Ros Crowder, Primary Care Continuing Professional Development Tutor, NHS Berkshire West &

Programme Manager, South Central Revalidation Pilot, NHS South Central

Medical Revalidation

Revalidation: what is it?• A system to assure patients and the public that

doctors are fit to practise, up to date and providing clinically effective, personal and safe care.

• Appraisal is part of revalidation and affirms professional practise and defines future learning plans

• Revalidation occurs within governance frameworks (GMC, DH & Royal Colleges) that aim to build trust, assure standards and improve patient safety

RevalidationRevalidationRevalidationRevalidation

Re-Re-CertificationCertification

Re-Re-CertificationCertificationRe-LicensingRe-LicensingRe-LicensingRe-Licensing

Is this doctor fit to Is this doctor fit to practice as a medical practice as a medical practitioner in the UK?practitioner in the UK?

Is this doctor fit to Is this doctor fit to practice as a medical practice as a medical practitioner in the UK?practitioner in the UK?

Is this doctor fit to Is this doctor fit to practice as a specialist practice as a specialist

or generalist?or generalist?

Is this doctor fit to Is this doctor fit to practice as a specialist practice as a specialist

or generalist?or generalist?

General Medical Council Royal Colleges & Faculties

General Medical Council

Local Responsible Officer

The initial proposed model

Revalidation – current thinking

• Licence to Practice issued to every doctor who requested one, October 2009

• The GP and Specialist Registers are a record of historical achievement; once on it the doctor will stay on it

• The Licence will reflect what a doctor is revalidated for and relicensing will be the main output from revalidation

Qualification

Registration

Renewal of Licence

Licence to Practice

Revalidation

Train

ing

Strengthened Appraisal

Every

5 Years

Life-long

Registration(Specialist or GP)

Changes in role and interests

The current proposed model

General Medical General Medical CouncilCouncil

General Medical General Medical CouncilCouncil

Local Local Responsible Responsible

OfficerOfficer

Local Local Responsible Responsible

OfficerOfficer

Royal Colleges Royal Colleges & Faculties& Faculties

Royal Colleges Royal Colleges & Faculties& Faculties

GMC GMC AffiliateAffiliateGMC GMC

AffiliateAffiliate

ProfessionaProfessionall

ProfessionaProfessionall LayLayLayLay

Local ProcessesLocal ProcessesLocal ProcessesLocal Processes

StrengtheneStrengthened Appraisald Appraisal

StrengtheneStrengthened Appraisald Appraisal Job PlanningJob PlanningJob PlanningJob Planning

PerformancPerformance e

ManagemenManagementt

PerformancPerformance e

ManagemenManagementt

Clinical Clinical AuditAudit

Clinical Clinical AuditAudit

Clinical Clinical GovernanceGovernance

Clinical Clinical GovernanceGovernance

Specialty Specialty Specific Specific

AssessmentsAssessments

Specialty Specialty Specific Specific

AssessmentsAssessments

BoardBoardBoardBoard

RegulatorRegulator‘‘R’ - high level R’ - high level remedial supportremedial support

‘‘r’ - low level r’ - low level remedial remedial supportsupport

Informal SupportInformal Support

College/Faculty Quality College/Faculty Quality Assurance (audit of sample)Assurance (audit of sample)

Port

folio

of

Port

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of

Evid

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Appra

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Appra

isal x 5

Loca

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Lo

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O

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Self-HelpSelf-Help

Colle

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acu

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Colle

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acu

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(fu

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(fu

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revie

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Colle

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acu

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Colle

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Offi

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Gen

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Gen

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Cou

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QueryQuery

Positive Statement of AssurancePositive Statement of Assurance

Satisfactory

Satisfactory

Appraisal is a tool which:• … helps individuals consider their performance

and their development needs in the context of:The requirements of their current role

The evolving needs of their organisation

Developments in their specialty/profession

Personal needs, wants, aspirations

Political imperatives

Appraisal is an opportunity to:• Review performance (and address issues)

• Consider the doctor’s contribution to the service

• Identify and address working environment issues

• Discuss opportunities and aspirations

• Discuss and plan personal development needs

• Balance skills and resources

Challenge

Personal Development

Support

The Appraisal Balance

Strengthened Medical Appraisal1. Common framework for appraisal, and

assessment of supporting information

2. Availability of supporting information to support the appraisal process

3. A common quality framework for appraisal

4. Effective local clinical governance systems

The appraiser’s role in strengthened medical appraisal (SMA)

• Ability to assess a portfolio of supporting information

• Ability to make judgements about the progress of an appraisee towards revalidation

• Ability to benchmark own personal standards against those of peers, and moderate individual judgements and assessments to achieve consistency with other appraisers

