Transcript Slide 1

Continuing Fitness to Practise
Fiona Browne and Tim Walker
18 July 2013
Introduction
What we want to achieve today:
• Develop a common understanding of the
changing political context around ‘continuing
fitness to practise’
• Share some key findings from the revalidation
pilot and CPD consultation
• Hear your views on emerging ideas
What is continuing fitness to practise?
• How registrants demonstrate that they
continue to meet standards
• How the General Osteopathic Council shows
that registrants continue to meet standards
• A process that does this in a proportionate
way that genuinely enhances practice, rather
than a ‘tick box’ exercise
Our presentation
• Political context
• Method for informing GOsC proposals.
• Findings from the Revalidation Pilot and emerging
questions
• Findings from the CPD Discussion Document
Consultation Analysis and emerging questions
• Examples of possible elements of a scheme
• Next steps
Political context
Date Event
Key findings
2006 GOsC CPD
Scheme
GOsC practitioner directed CPD scheme requiring 30 hours of
CPD each year and at least 15 hours of CPD learning with others.
2007 Trust,
Assurance
and Safety
‘Public opinion surveys suggest that people expect health
professionals to participate in the revalidation of their
registration and that many believe that this already takes place.’
2008 Principles of ‘Revalidation confirms that the registrant is practising in
non-medical accordance their regulator’s standards and will identify for
revalidation further investigation, and remediation, poor practice where local
systems are not robust enough to do this or do not exist.’
2009 Consultation Consultation on four stage revalidation scheme (including selfon GOsC
assessment, bespoke assessment of practice and Assessment of
Scheme
Clinical Performance) which requires a ‘pass/fail.’
Political context
Date
Event
Key Findings
2011
Enabling
‘Continue to develop the evidence base that will inform their
Excellence proposals for revalidation over the next year. For those
professions where there is evidence to suggest significant added
value in terms of increased safety or quality of care for users of
health care services from additional central regulatory effort on
revalidation, the Government will agree with the relevant
regulators … and the relevant professions the next steps for
implementation.’
‘In the meantime, the key responsibility for ensuring continued
high quality care will remain with employers, providers and
commissioners of services, the teams who assess and provide
care and with individual professionals themselves. It is there,
closest to the point of care, that any risk is most effectively and
most promptly addressed.’
Political context
Date
Event
Key Findings
2011
Health
Committee
Scrutiny of
the NMC
‘The current standard for re-registration—completing 450
hours of practice and 35 hours of professional development—
is wholly inadequate, as this tells patients and the public
nothing about the quality of nursing and midwifery practice
undertaken by the registrant. There is also no routine
assessment of whether nurses and midwives have even met
this minimal standard.’
2012
GOsC
Stage 1 self-assessment piloted and developmental (rather
Revalidation than pass/fail) feedback provided.
Pilot
Individual detailed feedback about strengths and areas of
development identified in the evidence provided to each
participant who submitted a portfolio.
PSA Report 2012
The Professional
Standards Authority has
published An approach
to continuing fitness to
practise which sets out
contemporary
expectations about nonmedical revalidation
The outcome required
The outcome of revalidation or equivalent … should
be that:
• registrants demonstrate they are safe and fit to
practise
• regulators should be able to provide assurances
of the continuing fitness to practise of its
registrants
• This can be achieved by means other than formal
revalidation
Key factors
• Compliance with continuing professional
development requirements is not in itself a
demonstration of continuing fitness to
practise
• Professional regulators can support and
encourage quality improvement
• Regulators of lower risk professions may not
need to have such high levels of confidence in
their decisions
In summary
• It doesn’t have to be revalidation but it can’t
just be CPD
• Therefore we have the opportunity within the
osteopathic profession to develop our
continuing fitness to practise scheme without
the use of a pass/fail assessment
• But the desired outcome must be maintaining
and improving standards, and identifying and
supporting development needs
Registrant expectations
Annual
registration
renewal with
no CPD (old
GMC)
Patient expectations
New GOC
scheme core
QA ‘d CPD
plus peer
review
Current GCC
consultation
proposal
Test of
competence
(e.g. PPP) or
practice-based
assessment
Complexity/cost/level of assurance
Current
GOsC
hoursbased CPD
scheme
Revised
GOsC
continuing
fitness to
practise
scheme
‘Developmental’ schemes
GOsC
revalidation
pilot
GMC (annual
appraisal
plus fiveyearly
revalidation)
‘Pass or fail’ schemes
Informing our thinking
• Developed and consulted on a draft
revalidation scheme
• Conducted a year-long revalidation pilot
• Developed and consulted on a CPD Discussion
Document analysing our current scheme and
looking at options for change
• Ongoing engagement and dialogue with
interested parties
The Revalidation Pilot
Why
What
When
• Testing a process supporting self-assessment
• Identifying costs, benefits and proportionality
• Four themes of the Osteopathic Practice Standards
• Complete four templates – including patient feedback, clinical
audit, structured reflection and case-based discussion
• Independent data collection every three months
• Independent report submitted to GOsC December 2012
Completed by 1 in 18 of all registered
osteopaths
What worked well
• High awareness of the
Standards
• 74% of participants
reflected more on areas
of clinical practice
• The pilot tools enabled
osteopaths to
document practice
• Patients liked the idea
of providing feedback
• 37% to 44% of
practitioners changed
the way that they
practised as a result of
using a tool
• 85% of assessors felt
their role enabled them
to critically evaluate
their own practice
What worked well
‘I have seem some
excellent evidence which
has triggered questions
about my own practice
both on a management
and a clinical level. Seeing
what other clinicians do
well or not so well is
invaluable to me as a
practitioner.’ (Assessor)
‘I have where possible
reflected on weaknesses
... generally I am spending
a little longer with a new
patient, checking … that
they understand what I
intend to do, with consent
and explaining more of a
long term plan with them.
