Appraisal and revalidation Eric Bater 9 th July 2014

Revalidation:- ‘The means by which all doctors must demonstrate on a 5-yearly basis that they remain up to date and fit to practise’

The purpose of revalidation To assure patients and public, employers and other health care professionals that licensed doctors are up to date and fit to practise

The 2 elements

GMC Revalidation: “Single-process” Relicensure: license to practise on medical register (i.e. NHS doctor, prescribe & death certification) in accordance with the GMC’s generic standards [GMC driven] Recertification (re-accreditation): certificate confirms doctors meet standards appropriate to be on GMC’s GP Register [RCGP driven] Support: As a backstop, to identify for further investigation/remediation, doctors whose practice is/may be impaired License to Practise Certificate to be on the GP register 5-Yearly Relicence 5-Yearly Recertification One-Process Revalidation

Why revalidation? James Wisheart Senior paediatric cardiac surgeon, Bristol Struck off by GMC 1998 after failing to note excess mortality (29 deaths between 1988 &1995)

Why revalidation? Harold Shipman GP in Hyde,Manchester Convicted in 2001 of 15 murders of patients Suspicion of involvement in 250+ deaths

How would you prove a doctor was ‘up to date’ and ‘fit to practice’? ?????????

Knowledge test /MCQ Taking the MRCGP Simulated surgery Masterpiece video Secret patients Self report Completion of postgrad education Annual appraisals (guided self reflection) Prescribing / referral data Patient satisfaction questionnaire

Finally commenced 3 rd December 2012

1) Annual appraisal 2) Portfolio of defined supporting information 3) Statement from responsible body of absence of performance issues

Responsible Officer Makes revalidation recommendation to GMC GMC: Doctor Revalidated Annual Appraisal Over 5-year period with local appraiser Supporting Information: Colleague & Patient Feedback CPD records Clinical Audit Medical Royal College / Faculty: Define standards for appraisal & supporting information Providing speciality guidance & advice for appraisers, appraisees and Responsible Officers Responsible Officer Receives feedback on appraisal Quality Assurance Royal Colleges System regulators (e.g. The Care Quality Commission) GMC

GMC ‘Good Medical Practice’ 2013 Domain 1: Knowledge, skills and performance Domain 2: Safety and quality Domain 3: Communication, partnership and teamwork Domain 4: Maintaining trust

Domain 1: Knowledge, skills and performance Develop and maintain your professional performance (para 7-13) Develop and maintain your professional performance (para 7-13) Apply knowledge and experience to practice (para 14-18) Apply knowledge and experience to practice (para 14-18) Record your work clearly, accurately and legibly (para 19-21) Record your work clearly, accurately and legibly (para 19-21)

Domain 2: Safety and quality Contribute to and comply with systems to protect patients (para ) Contribute to and comply with systems to protect patients (para ) Respond to risks to safety (para ) Respond to risks to safety (para ) Protect patients and colleagues from any risk posed by your health (para 28-30) Protect patients and colleagues from any risk posed by your health (para 28-30)

Domain 3: Communication, partnership and teamwork Communicate effectively (para 31-34) Work collaboratively with colleagues to maintain or improve patient care (para 35-38) Work collaboratively with colleagues to maintain or improve patient care (para 35-38) Teaching, training, supporting and assessing (para 39-43) Teaching, training, supporting and assessing (para 39-43) Continuity and coordination of care (para 44-45) Establish and maintain partnerships with patients (para 46-52) Establish and maintain partnerships with patients (para 46-52)

Domain 4: Maintaining trust Show respect for patients (para 53-55) Treat patients and colleagues fairly and without discrimination (para 56-64) Treat patients and colleagues fairly and without discrimination (para 56-64) Act with honesty and integrity (para 65-80)

Good Medical Practice: Domains and attributes [14] Domain 1: Knowledge, skills and performance Domain 2: Safety and quality 1.1 Maintain your professional performance 1.2 Apply knowledge and experience to practice 1.3 Ensure that all documentation (including clinical records) formally recording your work is clear, accurate and legible 2.1 Contribute to and comply with systems to protect patients 2.2 Respond to risks to safety 2.3 Protect patients and colleagues from any risk posed by your health Domain 3: Communication, partnership and teamwork Domain 4: Maintaining trust 3.1 Communicate effectively 3.2 Work constructively with colleagues and delegate effectively 3.3 Establish and maintain partnerships with patients 4.1 Show respect for patients 4.2 Treat patients and colleagues fairly and without discrimination 4.3 Act with honesty and integrity

