Revalidation: What Is It?New unified system of Reflective CPD & feedback to improve:Awareness of educational/professional needsQuality of care Confidence (patients, public, employers, colleagues)Addresses Current inconsistencies in re-mediation

Incorporates relicenship & recertification for all UK-licensed doctors

Revalidation: Why & When?NHS Plan 2001 Annual appraisal GMS

contractual obligation Scotland: compulsory since

2003 +/- inclusion on

Performer’s List

Previously CPD + 360° feedback +/-

supervisionNES led with local GP

appraisers1-2h Formative session(i.e.

Feedback not Pass/Fail)

Now Strengthen existing systemAnnual peer-led appraisalContinuous process Actioned every 5-year cycle

Current pilots Inc nPEP in DundeePhased-in from April 2011

Key Documents

“Trust, Assurance & Safety – The Regulation of Health Professionals in the 21st Century” Feb 2007

“Good Medical Practice for General Practitioners” 2008

“Medical revalidation – Principles & Next Steps” 2008“GMC Licence to Practice” Nov 2009

“RCGP Guide to Revalidation” Jan 2010

“Revalidation: The Way Ahead. Consultation Document” March 2010

Good Medical PracticeGMC’s standards of Professional Duty for all doctors 4 domains, 12 attributes

Knowledge, Skills & Performance

Maintain Professional Performance

Apply Knowledge & Experience to Practice

Clear, accurate, legible records

Safety & Quality

Systems to protect patients & improve care

Respond to safety risks Protect others from risks of own

health

Maintaining Trust

• Respect for patients• Treat others without

discrimination• Act with honesty & integrity

Communication, Partnership, Teamwork

• Communicate effectively• Works constructively /

delegates• Partnerships with patients

Annual AppraisalOver 5-year period with local appraiser

Supporting Information:• Colleague & Patient Feedback• CPD records• Clinical Audit Medical Royal College /

Faculty: • Define standards for appraisal & supporting information• Providing speciality guidance & advice for appraisers, appraisees and Responsible Officers

Annual AppraisalOver 5-year period with local appraiser

Supporting Information:• Colleague & Patient Feedback• CPD records• Clinical Audit Medical Royal College /

Faculty: • Define standards for appraisal & supporting information• Providing speciality guidance & advice for appraisers, appraisees and Responsible Officers

Responsible OfficerReceives feedback on

appraisal

New role [Health and Social Care Act 2008]Senior doctor within healthcare organisation e.g. medical

directorSupported by experienced GP adviser and trained lay

personReview supporting information submitted for several

thousand doctorsThus Appraiser has key-role in informing the Responsible

Officer

Responsible OfficerMakes revalidation recommendation to

GMC

GMC: Doctor Revalidated

Annual AppraisalOver 5-year period with local appraiser

Supporting Information:• Colleague & Patient Feedback• CPD records• Clinical Audit Medical Royal College /

Faculty: • Define standards for appraisal & supporting information• Providing speciality guidance & advice for appraisers, appraisees and Responsible Officers

Responsible OfficerReceives feedback on

appraisal

Quality Assurance• Royal Colleges• System regulators (e.g. The Care Quality Commission)• GMC

GMC Revalidation:“Single-process”

Relicensure: license to practise on medical register (i.e. NHS doctor, prescribe & death certification) in accordance with the GMC’s generic standards [GMC driven]

Recertification (re-accreditation): certificate confirms doctors meet standards appropriate to be on GMC’s GP Register [RCGP driven]

Support: As a backstop, to identify for further investigation/remediation, doctors whose practice is/may be impaired

License to Practise

Certificate to be on the GP

register

5-Yearly Relicence

5-Yearly Recertification

One-Process Revalidation

Supporting EvidenceCPD credits

Personal Development Plans

Appraisal

What do I need to do?

Portfolio: 13 evidence areas1. Profession Role description of work

2. Special Circumstances e.g. maternity/sick/sabbatical, job change

3. Annual Appraisals Review signed-off

4. PDP PDP for each annual appraisal

5. PDP Reviews6. Continuing Education ≥50 learning credits/year

7. Multi-Source Feedback 2 x MSF every 5 years

8. Patient Feedback 2 x PSQs every 5 years / 1 + video-analysis

9. Formal Complaint Review if any

10. Significant Event Audits 5 x SEA every 5 years

11. Clinical Audits 2 x full-cycle audits every 5 years

12. Probity/Health13. +/- Extended Practice e.g. OOH, GPwSI, teaching/research

Revalidation ePortfolio“Supporting information” (evidence) used for annual

appraisalRCGP College Revalidation ePortfolioMost GPs will include information from April 2009

Easy, intuitive data entry to allow easy review of progressStructured to encourage reflectionTraffic-light-coded ‘dashboard’ summary

