Ros Crowder, Primary Care Continuing Professional Development Tutor, NHS Berkshire West & Programme Manager, South Central Revalidation Pilot, NHS South Central Medical Revalidation

Revalidation: what is it? A system to assure patients and the public that doctors are fit to practise, up to date and providing clinically effective, personal and safe care. Appraisal is part of revalidation and affirms professional practise and defines future learning plans Revalidation occurs within governance frameworks (GMC, DH & Royal Colleges) that aim to build trust, assure standards and improve patient safety

RevalidationRevalidation Re- Certification Re-LicensingRe-Licensing Is this doctor fit to practice as a medical practitioner in the UK? Is this doctor fit to practice as a specialist or generalist? General Medical CouncilRoyal Colleges & Faculties General Medical Council Local Responsible Officer The initial proposed model

Revalidation – current thinking Licence to Practice issued to every doctor who requested one, October 2009 The GP and Specialist Registers are a record of historical achievement; once on it the doctor will stay on it The Licence will reflect what a doctor is revalidated for and relicensing will be the main output from revalidation

Qualification Registration Renewal of Licence Licence to Practice Revalidation Trainin g Strengthened Appraisal Every 5 Years Life- long Registration (Specialist or GP) Changes in role and interests The current proposed model

General Medical Council Local Responsible Officer Royal Colleges & Faculties GMC Affiliate ProfessionalProfessionalLayLay Local Processes Strengthened Appraisal Job Planning Performance Management Clinical Audit Clinical Governance Specialty Specific Assessments BoardBoard

Regulator ‘R’ - high level remedial support ‘r’ - low level remedial support Informal Support College/Faculty Quality Assurance (audit of sample) Portfolio of Evidence Appraisal x 5 Local Responsible Officer Self-Help College/Faculty (full evidence review) College/Faculty Plus Local Responsible Officer General Medical Council Query Positive Statement of Assurance Satisfactory

Appraisal is a tool which: … helps individuals consider their performance and their development needs in the context of:  The requirements of their current role  The evolving needs of their organisation  Developments in their specialty/profession  Personal needs, wants, aspirations  Political imperatives

Appraisal is an opportunity to: Review performance (and address issues) Consider the doctor’s contribution to the service Identify and address working environment issues Discuss opportunities and aspirations Discuss and plan personal development needs Balance skills and resources

Challenge Personal Development Support The Appraisal Balance

Strengthened Medical Appraisal 1.Common framework for appraisal, and assessment of supporting information 2.Availability of supporting information to support the appraisal process 3.A common quality framework for appraisal 4.Effective local clinical governance systems

The appraiser’s role in strengthened medical appraisal (SMA) Ability to assess a portfolio of supporting information Ability to make judgements about the progress of an appraisee towards revalidation Ability to benchmark own personal standards against those of peers, and moderate individual judgements and assessments to achieve consistency with other appraisers

What do appraisers do in SMA? Manage the process of the appraisal interview Manage the content of the appraisal interview Review/Assess supporting information Make a judgement about whether there are any immediate concerns about patient safety Make a judgement about whether doctor is on track to revalidate (at this point in the cycle) Record the agreed outcomes of the appraisal interview Assist in the planning of development needs

Supporting information Current GMC License and Registration Complaints and Litigation Adverse Incidents (incl. learning from) Multi-source Feedback Patient Satisfaction Questionnaires Other pertinent documents (e.g. audit; outcome measures) Significant Event Audits Specific items recommended by College Anything else the appraisee thinks appropriate

RST Proposed Generic Essential Information Type of Information Min. Required in 5 Years Comments 1 Significant Event Review/Case Review 10Minimum 2 per year 2Review of ComplaintsAll 3 Audit (of which some may be less formal data review) 5Minimum 1 per year 4 Patient Feedback Survey and Review 1To be presented no later than yr 5 5 Colleague Feedback Survey and Review 1To be presented no later than yr 5 6 New PDP and Review of Previous Year’s PDP 5Annually 7CPD Completion5Annually 8Health Self Declaration and Review5Annually 9Probity Self-Declaration and Review5Annually

RCGP Proposals for Continuing Education Continuing education recorded in the form of learning credits At least 50 learning credits a year More than 250 over 5-year revalidation cycle Minimum of 1 credit for each hour of education Each hour of education leading to improvements in care or practice will qualify for 2 credits.

Good Medical Practice Domains, Attributes & Standards GMC, Domains: Knowledge skills & performance Safety & quality Communication, partnership & team work Maintaining trust 12 Attributes 70+ ‘standards’

Assessing supporting information Does it suggest cause for immediate concern? Which attribute(s) of GMP does it inform? (NB Many items will inform more than one attribute.) Does it show evidence of personal reflection?

Does it contribute to revalidation: Yes, on it’s own (e.g. colleague and patient feedback) Yes, if produced regularly (e.g. outcome data) Not as it stands, because … (e.g. incomplete) No, it doesn’t reflect what the doctor does Has the doctor met the CPD recommendations of their College/Association? What learning needs (if any) does it identify

Conclusion by Appraiser … A)Potential risk: Are there genuine immediate concerns about this doctors practice? If yes, are measures in place to protect patients, colleagues, the doctor and the public? (with detail) B) Areas for development: Are there areas where the doctor’s performance has not been clearly demonstrated to be of a satisfactory standard with regard to the guidance expressed in GMP? Does the PDP cover all areas that the doctor needs to address, with timeframes? C) Revalidation: Are there areas where the doctor’s progress towards satisfactory Revalidation may be in doubt? Have these been identified and understood, with an appropriate plan in place?

The appraiser’s judgement and evidence from the organisation’s clinical governance systems will inform the Responsible Officer’s recommendation to the GMC.

Revalidation Support Team Pathfinder pilots 3000 appraisals across England Whole system testing Testing Information flows Nominated “Responsible officer” role Preparation for “live” testing Evaluation to inform Treasury impact assessment Single & Multi organisational Advanced and early stage sites Range of doctor specialties and roles

High level aims To identify the impact on individuals and organisations in terms of cost, time and resources To identify problems arising at organisation and individual level in implementing the proposed arrangements To identify any benefits related to the appraisal and revalidation process eg patient care and clinical outcomes

Whole system sites: Isle of Wight Milton Keynes Royal Berkshire Foundation Trust Voluntary sites: Other South Central organisations

Participation in the pilot: Consent Agree to complete evaluation forms Strengthened Training of Appraisers for Revalidation (STAR) Register on electronic toolkit Collect supporting information for appraisal on toolkit & map to GMC attributes Appraisal discussion Evaluation Responsible officer review

Further information: GMC consultation NHS South Central Revalidation Support Team RCGP South Central Revalidation Pilot Ros Crowder / Maggie Woods, CPD Tutors