1. Is medical revalidation building trust and assurance in doctors
Is medical revalidation building trust and assurance in doctors? Taking Revalidation Forward – insights from Sir Keith Pearson’s review of revalidation
Judith Chrystie, Assistant Director – Policy Information and Change

2. Revalidation Initial Impact Building Trust Presentation Outline
Background
Aims
Process
Revalidation
Key findings from review by Sir Keith Pearson Taking Revalidation Forward
Initial Impact
Sir Keith’s recommendations
Action plan
Building Trust

3. Revalidation

4. Revalidation - background
Introduced in December 2012
Most significant change in medical regulation in 150 years
Doctors demonstrate up to date and safe to practise

5. Revalidation: Aims ✔ Bring all doctors into clinical governed system
✔  Licence: indicator that doctor meets professional standards
✔  Doctors reflect on changes and improvements
✔  Help identify problems earlier - but revalidation does not exist solely to identify poor performance.
✔  Extra confidence to patients doctors are regularly checked
✔  Improved, safer patient care
✘Revalidation is not intended to catch another Shipman
✘Revalidation is not a complaints process
✘Revalidation is not the whole system of assurance.

6. Taking Revalidation Forward – Sir Keith Pearson
… the register only records past qualifications. It is not a contemporary account, and so it offers limited assurance that any particular doctor is as up to date now as they were when they entered the register, or that their practice across the range of their work is safe (para 30)
Patients want to be assured that doctors are keeping up to date and are safe to practise. Revalidation was introduced to provide that assurance (para 31).
Revalidation is a now in place and forms a core element of the systems that provide assurance to patients about the safety and quality of their medical care. (para 117)

7. Revalidation: Process
Annual appraisal

8. Revalidation: Process
Whole practice appraisal based on Good Medical Practice (GMP)
Discuss practice and performance against four domains and related attributes
Use and reflect on supporting information
Show meet standards and values of GMP

9. Revalidation: Routes to revalidate
Designated Body
Responsible Officer (RO) - licensed Dr
Legislation lists DBs and RO responsibilities
Make revalidation recommendations to GMC
Suitable Person
Approved by GMC against published criteria.
Licensed Dr with sufficient link to revalidating Dr
NPC
No prescribed connection – no DB or SP
Send GMC annual returns (including appraisals)
Sit revalidation assessment – knowledge test
GMC use material to make revalidation decision

10. Initial Impact

11. Review: Taking Revalidation Forward
March 2016 – asked Sir Keith Pearson to lead a review – good time to take stock
Complement the long-term evaluations being carried by UMbRELLA and Department of Health
Sir Keith met personally with over 100 individuals across the four countries

12. Sir Keith’s report - impact
Medical revalidation is settling well It is an achievement to have delivered such a complex intervention without major problems. We are where we expected to be.

13. Sir Keith’s report - impact
The main impact so far has been to embed appraisal and broaden reflective practice. But there is also clear evidence of stronger clinical governance arrangements. And some evidence that revalidation is helping to identify and tackle poor performance.

14. Sir Keith’s report - impact
Revalidation feels ‘owned’ by medical leaders and health departments in the four countries. They understand its value and potential. They do not want significant change at this point.

15. Sir Keith’s report - impact
Doctors who do not support revalidation generally have concerns about the administrative burden or have not had a constructive appraisal experience.
But doctors also need to approach the process constructively, recognising that revalidation is a legitimate and proportionate assurance mechanism for patients and employers.

16. Sir Keith’s report - impact
But revalidation is not equally robust for all doctors: locum doctors and doctors without a connection
Deferral rates for locum doctors are higher than for any other group. It has been suggested to me that one reason for this is the

17. Sir Keith’s report - impact
Confusion over prescribed connections (secondary care locums in England) owing to a lack of clarity in legislation.
Some locum agencies not properly fulfilling their responsibilities as designated bodies.
Difficulties for ROs in accessing all the information they need to make revalidation recommendations for locum doctors (higher deferral rates)
Deferral rates for locum doctors are higher than for any other group. It has been suggested to me that one reason for this is the

18. Sir Keith’s report - impact
Around 4,360 doctors in this position, of whom 750 are currently engaged in clinical work with patients in the UK
I am not confident that current revalidation arrangements for unconnected doctors provide the same level of assurance to patients as those for a doctor subject to clinical governance via an RO (para 228)

19. The TRF recommendations have wide impact
Rename revalidation
GMC
Royal Colleges
Consider data on deferral rates
Clarify guidance
Governments
Identify impact measures
Explore new approaches to patient feedback
Review RO Regs re locums and NPC
Better info sharing (doctors with concerns)
Patient groups
Publicise revalidation
Doctors
Healthcare organisations
Improve appraisal
Approach the process constructively
Increase
board-level engagement & challenge
Improve support & data to doctors

20. Building Future Trust

21. Stakeholder response so far
Varied responses and different emphases in areas of concern and support
Widespread support for Sir Keith’s conclusions: “they ring true”
Vast majority of recommendations welcomed
Commitment to work with GMC to implement
Important that there is wide engagement and that costs v benefits of change considered

22. GMC work streams
Making revalidation more accessible to patients and the public
Reducing burdens and improving the appraisal experience for doctors
Increasing oversight of, and support for, short-term locum doctors
Reducing the number of doctors without a connection
Measuring and evaluating the impact of revalidation
Supporting improved local governance 1 2 3 4 5 6

23. Any questions?