Revalidation, Relicensing, Recertification The Knowledge

Objectives Discuss continuing professional development (CPD) Know some useful educational theory Understand Revalidation, Relicensure, Recertification Know your learning style Discuss RCGP proposals What you need to do now you’re on your own!

Relicensing, Recertification, Revalidation Hands up anyone looking forward to revalidation?! Anybody know what revalidation means? (words in red are meant to highlight areas for interactivity i.e. get them to answer something!) Hopefully by the end of the morning you will not look like this girl when approaching revalidation…

The 3 R’s Revalidation! Relicensure via GMC for all practicing doctors Recertification by relevant royal college Both processes done simultaneously every 5 years. If successful = Revalidation! simples Can anyone explain the 3 R’s? Write on flipchart Latest change is whole process is known as just “revalidation” and they have dropped the other two as it was too confusing. Handy just to go through it though for some background

Reflect and improve and record! How do I get there? Reflect and improve and record! Most important slide of the morning

What is CPD? Open to audience, throw some ideas around, write on flipchart

CPD GMC: “A continuous learning process that complements formal undergraduate and postgraduate education and training. CPD requires doctors to maintain and improve their standards across all areas of practice.” Highlight red words

Why is it important? Individual: job satisfaction, decreased burnout, develop PDP, revalidation Patient: trust, increased Dr knowledge, ?better Rx Profession: trust Society: Changes to medical regulation, rapid increase in medical knowledge, Janet Smith inquiry Can ask audience why important as each word comes up individually (next click will reveal white text)

How do I do it? You probably are! Choosing what to learn (Educational needs assessment) Choosing how we learn (Learning Styles) Time to think about what you learned (Reflection) Making the learning work (Application) Studying the effects of what we have learned (Evaluation) (Write it down!) = cycle of learning

Educational Needs Assessment We tend to focus on comfortable, familiar, fun topics BUT, knowledge gaps lay hidden Johari’s window Identify using various techniques: PUNS, questionnaires, talking, feedback, MCQs, Audit, guidelines etc. Ask them to explain Jo-Hari’s window. Someone usually does it better than me!

Prioritising Learning Most Impact – personal/patients Urgency – clinical, time, resource Team needs National / local importance Own desires (care!) Easiest – time, travel Least resources Which fits best with PDP? Aim of this slide is to get point across that it is very easy to learn in an unstructured way; much better to be planned and organised in PDP. They will be used to this of course from ePortfolio

Doing the Learning What skill / knowledge do I want to have after the activity? SMARTER objectives Learning Styles (Honey and Mumford) Activist Reflector Theorist Pragmatist Most will know this stuff – good to ask Ask if they know their learning styles. They enjoy doing learning styles questionnaire half way through this powerpoint as a bit of a break.

Evaluation Kirkpatrick’s Hierarchy of evaluation: Own sense of achievement You actually learned something! Your behaviour changed and you use the learning Your patients have benefitted from your learning Top marks if anyone knows this hierarchy! Good to note how this hierarchy fits like a glove with the RCGP learning credits and PDP goals.

The Cycle of Learning Draw on board – essentially like audit cycle but for learning. Concrete experience – reflective observation – Abstract conceptualisation – Active experimentation See slide 18 also

Break Time & Qs Good point to stop and check all still with you, pause for Q’s I generally hand out learning style questionnaire now as has been a bit heavy last few slides.

Learning Style Types

Honey and Mumford’s learning cycle Reflect how similar to learning cycle and audit etc.. (Honey and Mumford, 1992)

What is the “normal” The next few slides borrowed from you! 18 REFLECTOR PRAGMATIST ACTIVIST THEORIST The next few slides borrowed from you! 18

Reflector Theorist REFLECTOR PRAGMATIST ACTIVIST THEORIST 19

Reflector - Theorist Commonest variant style “Analysis to paralysis” 20

Activist - Pragmatist REFLECTOR PRAGMATIST ACTIVIST THEORIST 21

Activist - Pragmatist 2nd commonest variant style but they do things too quickly!!! 22

Activist - Theorist REFLECTOR PRAGMATIST ACTIVIST THEORIST 23

Activist - Theorist Not a common style jump to conclusions 24

Activist - Reflector Group together the rare activist reflectors. PRAGMATIST ACTIVIST THEORIST Group together the rare activist reflectors. You may find 1 or none. Don’t be surprised….they are RARE. 25

Activist - Reflector uncommon But depending on the proportions, have the ability to reflect before they act = a good thing What do they think their bad points are. They are great at getting the ball rolling but having reflected on things and looked at the implications of things first (unlike pure activists). That is why they are often heavily sought by business management! 26

The Knowledge Part 2 This section generally done after tea break. Theory is over now – on to (generally better received) practicalities.

Appraisal Now Started April 2003, all GPs appraised yearly Formative process Mixed responses from GPs, depends on area Aim to discuss previous year and plan learning objectives for the next Produce PDP at end of the process Review each PDP at next appraisal You can choose appraiser from a list Documents in 2 weeks prior to appraisal Meet and discuss for 2-3 hours Post appraisal documents to be signed off Paid full day if a locum by PCT Encourage Q’s – this is the bit when lots of the practical Qs come out and I generally open the floor at this bit.

The Near Future…

Revalidation Three purposes of revalidation? = The process by which a regulated professional periodically has to demonstrate their fitness to practice Professional regulation is all about patient safety Three purposes of revalidation?

