Revalidation and Relicensing

1
Revalidation and Relicensing

• Professor Sir Graeme Catto
• BMA
• Annual Staff and Associate Specialist Conference
• 19 June 2008

2
Revalidation history

• 2000 - Revalidating Doctors, GMC consultation
  document
• 2004 - The Shipman Enquiry, Fifth Report
• 2006 - Good doctors, safer patients, a report by
  the CMO for England
• 2007 - Trust, Assurance and Safety The
  Regulation of Health Professionals in the 21st
  Century
• 2007 Medical Revalidation and Education Working
  Group (led by Sir Liam Donaldson)

3
White Paper Revalidation

• Revalidation to have two components
• relicensing, and
• specialist or general practice recertification

4
White Paper Relicensing

• all doctors will have a licence to practise
• This licence to practise will have to be renewed
  every five years to bring objective assurance of
  continuing fitness to practise, the appraisal
  process will include summative elements which
  confirm that a doctor has objectively met the
  standards expected.
• White Paper Chapter 2

5
Relicensing

• Agreed generic standards of practice set by the
  GMC
• Revised system of appraisal with a judgement
• 360 degree multi source feedback
• Resolution of any known concerns
• Positive affirmation of a doctors fitness to
  practise by a Responsible Officer

6
Relicensing

• The function of relicensing is to help drive
  quality improvements in the delivery of good care
  for patients
• Appraisal helping to identify developmental
  skills needs for delivering better care for
  patients
• Linked to the needs of the service
• Resources required to support quality
  improvements

7
White Paper Recertification

• Only for those doctors on the GP and Specialist
  Register
• Standards will be drawn up for each area of
  specialist recertification by the RCs and
  specialist associations
• Recertification will be based on a comprehensive
  assessment against the standards drawn up by the
  relevant college

8
White Paper Recertification

• The evidence that provides the basis for
  specialist recertification will vary between
  specialties.Evidence may be drawn from a range
  of sources and activities, including employer
  appraisal, clinical audit, simulator tests,
  knowledge tests, patients feedback, continuing
  professional development or observation of
  practice
• White Paper Paragraph 2.20

9
White Paper proposals

• Direction of travel and timetable.......

10
Health Social Care Bill Responsible Officers

• All licensed doctors will relate formally to a
  responsible officer
• Responsible officers will have new
  responsibilities in relation to regulation and
  revalidation
• DH(England) expect that ROs will be in place in
  all healthcare organisations in England by late
  2009

11
Licence to Practise

• GMC to issue licences (as a first step towards
  re-licensing) as soon as it is practicable to do
  so.
• Legislation will be in place by early 2009 to
  enable the GMC to introduce licensing
  summer/autumn 2009
• All registered doctors will be entitled to a
  licence to practise but some may choose to
  maintain registration only
• Only licensed doctors will be subject to
  revalidation
• 240,000 registered doctors/150,000 in active
  practice

12
What the White paper says - GMP

• To support relicensure, the DH will ask the GMC
  to consult with its key constituencies to
  translate its recent update of Good Medical
  Practice into an effective framework against
  which individual doctors practice can be
  appraised and objectively assessed.

13
Moving forward Good Medical Practice

• Translating Good Medical Practice into generic
  standards and then an effective framework
• Four new domains to form the basis of 12 generic
  standards
• Knowledge, skills and performance
• Safety and quality
• Communication, partnership and teamwork
• Maintaining trust

14
Moving forward Good Medical Practice

• Knowledge, skills and performance
• Generic Standards
• Maintain your professional performance
• Apply knowledge and experience to practice
• Keep clear, accurate and legible records
• Suggested Criteria for compliance, for example
• Keep knowledge and skills up to date (12)
• Participate in regular and systematic audit (14c,
  41d)
• Manage colleagues effectively (42)
• Adequately assess the patients conditions (2a)

15
Moving forward Good Medical Practice

• Possible Sources of Evidence?
• Evidence from training or assessment of skills
• CPD
• Audit
• Tools for feedback about doctors practice

16
MSF/Questionnaires

• Range of feedback tools being developed Picker
  Institute, AMRC, Royal Colleges
• GMC Patient and Colleague questionnaires
• Utility in ranking doctors performance
• Potential to identify outlying low performance
• Further research has been commissioned
• GMC to develop criteria/principles that any MSF
  tool would need to meet for revalidation purposes

17
Recertification

• Must be based, as far as practicable on what a
  doctor actually does in practice
• One set of processes with two outcomes
• Appraisal will bind the two strands into one
  process
• Process of relicensure and recertification will
  draw on largely the same evidence.

18
Recertification Some challenges

• Specialist Register developed for a different
  purpose
• Up to 20 of doctors no longer work in the
  specialty in which they originally certified
• Consultants not on the Specialist Register
• SAS grade doctors
• Medical managers

19
Implementation

• Relicensing should start where local appraisal
  and clinical governance systems are developed and
  fit for purpose
• Recertification should start where preparations
  by individual Royal Colleges are well advanced
• Colleague and patient questionnaires should be
  used as screening tools where local systems are
  weak
• Further analysis on how best to translate the
  managed targeted approach into practice

20
Next steps

• Further legislation enabling us to issue the
  licence to practise
• Report of the Medical Revalidation and Education
  Working Group
• Further testing of questionnaires and the
  readiness of selected local systems to support
  revalidation
• Implementation Groups required to drive forward
  changes needed at a local and national level