Revalidation for SAS doctorsJohn Bache FRCS

RST Associate

NHS Revalidation Support Team

SASG Annual Conference

Manchester

13th January 2010

How did we get here? …

1999Supporting Doctors, Protecting Patients - CMO2004Shipman Inquiry Report (plus Bristol, Alder Hey etc..)2006Good Doctors, Safer Patients – CMO2007Trust, Assurance and Safety – White Paper on ‘Regulation

of Health Professionals in 21st century’2008Medical Revalidation - Principles and Next Steps - CMO

2008Medical Revalidation – Principles and Next Steps

“In the NHS, appraisal is patchy geographically and is not fit for the purpose of re-licensing.

…To address this will require a standardised module of appraisal, agreed by the GMC, to be included in all appraisal systems. This module will be derived from Good Medical Practice… and will inform a judgment on whether the evidence presented supports revalidation or not over a five year cycle…”

Purpose of medical revalidation

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•To confirm that licensed doctors practise in accordance with the GMC’s generic standards(re-licensure)

•For doctors on specialist or GP register, to confirm that they meet the standards appropriate for their speciality (re-certification)

•To identify for further investigation, and remediation, poor practice where local systems are not robust enough or do not exist

What is needed for revalidation?

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The key elements required for implementation are:• a revised system of appraisal• a regional network of GMC Affiliates• a network of Responsible Officers• the issuing of licences to practise - done!• standards for assessment and evaluation

methods for specialist recertification (+ generic standards for all doctors)

Changes needed …

• Piloted introduction of revalidation through careful introduction of ‘new’ appraisal: - new appraisal forms

- electronic support

• Standards for assessment (Royal Colleges)

• Improvements in Trust/PCT/etc infrastructure to support ‘new’ appraisal

GMC, RST, NCAS, Royal CollegesGMC• Ultimate decision on whether doctor revalidated• Concerns about fitness to practise

RST• Design, support and piloting for strengthened appraisal

NCAS• Advice to RO in support of local remediation

Royal Colleges• Specialty standard setting + formal assessment

The legislation

- ensures that there is investment in systems of clinical governance, audit, and multi-source feedback

- ensures that RO decision making is rigorous, high quality, and consistent

- ensures that appraisal systems are mandatory, high quality, and consistent

GMC: Good Medical Practice

4 Domains – insufficiently sensitive for comprehensive assessment

12 Attributes – pragmatic level on which to base reasonable assessment

75 Standards – too complex to expect all doctors to present evidence on each one

Domain 1

Knowledge, skills and performance

Maintain your professional performance Apply knowledge and experience to practice

Keep clear, accurate and legible records

Domain 2Safety and quality

Put into effect systems to protect patients and improve care

Respond to risks to safety

Protect patients and colleagues from any risks posed by your health

Domain 3Communication, partnership and teamwork

Communicate effectively Work constructively with colleagues and delegate effectively

Establish and maintain partnerships with patients

Domain 4Maintaining trust

Show respect for patients Treat patients and colleagues fairly and without discrimination

Act with honesty and integrity

Good Medical Practice Attributes

Type of InformationNumber required in

five years Provided by

1 Significant event review/Case review 10 Dr/RO

2 Formal complaints review All Dr/RO

3 Audit/data collection and review 5 Dr/RO

4 Patient feedback survey and review 1 RO/RC

5 Colleague feedback survey and review 1 RO/RC

6 New PDP and review of previous PDP 5 Dr/Appraiser

7 CPD completion 5 RC

8 Specialist skills/knowledge assessment 5 RC

9 Probity self-declaration/review 5 Dr

10 Health self-declaration/review 5 Dr

11 Other information defined by organisation/RC All Dr/RO/RC

12 Review of all items in the context of GMP 5 Dr/Appraiser

‘Generic’ Portfolio

Multi-source (“360”) feedback

From colleagues

From patients (where appropriate)

Appraiser must know how MSF works, including statistical validity

Feedback of results must be done well

Timetable

Licenses issued to all doctors who requested them and on the GMC register in November 2009

Re-licensing will be based on future participation in appraisal

Re-certification proposals to be piloted in all specialities in 2010/11, to start probably in 2011

Guidance on approved MSF tools shortly

What do I need to do now?

1. Gather detailed evidenceCPDWorkload - hospital episode statisticsAuditsTeaching and other rolesReviews of significant events or interesting casesComplaints or concernsMSF - colleagues (and patients)Health- and reflect!

What do I need to do now?

2. Establish contact with relevant Royal College

Website

Colleagues

Direct

They are defining standards and methods of evaluation

What do I need to do now?

3. Keep up to date with developments

GMC

Royal Colleges

Revalidation Support

Websites

Literature

Colleagues

Direct

Any questions?

?