Professional Standards Authority Conference – 11 March 2016 Implementing medical revalidation in the UK: organisational changes and impacts Alan Boyd, Julian Archer, Karen Bloor, Chris Bojke, Marie Bryce, Nils Gutacker, Charlotte Hillier, Kayleigh Luscombe, Tristan Price, Sam Regan de Bere, Abigail Tazzyman, John Tredinnick-Rowe, Kieran Walshe University of Manchester, University of Plymouth and University of York

Acknowledgement and Disclaimer This presentation is an output from independent research commissioned and funded by the Department of Health Policy Research Programme. (PR-R9-0114-11002 Evaluating the development of medical revalidation in England and its impact on organisational performance and medical practice). The views expressed are those of the authors and not necessarily those of the Department of Health.

What we asked Individual, organisational and external resources for revalidation: The Responsible Officer (RO) and their Designated Body (DB) Staff and IT resources Training and support Organisational systems for managing medical performance How revalidation recommendations to the GMC are made Decision making processes and structures Recommendations that aren’t straightforward The implementation and impact of revalidation Factors affecting the implementation of revalidation Impact on: organisational systems; RO; clinical practice Suggestions for improvement

Implementing revalidation Factor Helped Hindered by lack Total Support team; interdepartmental working; governance system 111 28 139 Guidance; support; training 64 11 75 IT systems 22 50 Resources 32 43 Doctor engagement 5 18 23

Implementing revalidation “Company very proactive and supportive. Doctors and appraisers trained in house which helps engagement.” “Good national guidance and ongoing support from NHS England and GMC have helped.” “Lack of a system to tie up revalidation and appraisal and complaints, litigation and investigation. A lot depends upon organisational memory - mine and the appraisal lead and revalidation assistant.” “Only obstacles are resources; time, energy and costs.

Systems for managing medical performance: changed since revalidation?   No Yes N % Appraisal 49 15% 283 85% CPD 192 61% 124 39% Complaints 231 72% 88 28% Quality improvement 190 62% 118 38% Significant events/SUIs 218 87 29% Doctors causing concern 168 53% 150 47% Fitness to Practise 203 67% 99 33%

Impact on systems for managing medical performance “The appraisal process is much more robust with the introduction of revalidation. The quality is continuously checked and improvements made as a result of findings. Our compliance rate has improved significantly.” “Prior to my arrival, all CPD was 'signed off' as appropriate by a non-medical member of staff. As RO, I now sign off all CPD requests, ensuring that CPD is appropriate to both the individuals' as well as the organisations overall needs”

Impact on systems for managing medical performance “As an RO, I now ask questions about complaints and how they were investigated / resolved that previously I may not have had any knowledge of.” “Revalidation led us to link medical involvement in SUIs to our corporate info sheet so that it is more visible. I have also taken on a larger responsibility for the overall running of the SUI system as a result of being an RO”

Where there is a lack of impact … “Wayward doctors reluctant to embrace the process remain a challenge. Many doctors argue passionately and with some justification that revalidation is a paper exercise with very little real benefit.” “The doctors have been engaging in annual appraisal for several years so this did not change.” “… I think 'revalidation' is a bit of a red herring, since it is rigorous annual professional appraisal that is the potential 'game changer'…” “The agenda on Quality has been influenced by other factors as well as Revalidation - mainly the national focus following the Francis report, the regulator HFEA's focus on quality etc.”

Impact on clinical practice Standards / quality improved: 41 Little or no impact: 99 Doctor reflection and development improved: 37 Little or no impact: 7

Impact on clinical practice “50% of our doctors who responded to our questionnaire on appraisal report that it has a positive impact on patient care. This is because of the improved systems we have put in and that in turn is because of revalidation. I think that is fantastic, and all praise to the team for that.” “Enhanced focus of individual doctors on importance of quality governance agenda, reflection on practice and responsibility to keep up to date with practice. Has helped doctors to see their personal responsibility rather than over reliance on trust systems”

Ideas for improving revalidation Ways to improve consistency and rigour of processes such as appraisal Reducing data collection burden and bureaucracy Better fit for small DBs and those outside the NHS Better information sharing across organisational boundaries

Some tentative conclusions Revalidation – appraisal in particular - well embedded and supported in many DBs – often building on existing systems Driven some integration of systems – intra-organisational, inter-organisational, and organisational-regulator Evidence of substantial impact in some organisations Issues - smaller DBs and doctors not closely associated with a single DB