revalidation march 2010

REVALIDATIONPowerPoint Presentation

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Dr Juno Jesuthasan1 March 2010

Revalidation

• The videos and downloadable resources below are probably more useful than this PowerPoint presentation

• However it does contain some useful background information

• Clicking on the BLUE LINKS should take you to the websites or resources

• Can be viewed in FULL SCREEN if preferred

Revalidation

• Revalidation is neither EASY or HARD

It’s somewhere in the middle

• But your must get ORGANISED• And UNDERSTAND THE PROCESS

Revalidation

• The GMC introduced licensing in November 2009.

• It is the licence rather than registration that signifies to patients that a doctor has the legal authority to– write prescriptions – sign death certificates

Revalidation

Revalidation• These proposals are intended to be fit for the

purpose of demonstrating that GPs are

– Up to date – Fit to practice

Revalidation

• Revalidation starts 1st April 2011• Timetable would see the early adopter GPs

revalidating in the summer of 2011• It is important that GPs begin putting together

a portfolio of evidence from April 2009 [if they have not been doing so already]

Regulation

• Good Medical Practice [GMP]• inform education, training and practice

• Trust Assurance and Safety – The Regulation of Health Professionals in the 21st Century

• invited the GMC to translate Good Medical Practice into an effective framework against which individual doctors’ practice can be appraised and objectively assessed.

In other words

• The Government asked the GMC to develop a Framework for Appraisal and Assessment which would form a core element of Revalidation

• The key principles of professionalism set out in GMP are relevant to the whole profession and would therefore form the basis of this framework

4 Domains: 12 ATTRUBUTESThe definition and the scope and purpose of

each domainare derived principally from – Good Medical Practice

With contributions from other GMC publications:– Management for Doctors– Research: The role & responsibilities of doctors

Domains

• four domains• Knowledge, Skills and Performance • Safety and Quality • Communication, Partnership and Teamwork • Maintaining Trust

• GMP with its wider purpose – seven headings– Good clinical care– Maintaining good medical practice– Teaching and training, appraising and assessing – Relationships with patients– Working with colleagues– Probity– Health

Attributes• Domain 1 – Knowledge, Skills and Performance• Attribute 1 -Maintain your professional performance• Attribute 2 - Apply knowledge and experience to practice• Attribute 3 - Keep clear, accurate and legible records • Domain 2 – Safety and Quality• Attribute 1 - Put into effect systems to protect patients and improve care• Attribute 2 - Respond to risks to safety• Attribute 3 - Protect patients from any risk posed by your health • Domain 3 – Communication, Partnership and Teamwork• Attribute 1 - Communicate effectively• Attribute 2 - Work constructively with colleagues and delegate effectively• Attribute 3 - Establish and maintain partnerships with patients • Domain 4 – Maintaining Trust• Attribute 1 - Show respect for patients• Attribute 2 - Treat patients and colleagues fairly and without discrimination• Attribute 3 - Act with honesty and integrity

Revalidation

• The domains and standards in this framework are drawn from Good Medical Practice [GMP] but do not replace it.

• GMP will continue to fulfil its existing functions: • inform education, training and practice

GMC FRAMEWORK

As not all the guidance in GMP has been included in the framework. Not drawn on those sections that:

• State very high level values• Relate to matters where it would not be reasonably

practicable to produce evidence of compliance, or where effort of obtaining such evidence would be disproportionate to its benefit in assessing doctors’ practice.

• Describe unacceptable conduct, for example in relation to financial probity, or improper relationships with patients. Doctors cannot be asked to demonstrate that they are not defrauding the NHS.

