Trust, Assurance and Safety – White Paper on regulation –the implications for us all Dr Di Jelley GP Appraisal and Revalidation Advisor Northern Deanery Sessional GP Meeting May 17 th 2007

Contact Details Dr Di Jelley Collingwood Surgery North Shields Tel

Summary Core areas of the White Paper Core statements on appraisal and revalidation Questions still to be addressed concerning appraisal and revalidation What should we be doing now….

Core areas of White Paper-seven chapters [1] Role and structure of GMC [ 2] Revalidation –ensuring continuous fitness to practise [3] and [4] Tackling performance concerns locally and nationally [5] Education and Regulatory bodies [6] Information about health professionals [7] New roles and emerging professions

Overview of the White Paper[1]- core principles Improving quality standards across all areas Concerns all health professionals working within the UK healthcare system To support all professionals as well as early identification of any performance concerns

Overview of the White Paper[2]-the main drivers Greater patient involvement in health care Better communication between patients and professionals Better rehabilitation services for health professionals in difficulty High profile media cases and public concern

[1]Changes in professional regulatory bodies [GMC,GDC etc] Equal number of lay and professional members All councils to become accountable to Parliament or Devolved Assemblies Smaller councils with members independently appointed not elected

[2] Revalidation –ensuring continuous fitness to practise Revalidation is the combined process of re-licensure and re-certification[5 yearly] Re-licensure will depend principally on ‘successful’ completion of annual appraisal Re-certification will be against specific standards set by Royal colleges

[3] and [4] Tackling performance concerns locally and nationally Review of performers’ lists and keeping these up to date Regional network of ‘GMC affiliates’ to work with PCO medical directors ‘Recorded concerns’ about individual professionals will be introduced on a pilot basis Standard of proof will be civil [ a sliding scale ] GMC will no longer both investigate and adjudicate on fitness to practise concerns

[5] Education and the role of Regulatory bodies Three board model for overseeing undergraduate, post-graduate education, and continuing professional development Current PMETB will be retained and two more similar boards established

[6] Information about health professionals Improve information exchange between regulatory body and employer when an individual first enters employment Development of GMC register as the single authoritative source of information on doctors, with better access for patients, public and employers

[7] New roles and emerging professions Introduction of statutory regulation for health professionals such as psychologists, counsellors psychotherapists etc Review of regulation of other emerging professionals

So what are the core issues from these proposals for us as GPs?

[1] Changes in GP appraisal

Changing role of GP Appraisal –“Appraisal is a positive process to give someone feedback on their performance, to chart their continuing progress and to identify development needs” CMO –“The process of NHS appraisal should, in the future, make explicit judgements against generic standards contained within the doctor’s contract” CMO 2006

Appraisal is here to stay but shift from wholly formative to explicit link with performance review

Concerns about current appraisal process Lack of consistency in delivery of GP appraisal in England- Doctors can participate in appraisal yet have significant unresolved concerns [appraisee led agenda] Lack of clear guidance on core agenda for the appraisal meeting and required evidence set Appraisals do not always refer to previous year’s PDP and Form 4

Proposed changes in GP appraisal in White Paper Appraisal will be both summative [has performance met specific standards] and formative [looking forward to any changes that might be needed] QA of the appraisal process will be by GMC –especially appraiser selection, training and performance review Standardisation of evidence requirements

[2] Changes in proposals for revalidation

Revalidation Revalidation –keeping up to date and fit to practise For the large majority of doctors, this will provide reassurance and encourage continued improvement For a very small minority it will lead to identification of problems and an opportunity to put these right

So what will these revalidation proposals actually involve?

Re-licensing- a five yearly ‘generic’ process for all doctors Annual appraisal [‘satisfactory completion] 360[multi-source] colleague feedback [? At least every 3 years] Local Clinical governance sign off [no concerns or resolved concerns]

All doctors will need to be re- licensed every 5 years – a few may not need to be re-certified eg Some private sector posts ? Ships doctors

GP Re-certification-5 yearly, in line with Re-licensure if possible Comprehensive assessment against standards drawn up by RCGP for GPs External QA of process to ensure they are robust yet cost-effective re time taken away from patient care GPs will not need to join RCGP to be re- certified,but there will be a cost attached

Re-certification standards Information from clinical audit, employer appraisal, knowledge tests, patient feedback, CPD and observation of practice Establishment of robust local and national clinical audit groups to review performance indicators

Failure to revalidate Those few doctors who do not meet standards of revalidation will be required to spend a period in supervised practice or with a specific rehabilitation plan DoH will work with GMC,BMA,NCAS and Colleges to agree appropriate support mechanisms for these processes

What questions does this raise for you?

Core questions[1] What will be the ‘generic standards’ for GPs How in practical terms will GPs be appraised against these? What will be the criteria for passing or failing the summative element of appraisal

Core questions [2] Will submission of satisfactory evidence be a part of the summative component? What criteria will be used to judge whether evidence submitted is satisfactory? Will this judgement be made by your appraiser or via a separate mechanism?

Core Questions [3] What will 360 feedback process involve? Who will give GPs their colleague feedback and discuss it with them? What will GP re-certification comprise- ?knowledge tests and OSCEs for everyone? Will the evidence for appraisal overlap with data sources for re-certification?

What next? UK Revalidation Steering Group to be set up to guide carefully phased and managed introduction of revalidation- Detailed implementation programme awaited-? First re-validations in DoH commissioning and piloting a variety of 360 feedback tools-further guidance awaited