• Recognise and work within the limits of your competence (3a)
Doctors with management, teaching or research roles
• Follow appropriate national research governance guidelines (71)
• Apply the skills, attitudes and practice of a competent teacher/trainer (16)
• Work effectively as a manager (MfD 12, 17)
Doctors with clinical roles
• Adequately assess the patient’s conditions (2a)
• Provide or arrange advice, investigations or treatment where necessary (2b)
• Prescribe drugs or treatment, including repeat prescriptions, safely and appropriately (3b)
• Provide effective treatments based on the best available evidence (3c)
• Take steps to alleviate pain and distress whether or not a cure may be possible (3d)
• Consult colleagues, or refer patients to colleagues, when this is in the patient’s best interests
(2c, 3a, 3i, 54,55)
• Support patients in caring for themselves (21e)
Keep clear,
accurate and
legible records
All doctors
• Keep clear, accurate and legible records (3f)
• Make records at the same time as the events you are recording or as soon as possible
afterwards (3f)
Doctors with clinical roles
• Record clinical findings, decisions, information given to patients, drugs prescribed and other
information or treatment (3f)
Domain 2
Safety and Quality
Attribute
Put into Effect systems
to protect patients and
improve care
Respond to Risks to
Safety
Protect Patients and
Colleagues from any
Risk Posed by Your
Health
Standards
Standards
Standards
Domain 2 - Safety and Quality
Attributes
Generic Standards
Put into effect
systems to
protect patients
and improve
care
All doctors
• Respond constructively to the outcome of audit, appraisals and performance reviews (14e)
• Take part in systems of quality assurance and quality improvement (14)
• Comply with risk management and clinical governance procedures
• Co-operate with legitimate requests for information from organisations monitoring public health (14i)
• Provide information for confidential inquiries, significant event reporting (14g)
Doctors with management roles
• Make sure that all staff for whose performance you are responsible, including locums and students,
are properly
supervised (17)
• Ensure systems are in place for colleagues to raise concerns about risks to patients (45)
Doctors with clinical roles
• Report suspected adverse drug reactions (14h)
• Ensure arrangements are made for the continuing care of the patient where necessary (40, 48)
Respond to
risks to safety
All doctors
• Report risks in the health care environment to your employing or contracting bodies (6)
• Safeguard and protect the health and well-being of vulnerable people, including children and the
elderly and those with
learning disabilities (26, 28)
• Take action where there is evidence that a colleague’s conduct, performance or health may be
putting patients at risk (43, 44)
Doctors with clinical roles
• Respond promptly to risks posed by patients
• Follow infection control procedures and regulations
Protect patients
and colleagues
from any risk
posed by your
health
All doctors
• Make arrangements for accessing independent medical advice when necessary (77)
• Be immunised against common serious communicable diseases where vaccines are available (78)
Domain 3
Communication, Partnership & Teamwork
Attribute
Communicate
Effectively
Work Constructively
with Colleagues and
Delegate Effectively
Establish and Maintain
Partnerships with
Patients
Standards
Standards
Standards
Domain 3 - Communication, Partnership and Teamwork
Attributes
Generic Standards
Communicate
effectively
All doctors
• Communicate effectively with colleagues within and outside the team (41b)
• Explain to patients when something has gone wrong (30)
Doctors with management roles
• Encourage colleagues to contribute to discussions and to communicate effectively with each
other (MfD 50)
Doctors with clinical roles
• Listen to patients and respect their views about their health (22a, 27a)
• Give patients the information they need in order to make decisions about their care in a way
they can understand
(22b, 27)
• Respond to patients’ questions (22c, 27b)
• Keep patients informed about the progress of their care (22c)