Appraisal

• The framework can however be used by doctors to:– reflect on practice and their approach to medicine– identify where they could make improvements

Revalidation

• When placing evidence in the Revalidation Portfolio

• the GP and his or her appraiser• will agree which of the 12 standards are

covered by that evidence– building an overall picture against all GMC

Standards

Appraisal

• ‘strengthened appraisal’ or “enhanced appraisal” = Appraisal fit for Revalidation

Appraisal

Appraiser will be asked to check

• quantity of evidence is appropriate for that point in the revalidation cycle

gathered evidence, as far as the appraiser can assess

• appropriate quality

PDP

A valid PDP must contain the following key elements for each goal:

• a statement of the development need• an explanation of how the development need will

be addressed– the action to be taken– resources required

• the date by which the goal will be achieved• the intended outcome of the goal.

PDP

Most GPs will set themselves between three and five goals that reflect the breadth of their practice, responsiveness to the health needs of their local population, and their own development needs

PDP

It is very important that the GP reflects on • the goal • the development achieved • any reasons for not achieving the goal

This reflection is an important attribute of a GP’s fitness to practise

PDP

• Over a 5-year period the GP should not only consider clinical learning and development but also

the competencies around • leadership and managementrecognising the importance of all doctors’• role in a safe system of health care

CPD Credits

• The current proposal is that a GP will claim credits for the time involved in the activity,– which can include planning and reflection

RCGP CPD Credits Scheme

• The scheme works on the basis that:• A minimum of 50 credits is required per year• A broad range of general practice should be

covered in 250 credits over 5 years• Credits will be self-assessed and verified at

appraisal

QUALITY ASSURANCE OF GP APPRAISAL• Role of the RCGP will be to quality assure the process of appraisal

and the training and support of appraisers.• When doctors consider events from actual practice the word

‘review’ will be preferred to ‘reflection’ as this emphasises challenge and learning.

• Early indicators of underperformance highlighted by appraisal will lead to prompt support for doctors in difficulty. Early direction to sources of support will help to reduce potential under performance.

Support for Appraisers• All Appraisers must be selected, trained and supported to a

common standard the mechanism for this will be development of an RCGP Accredited Appraiser Training course, together with quality assurance, calibration and support systems.

Personal Development Plan (PDP) Guidance for Appraisers1. Most of a doctor's learning occurs continually in the

workplace and the PDP should not be thought of as a learning log, but as a tool that encourages reflection and provides evidence of this.

2. It should not be assumed that learning derived from the PDP is in some way superior to that which occurs on an ad hoc basis, as the two approaches to learning are often complementary.

3. Many appraisers use the term ‘general professional update’ to cover learning driven by events i.e. recognised during practice and usually directly concerning patient care.

Ad Hoc learning

• Opportunistic Ad Hoc learning can be just as important as the pre-planned developmental aims from you PDP

• Recording and commenting on this type of learning will also add to your learning credits

Personal Development Plan (PDP) Guidance for Appraisers• Typically at least three needs will be recorded

in the PDP following the appraisal interview.• Needs may be personal, practice-based, local,

or national [DIMENSION personal, local, external]

• SMART objectives :Specific, Measurable, Achievable, Relevant & Time-bound

• There is appropriate evidence to demonstrate learning.

Personal Development Plan (PDP) Guidance for Appraisers

• You will have collected evidence under GMP headings for your appraisal, including last year’s completed PDP. What does this evidence say about your performance?

Determine outcomes or evidence• What evidence of learning will you keep (notes/memos etc)?• Will you be able to show changes in your practice

(guidelines/protocols etc)?• Will you be able to show any impact of your learning

on patient care (audits, case reports etc)?

ImpactBy demonstrating the impact of the learning on practicethe credits claimed can be multiplied by a factor of 2.

IMPACT in this context refers to the impact on:• Patients e.g. a change in practice, implementing a new

clinical guideline, initiating a new drug for the first time• The Individual personal development, e.g. development of

a new skill or further development of existing skills• Service e.g. developing and implementing a new service,

becoming a training practice, teaching others• Others teaching, training, NHS locally or nationally

DEMONSTRATING IMPACT

• In addition, to claim the impact factor [credit × 2] the GP would be expected to include a

demonstration of application of new learning:• case study• simple data collection• audit• reflective piece demonstrating change in a

practice.