Not to put doctors on the rack!

Purposes of Revalidation Minimally acceptable care Reassure patients and the public Improve quality of care

Revalidation MORI survey 2005: half thought regular assessments already! Much delayed; 2005 proposed – now due launch April 2012! 20% Drs revalidated each year, five year cycle per Dr Some revalidated on several years work initially Some history Launch date may be even later than this now!

Why now? Good Doctors, Safer Patients, CMO 2006 Dame Janet Smith report - Shipman Public pressure International examples USA, NZ, Oz Revalidation for every health professional proposed I have only heard of revalidation for doctors though…

If they hate this stuff, maybe they should be blaming Dr Shipman

Relicensure License issued every 5 years by GMC You should be registered now! Starts officially 16/11/09 Standards for relicensing based strongly on Good Medical Practice GP version of GMP out (July 2008) – new focus on CPD Relicensure will only be problematic if fitness to practice concerns Local GMC affiliates and “responsible officers” can raise concerns Mostly seems a paper exercise if no concerns This is slightly old information – relicensure will happen in the background and will not be “noticed” by most doctors as it will be closely tied in with revalidation (and is not now described as a separate process)

Recertification Every 5 years For all doctors Run by relevant College Based on standards in GMP Each college has different CPD plans and requirements Annual appraisal forms bulk of evidence Again, similar to the previous slide – revalidation will ensure you are fit to practice as a doctor in your chosen specialty.

Revalidation Satisfactory recertification and relicensure = Revalidation - simples! Unsatisfactory Appraisal feedback PCO Responsible officer Local group (RO, College member, layperson) National Adjudication Panel GMC affiliates National Clinical Assessment Service GMC fitness to practice procedures Council for Healthcare and Regulatory Excellence Helpful to talk about what the process is if things go wrong. CQC should be in there somewhere also..

Might feel like we are being made to walk the plank..

RCGP Proposals for GPs From Revalidation for GPs v4 Pilots 2010 Merseyside Enhanced Appraisal will form basis Collect evidence across your areas of practice Greater role for appraisers in validating supporting documents Additional compulsory elements e.g. SEA, MSF, Complaints, Audit There is a more up to date version of this (v5 I think)

Documentation ePortfolio for GPs! Available Dec 2010 for early adopters Currently annual appraisals/PDPs form evidence GMP for GP’s will form standards – exemplary Vs Unacceptable This is available now but is very limited in it’s current form and scope.

Revalidation Portfolio Basic details Exceptional Circumstances Evidence of appraisals PDP’s from each appraisal Review of PDP and reflection Learning credits MSF Feedback from patients name, address, jobs etc Eg maternity leave, abroad, partnership dispute Form to say attended Must have PDP from each appraisal See later slide Requirements keep being watered down I think 2 needed over 5 years now Ditto

Revalidation Portfolio Causes for concern / complaints SEA Audits Statement on probity and health Evidence from extended practice 10. 5 over 5 years 11. 2 full cycle audits

RCGP Learning credits RCGP managed CPD scheme Members free, non members charged Credit system for CPD Scored by time and impact Double credits if followed learning cycle Includes reflections/reading etc 250 credits needed over 5 years for recertification

Essential Knowledge Updates Knowledge updates for credits released every 6 months by RCGP Linked essential knowledge challenge, voluntary, 70% pass rate Online now Based on curriculum for GP and latest developments

Role of Appraiser Effective delivery of appraisal Maintenance of standards Develop and analyse PDPs Validation of credits Feedback on MSF Feedback concerns to GP and RO if needed Validation of credits – usually generates some discussion – can they see any problems with this role?

Role of Responsible Officer New role created by Health and Social Care Act 2008 Senior doctor in healthcare organisation e.g. Medical Director Every licensed GP linked to one Access to local concerns Makes recommendation to GMC every 5 years National Adjudication Panel GMC

Money! Remediation will be biggest cost RCGP think DOH should pay Government thinking about it Still no clarity with this.

Minimum Requirements 3 appraisals, 150 credits, 200 sessions over 5 years – 100 of which in previous 2 years before revalidation Essentially 1 day a week over 2 years Absence from work more than 2 years – re-entry course and assessments Most are really keen on this bit. Maternity and spending time abroad are commonest Q’s – I usually have the guide on hand for this!

Sessional GPs 1/3rd of the workforce and growing Same requirements; possibly different evidence eg MSF, locum RO’s

Paper submissions not allowed! Luddites Paper submissions not allowed!

What do you need to do now? Protected by VTS/MRCGP until now Plenty of material to date, all in ePortfolio Read GMP for GPs Record your learning and prepare well for appraisals Ideally, write reflective comments after each learning activity Consider doing an audit, SEA etc. Take care if locuming – CPD trickier but revalidation still applies!

Passing MRCGP counts as your first Revalidation! The good news! Passing MRCGP counts as your first Revalidation! So no appraisal for 5 years!

Summary CPD to be much more scrutinised Get used to learning cycles, reflecting/evaluating your learning Record everything! Annual appraisal the cornerstone Recertification/Relicensure and hence Revalidation should follow easily for most good GPs

Questions?

Next Show Forms Snakes and ladders Usually I now show Appraisal forms to them and set up the snakes and ladders game. This is essentially a fun way of asking them what evidence they would put in the various sections of the form e.g. maintaining good medical practice, probity etc.