1. Taking Revalidation Forward
Alan Walker, Head of Northern Ireland Affairs
BMA SAS Conference
Friday 15 September 2017

2. Content Revalidation to date in NI
Independent Review by Sir Keith Pearson
Taking Revalidation Forward

3. Revalidation in Northern Ireland (3 Dec 2012 - 31 July 2017)
5686
Number of doctors with a connection to a designated body in Northern Ireland
4583
Number of approved recommendations to revalidate
930
Number of approved recommendations to defer (insufficient evidence to support a recommendation to revalidate) 32
Number of approved recommendations to defer (participating in an ongoing process) 4
Number of approved recommendations of non-engagement

4. RQIA Review of Governance Arrangements
Appraisal rates ( and ) in HSC organisations ranged from 71% to 100% for all eligible medical staff.
Some Trusts have set up dedicated Revalidation teams to support the process.
Variances between electronic and paper based appraisal and revalidation portfolios.
Systems do provide assurance to patients and the public

5. Independent Review by Sir Keith Pearson

6. Context: why the GMC commissioned the review
An opportune time to take stock. Four years into revalidation and most licensed doctors have been through the process.
An independent view on emerging evidence of impact. An opportunity to review and pull together published research and data, including the UmBRELLA and Manchester Business School reports.
An opportunity to deal with those involved in revalidation. Sir Keith met with over 100 individuals across the four countries. This included CMOs, ROs, appraisers, doctors and patient groups, as well as representatives from the Royal Colleges and Faculties, the BMA and systems regulators/quality improvement bodies.

7. Sir Keith’s key points on the IMPACT of revalidation
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.
There is excellent commitment, ownership and leadership of revalidation by medical leaders and health departments in the four countries.
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.
Doctors who do not support revalidation generally have concerns about the administrative burden or have not had a constructive appraisal experience.

8. Key AREAS FOR IMPROVEMENT
Public awareness of revalidation needs to be increased if it is to fulfil its role in raising assurance. We should talk about ‘relicensing’.
Raising quality and consistency in appraisal is a priority. This will both strengthen assurance and help secure buy-in from doctors
Revalidation can deliver further benefits. Boards need to take a more active role and challenge for learning and improvement
Burdens for doctors can be reduced if organisations provide better support and improve information systems
Secondary care locums and doctors without a connection are weak points in the system that need to be addressed

9. RECOMMENDATIONS to stakeholders
GMC to clarify guidance, explore a broader definition of patient feedback, support stronger local governance, encourage better information sharing, identify impact measures for revalidation and bring forward revalidation for new entrants to the register.
Governments to re-examine RO Regulations with a focus on locums and doctors without connections. As far as possible, I want doctors who need a licence to practise in the UK to have an RO.
Healthcare organisations to continue work to drive up quality of appraisal, improve systems to support doctors, share information and publicise the benefits of the ‘relicensing’ process.
Boards to challenge organisations to demonstrate learning from revalidation and assure themselves of the quality and fairness of local appraisal and revalidation processes.

10. Taking Revalidation Forward

11. TRF Action Plan published July 2017
Revalidation Oversight Group
Progress reports published every 6 months, starting Dec
Most actions complete by March 2018
Programme closure Sept
2018
6 work streams, each with agreed objectives
GMC outputs
(18)
1: Patient & public involvement
2: Improving appraisal/burdens
3: Better assurance re doctors working in multiple locations
4: Doctors without an RO
5: Tracking impact of reval
6: Improving governance +
Revalidation Oversight Group (ROG) consists of key revalidation stakeholders across the four countries – government health departments, training/education bodies, system regulators/improvement bodies, patient representatives, AIHO/IDF and the BMA. It’s chaired by the GMC Chief Exec and meets quarterly.
Northern Ireland is represented on ROG by Paddy Woods DCMO, Keith Gardiner for NIMDTA and Lourda Geoghegan for RQIA.
ROG is overseeing and co-ordinating a JOINT action plan to deliver improvements in response to Sir Keith Pearson’s recommendations. Important to note that this is a joint endeavour across the revalidation system – not just GMC. Actions are tailored to priorities in each country or sector. [In NI, revalidation is felt to be working well].
Together, NI stakeholders have contributed an action to the plan under Work stream 2 (improving appraisal and reducing burdens for doctors).
The NI action states: “The Northern Ireland Responsible Officers’ Forum and Revalidation Delivery Board will continue to consider how revalidation processes might best be streamlined; how appraisal processes can be enhanced and where there is best practice that can be shared”
Highly recommend that you take a look at the action plan and identify initiatives of interest to you and your organisations.
Initiatives led by others
(19)
Full action plan available on GMC website

12. Key activities underway on each work stream1 2 3
Improving guidance & website for doctors & ROs
Principles for sharing information about doctors with concerns
Revalidation ‘narrative’ for patients and public 4 5 6
Supporting DH with review of RO Regs. Reviewing SP scheme & licensing advice to doctors
Identification of metrics to track revalidation impact
Updating governance handbook & improving data for ROs
More detail, including timescales, on each of these can be found in the action plan.

13. Key areas of interest for education & training
Recommendation protocol
The updated Protocol will include better advice for ROs of doctors who have completed or left training (with a view to minimising the ‘extra’ evidence these doctors need to present for revalidation)
We’ll be exploring how we can introduce more flexibility into the existing patient feedback requirements so they work better for doctors and for patients
Patient feedback
Early revalidation
We are not pursuing Sir Keith’s recommendation to bring forward first revalidation for doctors in UK training

14. The GMC in Northern Ireland 9th Floor, Bedford House, 16-22 Bedford Street, Belfast, BT2 7FD
@gmcuk