1. Physician assessment and revalidation in the UK Regional Health Regulation Conference - Dubai 23 October 2014 Niall Dickson Chief Executive and Registrar, GMC Chair, IAMRA

2. A safety critical industry? Institute of Medicine in the US estimates that Healthcare is 10 years behind other safety critical industries (2000) Errors difficult to detect Poor history of reporting serious incidents High levels of litigation – individuals and institutions defensive Poor history of reporting incompetent colleagues Blame culture Management focus on volume High levels of trust among consumers Major asymmetry in knowledge and understanding

3. Early moves to tackle safety To Err is Human (1999) An Organisation with a Memory (2000) The Bristol Inquiry (2001) Iatrogenic Injury (2001) To Err is Human Institute of Medicine 1999 An Organisation with a Memory Department of Health 2000 The Bristol Inquiry HMSO 2001 Iatrogenic Injury Commonwealth Government of Australia 2001

4. Revalidation – what is it & what does it mean? UK Revalidation - is the process by which doctors are required to show on a regular basis that they are up to date and fit to practise. aka: relicensure, recertification  In the past, UK professional regulation was only interested in a doctor’s competence at the point of registration, or when concerns/complaints were raised.  UK Revalidation is part of a wider employer-led system of improved clinical governance and oversight, that is designed to give ongoing assurance that every doctor is competent and fit to practise.  The system is intended to drive safety around both individual doctors and systems

5. Sir Cyril Chantler, Julia Fullerton Batten, National Portrait Gallery, 2006 Lancet 2001vol 353 (1999), p 1181 Revalidation – why do we need it? ’Medicine used to be simple ineffective and relatively safe. It is now complex, effective and potentially dangerous’  The capacity to do good is greater  The capacity to do harm is also greater  Trust is the foundation of medical practice – it needs to be reinforced  The medical register can move from being an historical record of educational achievement to a contemporary affirmation of competence  Every other safety industry checks its people  Every major business throughout the world uses appraisal and systems of performance management

6. How does Revalidation drive improvement? Revalidation has three clear aims  Bring all doctors into a governed system – including lone practitioners, basic trained doctors, peripatetic locums  Help to identify problems earlier  Encourage self reflection

7. Revalidation: requi rements 4 areas of Good Medical Practice

8. Rolling out the Revalidation process

9. Where are we now? The numbers  Doctors subject to revalidation in the UK: 229,555 GMC figures, as at 10 October 2014 all UK doctors recommendations  recommendations received by the GMC: 85,509  number of doctors revalidated: 67,911  number of deferrals: 14,984  number of doctors not engaging with their Responsible Officers: 79 revalidated doctors deferred doctors non-engaged doctors We have removed 664 licenses from doctors who have failed to engage with the process at any stage

10. Revalidation – early days “Big improvement in quality with the advent of revalidation” - Responsible officer “These are early days. As we develop better systems and introduce new practices and embed them, we are getting better at this. Inevitably doctors complain, at times, that this is just about ticking boxes. My approach has been to make appraisal a part of quality improvement” – Responsible officer The Early Benefits and Impact of Medical Revalidation, Revalidation Support Team Report, March 2014

11. Engaged doctors leads to greater patient safety Appraisal rates are going up. Doctors are starting to recognise the value of Revalidation as an affirmation of competence and fitness to practise Nath, V, Searle, B, Kaur, M, The Kings Fund, Medical revalidation From compliance to commitment, March 2014 2011 - 63.3% 2012 - 72.7% 2013 - 76.1% 2014 - 83.8% 20.5% increase since March 2011 NHS England, October 2014, excludes doctors in training ‘Revalidation has started to create a level playing field for doctors within organisations, a change that was particularly relevant for those groups who have traditionally felt marginalised.’

12. Kings Fund report: Revalidation - The early experiences and views of responsible officers from London, Author: Vijaya Nath, October 2013 Revalidation: early reports Evidence also shows there is:  An increased focus on the quality of appraisers and the appraisal process  Indicative signs that concerns about a doctors practice are being identified at an earlier stage  Strong support for the system among ROs and appraisers  A change in the views among doctors The Early Benefits and Impact of Medical Revalidation, Revalidation Support Team Report, March 2014

13. Revalidation – early impact  The GMC has suspended approval of revalidation recommendations in two organisations after concerns about the robustness of the process  50% increase in doctors giving up their licence to practice since 2012 - doctors choosing not to be part of the system  855 deferred due to local processes  686 deferred because they are under GMC investigation or in our processes GMC figures, as at 10 October 2014

14. How will we know it is working? Peninsula Medical School undertaking a major research project to evaluate Revalidation. http://www.gmc-uk.org/Evaluating_the_strategic_impact_of_medical_revalidation.pdf_55293756.pdf  Does revalidation help identify potential concerns earlier?  How are GMC guidelines on appraisal being applied in practice and how might they be improved?  What level of involvement do patients want in the Revalidation process?  Has the process of collecting the supporting information and the appraisal process increased doctors’ levels of reflection?

15. The future of Quality Improvement Revalidation can:  lead to better support for doctors to engage in PDP  foster belief in doctor’s own development  give greater transparency and assurance for patients  deliver safer and better care  be a driver for quality improvement  Moving towards Revalidation must be seen as part of the wider quality movement within healthcare in the UK  Not just a tick box exercise for doctors  Data collection and critical analysis for ongoing improvement

16. Most systems based on CPD rather than assessment of competence.  UK – GMC model for doctors is new and will be evaluated and revised. NMC currently consulting on process for nurses.  US – ‘Relicensure’ being considered by FSMB. Speciality specific models (ABIM) already in place.  AUS – 1st phase unsuccessful. Commitment to revisit - change 3-6 years away.  UAE – Abu Dhabi and Dubai are looking to develop their own model. IAMRA – will be producing reports, exploring different models worldwide and encouraging exchanges of information Other models of revalidation

17. Thank you www.gmc-uk.org www.iamra.com niall.dickson@gmc-uk.org