Revalidation, Relicensing, Recertification The Knowledge

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

Relicensing, Recertification, Revalidation

The 3 R’s Relicensure via GMC for all practicing doctors Relicensure via GMC for all practicing doctors Recertification by relevant royal college Recertification by relevant royal college Both processes done simultaneously every 5 years. Both processes done simultaneously every 5 years. If successful = If successful = Revalidation! Revalidation! simples simples

How do I get there? Reflect and improve and record!

Now for some background…

What is CPD?

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.”

Why is it important? Individual: job satisfaction, decreased burnout, develop PDP, revalidation Individual: job satisfaction, decreased burnout, develop PDP, revalidation Patient: trust, increased Dr knowledge, ?better Rx Patient: trust, increased Dr knowledge, ?better Rx Profession: trust Profession: trust Society: Changes to medical regulation, rapid increase in medical knowledge, Janet Smith inquiry Society: Changes to medical regulation, rapid increase in medical knowledge, Janet Smith inquiry

How do I do it? You probably are! 1. Choosing what to learn (Educational needs assessment) 2. Choosing how we learn (Learning Styles) 3. Time to think about what you learned (Reflection) 4. Making the learning work (Application) 5. Studying the effects of what we have learned (Evaluation) (Write it down!)

Educational Needs Assessment

We tend to focus on comfortable, familiar, fun topics We tend to focus on comfortable, familiar, fun topics BUT, knowledge gaps lay hidden BUT, knowledge gaps lay hidden Johari’s window Johari’s window Identify using various techniques: PUNS, questionnaires, talking, feedback, MCQs, Audit, guidelines etc. Identify using various techniques: PUNS, questionnaires, talking, feedback, MCQs, Audit, guidelines etc.

Doing the Learning What skill / knowledge do I want to have after the activity? What skill / knowledge do I want to have after the activity? SMARTER objectives SMARTER objectives Learning Styles (Honey and Mumford) Learning Styles (Honey and Mumford) ActivistActivist ReflectorReflector TheoristTheorist PragmatistPragmatist

Prioritising Learning Most Impact – personal/patients Most Impact – personal/patients Urgency – clinical, time, resource Urgency – clinical, time, resource Team needs Team needs National / local importance National / local importance Own desires (care!) Own desires (care!) Easiest – time, travel Easiest – time, travel Least resources Least resources Which fits best with PDP? Which fits best with PDP?

Evaluation Kirkpatrick’s Hierarchy of evaluation: 1. Own sense of achievement 2. You actually learned something! 3. Your behaviour changed and you use the learning 4. Your patients have benefitted from your learning

The Cycle of Learning

Honey and Mumford’s learning cycle and learning styles (Honey and Mumford, 1992)

Learning Style Types

What is the “normal” REFLECTOR PRAGMATIST ACTIVISTTHEORIST

Reflector Theorist REFLECTOR PRAGMATIST ACTIVISTTHEORIST

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

Activist - Pragmatist REFLECTOR PRAGMATIST ACTIVISTTHEORIST

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

Activist - Theorist REFLECTOR PRAGMATIST ACTIVISTTHEORIST

Activist - Theorist Not a common style Not a common style jump to conclusions jump to conclusions

Activist - Reflector REFLECTOR PRAGMATIST ACTIVISTTHEORIST

Activist - Reflector uncommon uncommon But depending on the proportions, have the ability to reflect before they act = a good thing But depending on the proportions, have the ability to reflect before they act = a good thing

The Knowledge Part 2

Appraisal Now Started April 2003, all GPs appraised yearly Started April 2003, all GPs appraised yearly Formative process Formative process Mixed responses from GPs, depends on area Mixed responses from GPs, depends on area Aim to discuss previous year and plan learning objectives for the next Aim to discuss previous year and plan learning objectives for the next Produce PDP at end of the process Produce PDP at end of the process Review each PDP at next appraisal Review each PDP at next appraisal You can choose appraiser from a list You can choose appraiser from a list Documents in 2 weeks prior to appraisal Documents in 2 weeks prior to appraisal Meet and discuss for 2-3 hours Meet and discuss for 2-3 hours Post appraisal documents to be signed off Post appraisal documents to be signed off Paid full day if a locum by PCT Paid full day if a locum by PCT

The Near Future…

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

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

Revalidation MORI survey 2005: half thought regular assessments already! MORI survey 2005: half thought regular assessments already! Much delayed; 2005 proposed – now due launch April 2011! Much delayed; 2005 proposed – now due launch April 2011! 20% Drs revalidated each year, five year cycle per Dr 20% Drs revalidated each year, five year cycle per Dr Some revalidated on 1 years work initially Some revalidated on 1 years work initially