What can be claimed?What should not be claimed?

• “Time spent on developmental activities may include preparation, activity and reflection. Credits should only be awarded when a demonstration of the learning achieved is relevant to the practice of the GP.

• What should not be claimed?• The credit-based system is designed to move beyond a simple ‘hours = credits’

scenario. By requiring the individual to record learning relevant to the GP’s practice, simple certification of time spent is not adequate to claim credit. Examples of inadequate credit claim would be:

• reading the BMJ every week for 1 hour – claim 52 credits• audit data collection, 6 hours – claim 6 credits.• The above example of reading the BMJ may be eligible for credit claims. However,

in the format presented it gives little indication of relevance to the GP’s practices, and such untargeted reading should not normally exceed 10 credits. Performing

data collection for the purposes of audit should not be claimed.”

STRUCTURED LEARNING

CREDITS FAQ

CREDITS FAQ

Responsible Officer

RO will usually be the medical director or equivalent who, at local level, will:

• ensure that appraisal is carried out to a good standard• support doctors in addressing any shortfalls• ensure any concerns/complaints are addressed• collate information to support a recommendation on

the Revalidation to doctors to the GMC

REVALIDATION

The evidence as a whole will be initially assessed into three broad categories:

• appears satisfactory• needs discussion• substantial issues are raised In every PCO there will be a trio consisting of • Responsible Officer• RCGP external assessor• Lay assessor

REVALIDATION

The trio will allocate their time appropriately, sampling satisfactory portfolios and assessing

fully other portfolios.

REVALIDATIONIn addition to the evidence provided by GPs in theirRevalidation Portfolio the RO in the Primary CareOrganisation (PCO) will have access to • clinical governance evidence• performance evidence relevant to that GP

• Such data will be shared with the GP, who will• have an opportunity to reflect on it.

The Responsible Officer will take all the evidenceavailable into account when making a revalidationrecommendation.

REVALIDATION

The Responsible Officer will notify the GMC• Names of those GPs that the local group is

able to Recommend for Revalidation. • Notification will be copied to the RCGP so that

a sample of anonymised approved portfolios can be quality assured

REVALIDATION

Where the local trio are unable to recommend Revalidation to the GMC

• Portfolio will be shared centrally • RCGP’s National Adjudication Panel

GMC Affiliates

• The GMC is currently conducting pilots to develop the role of the regional GMC affiliate

• Offer guidance on standards and quality assurance for ROs

Independent assurance of the quality and consistency of • local appraisal • clinical governance systems

that underpin revalidation decisions

Sessional Doctors

• Salaried Doctors• But especially Locums and other Sessional

Doctors• Face special challenges in meeting the

requirements for revalidation• The RCGP is Piloting this area

Sessional Doctors: Click here to watch an interesting Healthcare Republic interview with

Richard Fieldhouse the chair of the National Association of Session GPs

RCGP Revalidation PortfolioAn at a glance Traffic Lights system will help you

easily keep tabs on your progress

RCGP Revalidation Portfolio

• The GMC Framework is important

RCGP Revalidation PortfolioSo is Curriculum Coverage over the course of the

5 year revalidation cycle

RCGP Revalidation Portfolio

Familiarity with the concepts of Area and Dimension is important

RESOURCES

• RCGP REVALIDATION HOME PAGE

• Revalidation – FAQ

• REVALIDATION GUIDE• Changes to the Guide• Revalidation Guide - Section by Section

RESOURCES

• RCGP Guide to the Credit-Based System for CPD.

• GMC • GMC FRAMEWORK

The End

• Well not quite!• If you are viewing this slideshow on my

website slideshare will mention some “related slideshows” at the end of this presentation • IGNORE THEM THEY ARE UNRELATED!