• Treat those close to the patient considerately (29)
• Pass on information to colleagues involved in, or taking over, your patients’ care (40, 51-53)
Work
constructively
with colleagues
and delegate
effectively
All doctors
• Treat colleagues fairly and with respect (46)
• Support colleagues who have problems with their performance, conduct or health (41d)
• Act as a positive role model for colleagues (41)
• Ensure colleagues to whom you delegate have appropriate qualifications, experience (54)
Doctors with management roles
• Provide effective leadership (MfD 50)
Establish and
maintain
partnerships
with patients
Doctors with clinical roles
• Encourage patients to take an interest in their health and take action to improve and
maintain it (4, 21f)
• Be satisfied that you have consent or other valid authority before you undertake any
examination or investigation, provide
treatment or involve patients in teaching or research (36)
Domain 4
Maintaining Trust
Attribute
Show Respect for
Patients
Treat Patients and
Colleagues Fairly and
Without Discrimination
Act with Honesty and
Integrity
Standards
Standards
Standards
Domain 4 - Maintaining Trust
Attributes
Generic Standards
Show respect
for patients
All doctors
• Implement and comply with systems to protect patient confidentiality (37)
Doctors with research roles
• Respect the rights of patients participating in research (Research 2, 5)
Doctors with clinical roles
• Be polite, considerate and honest and respect patients’ dignity and privacy (21a, b, d)
• Treat each patient fairly and as an individual (38-39, 21c)
Treat patients
and colleagues
fairly and
without
discrimination
All doctors
• Be honest and objective when appraising or assessing colleagues and when writing
references (18-19)
• Respond promptly and fully to complaints (31)
Doctors with clinical roles
• Provide care on the basis of the patient’s needs and the likely effect of treatment (7-10)
Act with
honesty and
integrity
All doctors
• Ensure you have adequate indemnity or insurance cover for your practice (34)
• Be honest in financial and commercial dealings (73)
• Ensure any published information about your services is factual and verifiable (60, 61)
• Be honest in any formal statement or report, whether written or oral, making clear the
limits of you knowledge or
competence (63-65, 67-68)
Doctors with research roles
• Obtain appropriate ethical approval for research projects (Research 5)
• Be honest in undertaking research and reporting research results (71b)
• Ensure that your research is audited regularly (Research 43)
Doctors with clinical roles
• Inform patients about any fees and charges before starting treatment (72a)
Appraiser’s role - Assessing
Supporting Information
• Does it suggest cause for immediate
concern?
• Which attribute(s) of GMP does it inform?
(NB Many items will inform more than one attribute.)
• Does it show evidence of personal
reflection?
Assessing Supporting Information
• Does it contribute to revalidation:
• Yes, on it’s own (e.g. colleague and patient
feedback)
• Yes, if produced regularly (e.g. outcome data)
• Not as it stands, because … (e.g. incomplete)
• No, it doesn’t reflect what the doctor does
• Has the doctor met the CPD
recommendations of their
College/Association?
• What learning needs (if any) does it identify
Conclusion by Appraiser …
A) Potential risk:
• Are there genuine immediate concerns about this doctors practice?
• If yes, are measures in place to protect patients, colleagues, the
doctor and the public?
B) Areas for development:
• Are there areas where the doctor’s performance has not been
clearly demonstrated to be of a satisfactory standard with regard to
the guidance expressed in GMP?
• Does the PDP cover all areas that the doctor needs to address, with
timeframes?
C) Revalidation:
• Are there areas where the doctor’s progress towards satisfactory
Revalidation may be in doubt?
• Have these been identified and understood, with an appropriate plan
in place?
The appraiser’s judgement and evidence
from the organisation’s clinical governance
systems will inform the Responsible
Officer’s recommendation to the GMC
Any questions?