Why now? Good Doctors, Safer Patients, CMO 2006 Good Doctors, Safer Patients, CMO 2006 Dame Janet Smith report - Shipman Dame Janet Smith report - Shipman Public pressure Public pressure International examples USA, NZ, Oz International examples USA, NZ, Oz Revalidation for every health professional proposed Revalidation for every health professional proposed

Relicensure License issued every 5 years by GMC License issued every 5 years by GMC You should be registered now! Starts officially 16/11/09 You should be registered now! Starts officially 16/11/09 Standards for relicensing based strongly on Good Medical Practice Standards for relicensing based strongly on Good Medical Practice New GP version of GMP out (July 2008) – new focus on CPD New GP version of GMP out (July 2008) – new focus on CPD Relicensure will only be problematic if fitness to practice concerns Relicensure will only be problematic if fitness to practice concerns Local GMC affiliates and “responsible officers” can raise concerns Local GMC affiliates and “responsible officers” can raise concerns Mostly seems a paper exercise if no concerns Mostly seems a paper exercise if no concerns

Recertification Every 5 years Every 5 years For all on any specialist register For all on any specialist register Run by relevant College Run by relevant College Based on standards in GMP Based on standards in GMP Each college has different CPD plans and requirements Each college has different CPD plans and requirements Annual appraisal forms bulk of evidence Annual appraisal forms bulk of evidence

Revalidation Satisfactory recertification and relicensure = Revalidation - simples! Satisfactory recertification and relicensure = Revalidation - simples! Unsatisfactory Unsatisfactory Appraisal feedbackAppraisal feedback PCO Responsible officerPCO Responsible officer Local group (RO, College member, layperson)Local group (RO, College member, layperson) National Adjudication PanelNational Adjudication Panel GMC affiliatesGMC affiliates National Clinical Assessment ServiceNational Clinical Assessment Service GMC fitness to practice proceduresGMC fitness to practice procedures Council for Healthcare and Regulatory ExcellenceCouncil for Healthcare and Regulatory Excellence

RCGP Proposals for GPs From Revalidation for GPs v3 From Revalidation for GPs v3 Pilots 2009/10 Merseyside Pilots 2009/10 Merseyside Enhanced Appraisal will form basis Enhanced Appraisal will form basis Collect evidence across 12 GMC attributes Collect evidence across 12 GMC attributes Greater role for appraisers in validating supporting documents Greater role for appraisers in validating supporting documents Additional compulsory elements e.g. SEA, MSF, Complaints, Audit Additional compulsory elements e.g. SEA, MSF, Complaints, Audit

Documentation ePortfolio for GPs! ePortfolio for GPs! Currently annual appraisals/PDPs form evidence Currently annual appraisals/PDPs form evidence GMP for GP’s will form standards – exemplary Vs Unacceptable GMP for GP’s will form standards – exemplary Vs Unacceptable

Revalidation Portfolio 1. Basic details 2. Exceptional Circumstances 3. Evidence of appraisals 4. PDP’s from each appraisal 5. Review of PDP and reflection 6. Learning credits 7. MSF 8. Feedback from patients

Revalidation Portfolio 9. Causes for concern / complaints 10. SEA 11. Audits 12. Statement on probity and health 13. Evidence from extended practice

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

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

Role of Appraiser Effective delivery of appraisal Effective delivery of appraisal Maintenance of standards Maintenance of standards Develop and analyse PDPs Develop and analyse PDPs Validation of credits Validation of credits Feedback on MSF Feedback on MSF Feedback concerns to GP and RO if needed Feedback concerns to GP and RO if needed

Role of Responsible Officer Senior doctor in healthcare organisation e.g. Medical Director Senior doctor in healthcare organisation e.g. Medical Director Advised by GP assessor and lay person Advised by GP assessor and lay person Access performance data about each Dr and assess revalidation portfolio Access performance data about each Dr and assess revalidation portfolio Appears satisfactory Vs Needs discussion Vs Substantial issues raised Appears satisfactory Vs Needs discussion Vs Substantial issues raised National Adjudication Panel National Adjudication Panel GMC GMC

Money! Remediation will be biggest cost Remediation will be biggest cost RCGP think DOH should pay RCGP think DOH should pay Government thinking about it Government thinking about it

Minimum Requirements 3 appraisals, 150 credits, 200 sessions over 5 years – 100 of which in previous 2 years before revalidation 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 Essentially 1 day a week over 2 years Absence from work more than 2 years – re-entry course and assessments Absence from work more than 2 years – re-entry course and assessments

Sessional GPs 1/3 rd of the workforce and growing 1/3 rd of the workforce and growing Most will manage fine Most will manage fine Some leeway allowed in extreme circumstances Some leeway allowed in extreme circumstances Usually means doing video / CSA / MCQ instead of some elements Usually means doing video / CSA / MCQ instead of some elements

Luddites Paper submissions not allowed!

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

The good news! Passing MRCGP counts as your first Revalidation!

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

Questions?