(Participant)
Questions
• How could we continue to build awareness of
the Osteopathic Practice Standards:
communication and patient partnership;
knowledge, skills and performance; safety and
quality and professionalism?
• How could we encourage continued higher
levels of reflection on practice?
• How can we encourage and support feedback
on practice?
What needs to be improved?
• Complexity of scheme,
e.g. volume of mapping
grids, kinaesthetic
nature of osteopathy at
odds with paperwork,
complexity of 3-D
matrix of evidence
requirements
• Time requirements, i.e.
the time required was
disproportionate (based
on four pieces of
evidence and a selfassessment in one year)
• Communication, e.g.
simplifying the support
materials
What needs to be improved?
• ‘Simplify, simplify,
simplify’ (participant)
• ‘Simplify and clarify, The
assessment manual is
ridiculously long’
(assessor)
• ‘Too much to do’
• ‘The manual was very
complicated and the
language too complex’
• ‘Overwhelming’
• ‘May have been better
presented in bite sized
chunks’ (participants)
Questions
• How could we reduce the time spent on the
requirements to demonstrate continued
fitness to practise?
• How could we reduce the burden of the
mapping of evidence – that is showing which
piece of evidence relates to which standard?
• How can we reduce the complexity of the
structure (the 3-D matrix of requirements)?
Self assessment and reflection
• The difference between the participants’ selfassessment and the views of the assessors
challenge the principle of self-assessment
• The ability or willingness of participants to
demonstrate reflection on the data collected
was variable
Self assessment and reflection
• ‘Some of the participants felt that it was very
difficult to reflect on their practice without
being seen to criticise their practice and
expose themselves to risk of scrutiny by the
GOsC’
• ‘Pilot scheme ‘assumes’ that osteopaths are
able to write reflectively, whereas no formal
training is currently offered to osteopaths in
this area’
Questions
• Should we explore other ways of
demonstrating continuing fitness to practise
e.g. more formal assessment?
• How might we strengthen self-assessment?
• What roles could other organisations or
groups play in the process to support honest
reflection in practice?
• Could more local or peer scrutiny work in the
osteopathic context?
Consent
• A further issue identified is that consent is not
always being gained and/or documented
appropriately
• This is evidenced by:
– participants
– insurers
– patients
– findings from other research
Questions
• How could we work together to improve the
patients experience in relation to consent?
• What support should the GOsC provide?
• What support should other organisations
provide?
CPD Discussion Document
CPD Discussion Document published from
September 2011 to September 2012 – 441
responses including:
•
•
•
•
Online questionnaire: 84 responses
Regional Conferences: 333 responses
Regional Network Meetings: 10 responses
Other professional and regulatory bodies:
14 responses
Findings – aims and principles of CPD
• To keep up to date with osteopathic/healthcare
practice/embed knowledge and maintain skills within
the changing context of patient and societal
expectations
• To strive to continually improve standards
• To learn new things
• Proportionate, accountable consistent, transparent,
accountable agile
• Relationships with other health professionals
• Research and osteopathic principles
Findings – learning cycles
• Makes the process more conscious
• Support osteopaths to undertake CPD annually
‘Could be used. There would be a need for the
profession to be trained in this process. I’d like to see
the option of using this learning cycle.’
Findings – learning cycles
• Limited support – boxed-in and form filling
• ‘too academic and complex’ BOA
• ‘the current CPD scheme was hard fought to
maintain the right to pursue personal interest and
not be forced into the learning cycle mentality’
Sutherland Society
• ‘opportunistic learning can be as valuable as
activities planned well in advance’ GCC
Questions
• How can we strike a balance between CPD
that is purposefully related to the Osteopathic
Practice Standards but also ensure that we
don’t restrict registrants’ personal interests
and personal development?