Preparing for revalidation
• Prepare your portfolio of supporting information
• Become familiar with the RCGP standards
• Become familiar with the GMP domains,
attributes & standards & start to map supporting
information
• Document reflection on supporting information
• Develop IT skills if necessary (electronic toolkit)
• Keep up to date with revalidation plans: GMC,
RCGP, RST, Healthcare Republic
• Participate in the South Central pilot (optional)
Revalidation Support Team Pathfinder
pilots
April 2010 – March 2011
•
•
•
•
•
•
3000 appraisals across England
Whole system testing
Testing Information flows
Nominated “Responsible officer” role
Preparation for “live” testing
Evaluation to inform Treasury impact
assessment
• Single & Multi organisational
• Advanced and early stage sites
• Range of doctor specialties and roles
High level aims
To identify the impact on individuals and
organisations in terms of cost, time and
resources
• To identify problems arising at
organisation and individual level in
implementing the proposed arrangements
• To identify any benefits related to the
appraisal and revalidation process eg
patient care and clinical outcomes
All NHS South Central organisations
Whole systems pilot sites:
• Isle of Wight
• Milton Keynes
• Royal Berkshire NHS Foundation Trust
Voluntary pilot sites
• All other NHS South Central organisations
Participation in the revalidation pilot:
Identification of Responsible Officer
Strengthened Training of Appraisers for Revalidation
(STAR)
Revalidation Pilot Toolkit (new electronic toolkit)
Consent to take part
Collect supporting information for appraisal on toolkit
Appraisal discussion
Participate in evaluation
Post Appraisal
Sign off
Appraisee
Personal
Profile
Post Appraisal
Review and
Signoff
Supporting
information
PDP
Appraisal cycle
using RPT
Post Appraisal
Commentary &
Actions Agreed
Appraisal
Key
Appraisee Appraiser Offline Activity
GMP Review
Pre Appraisal
Toolkit Portfolio
Review and
Sign off
Pre Appraisal
Toolkit portfolio
Sign off
Revalidation Pilot Toolkit sandpit
site
https://training.revalidationpilottoolkit.nhs.uk/
sandpit/login/login.aspx
Activity 1
In pairs:
• Identify a piece of supporting information (audit,
significant event, complaint, patient/colleague
feedback etc)
• Use the forms provided to reflect on this (using
the examples of questions for reflection form)
• Identify the GMP attributes and map to the
appropriate ones
Feedback to the rest of the group:
• are the templates helpful for reflection?
• how easy is it to map to GMP attributes?
RCGP Proposals for Continuing
Professional Education (CPD)
• Continuing education recorded in the form of
learning credits
• At least 50 learning credits a year
• More than 250 over 5-year revalidation cycle
• Minimum of 1 credit for each hour of education
• Each hour of education leading to improvements
in care or practice will qualify for 2 credits.
CPD
• Attendance at conferences, meetings,
seminars, workshops etc
• Reading journals & recording learning
• Shadowing a colleague
• E- learning
• etc
Identifying items for a PDP
•
•
•
•
•
•
•
•
From previous appraisal
From a service/practice review
From an audit
From a significant event
From a complaint
From a patient satisfaction survey
From multi-source feedback
From PUNs & DENs
Identifying items for a PDP
• Identify the source e.g. audit, complaint
• Think about what is required e.g. better
outcomes for patients with diabetes
• Identify your individual learning needs
• What is your preferred learning style?
• Work out how best to meet your learning needs
– seminar?/e-learning?/reading?
• Identify the desired outcome - how will you
know when you have met the outcome?
• Plan a realistic timescale
PDP
What
developme
nt needs
have I?
Explain the need
How will I
address
them?
Explain how
you will take
action, and
what
resources
you will
need
Date by which I
plan to achieve
the development
goal
The date
agreed with
your
appraiser for
achieving
the
developmen
t goal
Outcome
How will
your
practice
change as a
result of the
developmen
t activity
Completed
Agreement
from your
appraiser
that the
developmen
t need has
been met
Recording CPD
• Document learning outcomes
– for you
– for the team / the practice
– for the patient
• Action plan for implementing learning
– for you
– for the team / the practice
– for the patient
• Work out number of CPD credits
• Keep an ongoing summary record of CPD
activity & credits
CPD credits - RCGP guidance
Based on the time spent on the learning but with an
opportunity to gain further credits by demonstrating the
outcome (impact) of development.
• Impact in this context refers to the impact on:
􀁺 patients (e.g. a change in practice, implementing a new
clinical guideline, initiating a new drug for the first time)
􀁺 the individual (personal development, e.g. development
of a new skill or further development of existing skills)
􀁺 service (e.g. developing and implementing a new
service, becoming a training practice, teaching others)
􀁺 others (teaching, training, NHS locally or nationally).