Integrate other online-toolsEssential Knowledge Update (EKU): scenario-based learningEssential Knowledge Challenge (EKC): multiple-choice,

voluntaryPEP, e-GP, RCGP trainee ePortfolio, NHS appraisal toolkit

The

Early

Years

Learning Credits All colleges agree - record continuing education in the form of

learning credits At least 50/year = 250 over a full 5-year revalidation cycle

RCGP: 1 credit = 1 hr education (learning, planning, reflecting) Self-assessed then reviewed at appraisal

IMPACT FACTOREach hour of education that can been shown to lead to

improvement in care or practice will qualify for 2 credits Impact on

Patients e.g. Implement new guideline / initiate new drug Individual e.g. new / further developing skill Service e.g. new service / becoming training practice Others e.g. Teaching, training, NHS services

HF Meeting (1h)

Dr A: Logs learning (knowledge & relevance)

Dr B:As Dr A 2 case studies of appropriate B-blockers use in HF

Dr C:As Dr A + plans an audit (1h) + discusses findings (1h)Change implemented & 2nd cycle demonstrates change

1 credit

6 credits

2 credits

1 credit

Impact Factor x 2

Special ConsiderationMaternity leave Work Abroad

Sessional GPsGPs in remote or small practicesGPs in Forces / Prison ServiceGPs in trainingNon-clinical (medical managers)

? re-entry portfolio

Career Breaks RCGP Video May 2010Ordinary Portfolio requirements (within 5 year period)Appraisal ≥3 yearsKept up-to-date (CPD) ≥ 3 yearsClinical Activity ≥ 200 half-day clinical sessions

Otherwise Responsible Officer may d/w RCGP / GMC

Out-of-practice at time licence up for revalidation...License may not be continuedCan re-apply when ready to go backIf “sustained” period of time will need “re-

orientation”AssessmentRe-entry course

Drawbacks“Unfair”Punitive process for wholly independent practiceOlder GPs & electronic record and reflective practiceLocums (paper record prescribing, referrals,

feedback)

“Bureaucracy”More political form-fillingWasted time away from clinical careCosts (implementing, carrying out, remediation)Uncertainty DoH terminating contracts of underperforming

practices

BJGP (July 2009:476)Most doctors see revalidation as a focus for CPD to bring

regulation and education togetherSome GPs the process seems like a bureaucratic nightmare

and an inefficient way to weed out villains of the professionNeed to move away from this idea if revalidation is to reach

its potential (improve care, reassure public/profession, support)

Society wants doctors to be more accountableCollecting evidence of what we do is significant part of

professionNeeds to be properly resourced to avoid “squeezing it in”

around “proper work”

Public InterestIncreasing climate of general

loss of public trust & increased awareness of medical errorBristol enquiry, Shipman, etc

GMC figures April 20102,300 patients14 % not confident in last Dr

seen71% felt revalidation would

boost confidence Inc 2/3 those quite/very confident

“Information for Patients”Tell doctors when care is good

Thank you letters, compliments

Say when care is not as good as expectedTalk, letter, formal

Report when things go wrong

Give views when asked

Appraisal Performance“Central document underpinning revalidation & supporting GPs through it”

Performance GMP Objectives =

Appraisal Standards

3 phases:Preparation of

evidenceSubmission &

Assessment Relicense/Remediate

The Excellent, Good & Unacceptable DrClinical CareRecord keepingAccess, Availability,

OOHResourcesAccess to Medical

Care Emergency

Treatment

Keeping Up To DateTraining &

AssessingDr-Pt RelationshipTeam-workProbityHealth

Standards

F“A doctor’s certificate and

registration cannot be restricted or removed, except through due process, under the GMC’s fitness to practise rules and where there is evidence of impaired practice”

RemediationSmall minority Early identification of

concerns Follow up local support

/actionRCGP National Adjudication

Panel after 2 unsatisfactory appraisals

Next stop GMC (can appeal)May defer decision to allow Dr

to fill gaps in supporting infoOutcome based on local,

National Clinical Assessment Service or GMC process

Re-entry portfolioResourcing is key concern

Other CountriesFormal revalidationGermanyNetherlands

Netherlands ‘Herregistratie’

(recertification) 2001 OOH mandatory, thus

older GPs felt discriminated against

Initially required GPs complete whole 3 y of GP-training again

2002 1-year programme started 4 days/week supervised work + 1 day education

SummaryAims to continually

improve:Professional

accountabilityStandards of CareFaith in doctors

Taking into accountStandards

Clinical guidelinesGood Medical Practice

Accumulate evidence:

Annual appraisalsAudits / SEA /

ComplaintsRecord learning hoursFeedback

Patients & Colleagues Responsible officer

review Every 5 years