Findings – core CPD content
• ‘Could be advantageous if it concentrated on
communication and professionalism’ OA
• ‘Yes it means the registrants can maintain minimum
standards of safe and effective practice’ HCPC
• ‘Difficult for bodies with diverse membership/
registrants’
• ‘It limits the scope and range of CPD taken up by
osteopaths and therefore the future development of
the profession’ SCC
Questions
What roles could CPD providers, special
interest societies and educational
institutions play in the provision of CPD in
the areas of:
• communication
• professionalism
• consent
Findings – CPD cycle/minimum hours
• Length of cycle – very mixed – about 50% for
retaining 12 months and remainder looking at
longer periods
• Number of hours – majority favour 30 hours
as being about right
Questions
• Are we content that the minimum
requirements for CPD should remain 30 hours
including 15 hours learning with others?
• What more needs to be in place to meet PSA’s
expectations?
• Would a longer cycle make it easier to include
additional requirements?
Findings – quality assured CPD
• Some support for QA but more for other
organisations to do, not the GOsC
• Although polarised views
• Clear objections also raised including:
– Reducing diversity of CPD available
– Increased cost
– Concern about who would do it
• 62.7% of osteopaths wanted more feedback
about their CPD
Questions
• How could we build (developmental) feedback
to osteopaths into a revised scheme?
• Should we consider the role of QA further as
we develop the role of other organisations in
the continuing fitness to practise framework?
Findings – why is CPD effective?
•
•
•
•
•
•
•
•
It benefits my patients
It helps me develop/stay up to date
It extends and advances my skills
I can use it
It improves my knowledge and confidence
It makes me safer and more effective
I enjoy it
I reflect
How do you measure effectiveness?
Method
Online
(n=63)
Conferences and
Meetings (n=274)
Patient satisfaction/feedback
28
77
Clinical outcomes/patients get better
8
47
Don’t know/I don’t
3
45
Patient numbers/busyness of practice
9
40
Referrals and recommendations
16
38
Self-evaluation/reflection
3
36
Audit
16
29
Patients don’t drop out of treatment
4
24
Benchmarking/feedback from colleagues
2
14
Need support with this
0
10
Participating in the revalidation pilot / research
1
6
Conferences/CPD
0
2
Demonstrating continuing fitness to practise
How could osteopaths best show they are up to date and fit
to practise?
Online
(n=56)
Conference
(n=243)
Existing CPD process
18
101
Modified CPD system (including a core/mapping to OPS/QA)
5
30
Completing revalidation
19
23
Test/exam
7
15
Contact with other osteopaths e.g. attending
courses/meetings
2
15
Clinical audit
1
14
Patient feedback
2
13
I don’t know/difficult to do
4
12
Reflection on practice
0
8
Peer assessment/review
1
7
Full patient list
1
6
Lack of complaints
1
3
Questions
• How can we build what many osteopaths are
already doing into a continuing fitness to
practise scheme?
• What roles can other organisations play to
support osteopaths to do this effectively?
Where have we got to?
• We know that we need to develop a scheme
that goes beyond current CPD requirements
• We have a variety of evidence of what works
well and not so well
• There are a number of individual elements
that could be combined to produce a suitable
scheme
• We have not made any decisions on what
those should be
Some possible elements
•
•
•
•
•
•
Overall process
CPD
Osteopathic Practice Standards themes
Feedback on practice
Demonstrating reflection
Engagement
Overall process
• Do we keep the CPD scheme and have a
separate continuing fitness to practise scheme
or combine them?
• What are the benefits/costs of either
approach?
• Which approach would best support
osteopaths to demonstrate that they continue
to meet the Osteopathic Practice Standards?
CPD
• Retain requirement of 30 hours and a
minimum of 15 hours learning with others
each year
• Lengthen CPD cycle so that across a three year
period other elements are added in
Osteopathic Practice Standards
Personal
interests
Communication and
Patient Partnership
Professionalism
Consent
Knowledge, skills
and performance
Safety
and
quality
Feedback on practice
• Choice of a small number of tools within a
(longer) cycle, including:
– Patient feedback and analysis
– Peer and / or student feedback and analysis
– Clinical Audit and analysis
– Case based discussion and analysis
– Complaints analysis
– Structured reflection and analysis
– CPD Courses
Demonstrating reflection
• Increase ways of demonstrating reflection and
receiving feedback on this, for example:
– Appraisal – this is already happening with a small
number of osteopaths, primarily those in an
educational environment
– Peer review at local level – for example discussing
and documenting learning with peers through a
regional group or society
– GOsC review, i.e. what was done in the pilot
Engagement
• Expectation that osteopaths will engage with
the process
– Undertaking the required elements
– Interacting with others
– Demonstrating positive response to feedback
• Not a pass/fail for those who engage
What happens next?
Date
Activity
Spring to
Autumn 2013
Consideration of findings of KPMG Evaluation and Impact
Assessment and CPD Discussion Document consultation to identify
all issues and options.
Summer 2013
Discuss and listen to osteopaths, patients, osteopathic organisations
and others as we develop revised proposals. Seminars.
Autumn 2013
Publish framework proposal about regulating continuing fitness to
practise.
Winter 2013
Work with existing societies, providers, educational institutions and
groups to develop resources to support osteopaths in the revised
framework.
Spring/Summer
2014
Publish more detailed guidance for consultation.