CPD credits - RCGP guidance
• In essence 1 hour of education is 1 learning
credit. However, if that education leads to
changes for patients, the doctor or the practice,
the GP can claim 2 learning credits for each
hour of such education.
• Credits are self-assessed and verified at
appraisal, and account should be taken of the
need for GPs to use their CPD to ensure that
they are up to date in all areas of their work.
CPD credits - RCGP guidance
• A CPD credit is defined as being based on an
hour of learning activity (including planning and
reflection) recorded in such a way that it
demonstrates the learning achieved relevant to
the working situation of the GP.
• Credits are self-assessed and, although a
certificate of completion or attendance may be
used as evidence of activity, it is the
demonstration of learning achieved and
relevance to the work that the GP undertakes
that defines the credit.
CPD credits - RCGP guidance
For instance:
􀁺 an individual attends a meeting (1 hour) on heart
failure, acquires the knowledge that certain
beta-blockers are beneficial to patients with this
condition, and then records this within his or
her appraisal documentation
Credits claimed = 1 – this demonstrates the
acquisition of knowledge and as yet there is no
demonstration of personal, practice or patient
benefit
CPD credits - RCGP guidance
􀁺 a different individual attends the same
meeting. He or she records the same
acquisition of knowledge. However,
included are two patient case studies
demonstrating the introduction of betablockers in heart failure
Credits claimed 1 × 2 (impact) = 2
CPD credits - RCGP guidance
A third individual attends the same meeting. The
acquisition of knowledge is recorded. However,
in his or her appraisal folder, an audit is planned
after consideration of current practice (1 hour).
This individual demonstrates audit of his or her
patients with heart failure, changes are made
appropriately following discussion with
colleagues (1 hour) and a second audit cycle
demonstrates an improvement in care
Credits claimed 1 (initial meeting (1 hour)) + 2
(planning (1 hour) and discussion associated
with audit (1 hour)) × 2 (impact) = 6
CPD credits - RCGP guidance
The GP would be expected to include the following
evidence in his or her appraisal folder:
􀁺 a record of the developmental activity
􀁺 learning points acquired
􀁺 relevance to his or her working situation.
In addition, to claim the impact factor (credit × 2) the GP
would be expected to include a demonstration of
application of new learning:
􀁺 case study
􀁺 simple data collection
􀁺 audit
􀁺 reflective piece demonstrating change in a practice.
CPD record – an example
Date
CPD activity No of
hours
Learning
outcomes
Impact
Credits
claimed
Activity 2
In pairs:
Think of an example of CPD
Work out how many credits you would claim
Feedback to group:
How you worked out the number of hours
How you identified the impact of the CPD
Activity 3
In pairs:
Identify 2 or 3 items for a PDP & complete
the template
- make sure that they are personal
development needs
- document the action you will need to take
and the resources you will require
- be clear what outcome you wish to achieve
PDP
What
developme
nt needs
have I?
Explain the need
How will I
address
them?
Explain how
you will take
action, and
what
resources
you will
need
Date by which I
plan to achieve
the development
goal
The date
agreed with
your
appraiser for
achieving
the
developmen
t goal
Outcome
How will
your
practice
change as a
result of the
developmen
t activity
Completed
Agreement
from your
appraiser
that the
developmen
t need has
been met
Further information:
GMC
http://www.gmc-uk.org/doctors/licensing.asp
• Revalidation Support Team
www.revalidationsupport.nhs.uk
• RCGP
http://www.rcgp.org.uk/_revalidation.aspx
• South Central Revalidation Pilot
http://www.southcentral.nhs.uk/page.php?id=433
• Ros Crowder / Maggie Woods, CPD Tutors
[email protected]
[email protected]
CPD Resources
Website;
http://www.berkshirewestprimarycarelearnin
g.org.uk
Leicester Statement, Structured Reflective
Templates;
http://www.appraisalsupport.nhs.uk/news4.a
sp?item=08052007090123
The end!
How do you feel about revalidation now?