Personal Development Plan RCGP Guide to the Revalidation of GPs. Jan version 3.0

Supporting information GMC ‘Supporting information for appraisal and revalidation’

6 types of supporting information:- 1) Continuing professional development 2)Quality improvement activities 3) Significant events 4) Feedback from colleagues 5) Feedback from patients 6) Review of complaints and compliments

RCGP – Supporting information for GPs Review of completion of last year’s PDP 50 credits/ year or exceptional circumstances statement 10 SEAs in 5 years 1 clinical audit or project in 5 years 1 MSF with reflection in 5 years 1 PSQ with reflection in 5 years All complaints/ cause for concern, and compliments Statements on probity, health and professional indemnity Information to support extended roles

Introducing…… The MAG form

Knowledge, skills and performance ‘Maintain your professional performance ’ Completion of last year’s PDP Case reviews Anonymised records Courses, conferences, seminars, with reflections Certificates of course attendance

Knowledge, skills and performance ‘Apply knowledge and experience in practice’ Case histories Audit Prescribing data PUNs and DENs Examples of publications or teaching

Knowledge,skills and performance ‘Ensure all documentation formally recording your work is clear,accurate and legible’ Anonymised case records Samples of letters The appraisal document itself Examples of material used for presentations

Safety and quality ‘Contribute to and comply with systems to protect patients. Significant events Personal involvement in quality improvement programmes Mandatory training (safeguarding,BLS) Examples of ‘whistle-blowing’

Safety and quality ‘Responds to risks to safety’ Handover systems and policies Communication of test results Health and safety, and manual handling Personal immunisation record Significant events

Communication, partnership,teamwork ‘Communicate effectively’ Evidence of practice development activity (e.g patient pathways) Reflections on role in the team Myers Briggs personality inventory Belbin profile, and reflections

Communicating, partnership, teamwork ‘Work constructively with colleagues,and delegate effectively’ Teaching for students or colleagues Multi-source feedback

Communicating, partnership, teamwork ‘Establish and maintain partnership with patients ’ Patient surveys Letters from patients or relatives Information and reflection on patient participation groups

Maintaining trust ‘Show respect to patients’ Chaperone policy Knowledge of information governance Managing requests from patients

Maintaining trust ‘Treat patients and colleagues fairly and without discrimination’ Complaints Management and leadership activities Feedback and learning from research

Maintaining trust ‘Act with honesty and integrity’ Declaration of any interest in pharmaceutical companies Managing of finances Protocol for dealing with gifts MDU /GMC membership

What about revalidation of doctors in training?

GMC ‘Information for doctors in training’ ‘The responsible officer will make a revalidation recommendation based on participation in the ARCP process’

What is a ‘responsible officer’ Dr Mike Prentice (HENE LETB)

When will you revalidate? CCT Between 1 st April 2014 & 31 st March 2018 After 31 st March 2018, and those trainees who do not currently have a CCT date First revalidation At point of eligib ility for CCT Between 1 st April 2016 and 31 st March 2018

Appraisal for ST3s See HENE website ‘A brief appraisal guide for ST3 GPRs’

Aim is for all ST3s to have experienced an appraisal and formed a PDP Evidence come from e-portfolio Appraisal done using MAG form Appraiser will be trainer, or other trained appraiser in the practice

Introducing the MAG form e/.uploads/documents/pdf/MAGmodelapp raisalformv3.pdf

MAG form sections 4) Roles as a doctor 6) PDP from last year 7) CPD 8) Quality improvement activities 9) SEAs (don’t upload) 10) Complaints (leave blank) 12) Challenges and aspirations 15) Proposed PDP 17) Reflections on domains of ‘Good Medical Practice’

Future appraisals related to birth month (6- 17 months from ST3 appraisal) Next revalidation 5 years after leaving VTS unless prolonged absence (>2 years) from practice

Other possible formats:- RCGP revalidation e-portfolio Clarity website