Revalidation THE ROYAL COLLEGE OF ANAESTHETISTS

What, when and how  What?  Responsibility of individual doctors (and the GMC and Professional bodies)  When?  Piloting in 2009, ready and delivered in 2010  How?  Locally with RCoA support

Definition  ‘Revalidation is a process where doctors will be required to “periodically demonstrate their continued fitness to practise … and for specialist doctors, to demonstrate that they meet the standards that apply to their particular medical specialty (DH 2007: 6). If demonstration fails then an evaluation (GMC guidance relating to Medical Act, 2002) of evidence would be required, progressing to assessment if it is deemed necessary’.

It is important to remember that …..  The purpose of revalidation and medical regulation is not solely to identify doctors whose performance is not of a sufficiently high standard  The vast majority of doctors are practicing medicine to a high standard  Revalidation should be a process that will support continuous quality improvement in standards and practice for both doctors and patients alike

What is it?  A combined process of public assurance about medical fitness to practice  Three elements:  Registration  Licensing  Certification

Registration  Identified as a doctor  No rights To practice To prescribe To certify death

Licensing  Identified on register to practice  General rights (pays Fee)  No specialist recognition  Remains open after retirement  Renewed every 5 years Local process

Certification  Identified as a specialist (or GP)  All non-training post holders Consultants / SAS + Trust posts Independent sector doctors  Renewed every 5 years Recommendation from RCoA to GMC Linked to local process

Summary so far  Registration  Able to be called a doctor  License to practice  Can practice as a doctor  Certification  Can practice as a specialist (anaesthetist)

When?  2009  All on GMC register issued a license to practice  Clock starts  2010  Recertification starts  Not across all specialities  20% each year - who will it be?  NB – no evidence older than 5 years is admissible

How?  Demonstration that we meet the standards depends on a cascade  Stage 1 provide evidence >95%  Stage 2 may need evaluation <>5%  Stage 3 GMC assessment <>1%

Demonstrating Practice – 5 years, 5 appraisals, 5 types of evidence Evidence required for Revalidation 1.Local Evidence – Clinical Governance information including recorded concerns, complaints and incidents. Evidence of annual review and discussion at appraisal 2.MSF and Patient Survey – completion of 1 cycle (e.g. 2 MSFs) 3.CPD – 5 year cycle of 250 credits 4. Non-Clinical Evidence (if appropriate), e.g. - Teaching Evaluations - Published Research Papers - Management Appraisals 5. Two Specialist Methods and Evidence which could include: - Clinical Audit (Completion of 1 cycle) - Peer Review - Case Based Discussion - Outcomes Data - Knowledge Assessment - Observation of Consultations / Procedures - Case Notes or Outpatient Letter Audit (1 cycle) - Involvement in Clinical Guideline Development (e.g. Participation on a NICE GDG) Portfolio of Evidence Non-Clinical Work 2 Specialty Methods MSF and Patient Survey Local Evidence – Clinical Governance CPD

Demonstrating Practice – 5 years, 5 appraisals, 5 types of evidence Evidence required for Revalidation 1.Local Evidence – Clinical Governance information including recorded concerns, complaints and incidents. Evidence of annual review and discussion at appraisal 2.MSF and Patient Survey – completion of 1 cycle (e.g. 2 MSFs) 3.CPD – 5 year cycle of 250 credits 4. Non-Clinical Evidence (if appropriate), e.g. - Teaching Evaluations - Published Research Papers - Management Appraisals 5. Two Specialist Methods and Evidence which could include: - Clinical Audit (Completion of 1 cycle) - Peer Review - Case Based Discussion - Outcomes Data - Knowledge Assessment - Observation of Consultations / Procedures - Case Notes or Outpatient Letter Audit (1 cycle) - Involvement in Clinical Guideline Development (e.g. Participation on a NICE GDG) Portfolio of Evidence Non-Clinical Work 2 Specialty Methods MSF and Patient Survey Local Evidence – Clinical Governance CPD

Colleges and Faculties: Roles and Responsibilities 1.Set Standards Specialist Recertification Specialty Service Provision and potentially Accreditation 2.Develop Specialty Tools and Methods 3.Train Appraisers in Specialty Standards and Methods 4.College/Faculty Role in Revalidation Recommendation Quality assure local systems and processes leading to the Recommendation Provide College Representatives to work at the Local level with the LRO to review appraisals and evidence throughout the 5 year cycle and jointly confirm the Recommendation and send a Statement of Assurance to GMC College Regional Advisors? Larger Colleges may need additional representatives in the larger regions Review all evidence portfolios and confirm Recommendation from LRO to GMC Audit a proportion of evidence portfolios for quality assurance 5. Provide remediation support or advice for doctors identified as in need

Appraisal / assessment  We are well into the 5 year cycle  The evidence has to match the current GMC Domains of Good Medical Practice (4 not initial 7)  Probity and health are for local use only

Specialist Standards for re-certification 4 Domains adapted from Good Medical Practice  Domain 1 - Knowledge, skills and performance  Domain 2 - Safety and quality  Domain 3 - Communication, partnership and teamwork  Domain 4 – Maintaining Trust

Work Streams  These all interlink:  CPD  E-portfolio  Non-clinical activity  MSF  Remediation  Departmental accreditation

CPD  Core topics are essential for all  Primarily a knowledge based process  Largely ‘internal’ process  Higher levels of CPD are necessary to demonstrate currency of practice  External process is likely to be necessary

CPD Process  Appropriate  Recordable  Verifiable  The ‘levels’ of CPD will vary  The content of CPD will vary

Definitions of CPD  Core topics  Essential knowledge for all practitioners  Redefined from core topics agreed by UEMS  Level 1  Essential for safe practice when on call  Hospital specific May be evidenced by clinical activity or external CPD

Advanced CPD  Job planned clinical activity  The content of this specialised clinical work has been defined by the relevant specialist societies It will be published on the CPD web-site It will be used for evaluation if necessary It will be a largely external process

Multi-source feedback  Two systems  The precise nature will vary across specialities There is a minimum number of returns necessary There is a maximum number of questions  Patient feedback  Not yet clearly defined for anaesthesia  Peer / team  Many commercial systems exist

Anaesthesia  Team systems  These must inform the GMC Good Medical Practice domains They are often part of a Trust-wide process Most are poorly validated  Remedial process must be in place

Non-clinical activity  A process for identifying activity for the ‘wider’ NHS  Teaching / training  Research  College / AAGBI work  Audit  Writing / editing

Non-Clinical Activity  This will be considered as part of revalidation  Evidence from the appraisal process related to that activity will be used  Non-clinical activity does not replace the CPD requirements for full-time practitioners

E-portfolio  This should underpin the entire process  Provides the easiest method of completing appraisal Expensive High security demands Multi-speciality  Not likely to be fully functional on time

E-portfolio  More than a revalidation tool  Personal documents  Linked to e-CPD system  Secure  Learning / reflective diary  Logbook data  Teaching / training activity

Departmental Accreditation  Part of healthcare regulation  The context for assessing performance in revalidation Evaluation of a doctor’s performance has to include the environment in which they work Local CPD activity may be recognised only from accredited departments in the future

What should you do?  Today!  Review your appraisals  Identify any gaps in CPD  Check with your CD about opportunities to ‘catch up’  Start / continue to record logbook data or identify systems that can

Planning  Find and organise the box-files  One folder for each year Identify appraisals Identify ‘themes’ from appraisals Log praise / complaints Collate CPD Pilot / complete MSF

Where is the information  Links :   