• What do appraisers do in SMA?• Manage the process of the appraisal interview

• Manage the content of the appraisal interview

• Review/Assess supporting information

• Make a judgement about whether there are any immediate concerns about patient safety

• Make a judgement about whether doctor is on track to revalidate (at this point in the cycle)

• Record the agreed outcomes of the appraisal interview

• Assist in the planning of development needs

Supporting information• Current GMC License and Registration• Complaints and Litigation• Adverse Incidents (incl. learning from)• Multi-source Feedback• Patient Satisfaction Questionnaires• Other pertinent documents

(e.g. audit; outcome measures)• Significant Event Audits• Specific items recommended by College• Anything else the appraisee thinks appropriate

RST Proposed Generic Essential Information

Type of InformationType of Information Min. Required Min. Required in 5 Yearsin 5 Years CommentsComments

1Significant Event Review/Case

Review10 Minimum 2 per year

2 Review of Complaints All

3Audit (of which some may be less

formal data review)5 Minimum 1 per year

4Patient Feedback Survey and

Review1 To be presented no later than yr 5

5Colleague Feedback Survey and

Review1 To be presented no later than yr 5

6New PDP and Review of Previous

Year’s PDP5 Annually

7 CPD Completion 5 Annually

8 Health Self Declaration and Review 5 Annually

9 Probity Self-Declaration and Review 5 Annually

RCGP Proposals for Continuing Education• Continuing education recorded in the form of

learning credits• At least 50 learning credits a year• More than 250 over 5-year revalidation cycle• Minimum of 1 credit for each hour of education• Each hour of education leading to improvements

in care or practice will qualify for 2 credits.

Good Medical Practice Domains, Attributes & StandardsGMC, 2005

4 Domains:Knowledge skills & performanceSafety & qualityCommunication, partnership & team workMaintaining trust

12 Attributes70+ ‘standards’

Assessing supporting information

• Does it suggest cause for immediate concern?

• Which attribute(s) of GMP does it inform?

(NB Many items will inform more than one attribute.)

• Does it show evidence of personal reflection?

• Does it contribute to revalidation:• Yes, on it’s own (e.g. colleague and patient feedback)

• Yes, if produced regularly (e.g. outcome data)

• Not as it stands, because … (e.g. incomplete)

• No, it doesn’t reflect what the doctor does

• Has the doctor met the CPD recommendations of their College/Association?

• What learning needs (if any) does it identify

Conclusion by Appraiser …A) Potential risk:• Are there genuine immediate concerns about this doctors practice?• If yes, are measures in place to protect patients, colleagues, the doctor and

the public? (with detail)

B) Areas for development:• Are there areas where the doctor’s performance has not been clearly

demonstrated to be of a satisfactory standard with regard to the guidance expressed in GMP?

• Does the PDP cover all areas that the doctor needs to address, with timeframes?

C) Revalidation:• Are there areas where the doctor’s progress towards satisfactory

Revalidation may be in doubt? • Have these been identified and understood, with an appropriate plan in

place?

The appraiser’s judgement and evidence from the organisation’s clinical governance systems will inform the Responsible Officer’s recommendation to the GMC.

Revalidation Support Team Pathfinder pilots• 3000 appraisals across England• Whole system testing• Testing Information flows• Nominated “Responsible officer” role• Preparation for “live” testing• Evaluation to inform Treasury impact

assessment• Single & Multi organisational• Advanced and early stage sites• Range of doctor specialties and roles

High level aims• To identify the impact on individuals and

organisations in terms of cost, time andresources

• To identify problems arising atorganisation and individual level inimplementing the proposed arrangements

• To identify any benefits related to theappraisal and revalidation process egpatient care and clinical outcomes

Whole system sites:Isle of WightMilton KeynesRoyal Berkshire Foundation TrustVoluntary sites:Other South Central organisations

Participation in the pilot:• Consent• Agree to complete evaluation forms• Strengthened Training of Appraisers for

Revalidation (STAR)• Register on electronic toolkit• Collect supporting information for appraisal on

toolkit & map to GMC attributes• Appraisal discussion• Evaluation• Responsible officer review

Further information:• GMC consultationhttp://www.gmc-uk.org/doctors/licensing/5786.asp• NHS South Centralhttp://www.southcentral.nhs.uk/page.php?id=433• Revalidation Support Teamwww.revalidationsupport.nhs.uk• RCGPhttp://www.rcgp.org.uk/_revalidation.aspx• South Central Revalidation Pilothttp://www.southcentral.nhs.uk/page.php?id=433• Ros Crowder / Maggie Woods, CPD Tutorsros.crowder@southcentral.nhs.ukMaggie.woods@southcentral.nhs.uk