Revalidation: What Is It?

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Revalidation What Is It?

• New unified system of Reflective CPD feedback
  to improve
• Awareness of educational/professional needs
• Quality of care
• Confidence (patients, public, employers,
  colleagues)
• Addresses Current inconsistencies in re-mediation
• Incorporates relicenship recertification
• for all UK-licensed doctors

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Revalidation Why When?

• NHS Plan 2001
• Annual appraisal GMS contractual obligation
• Scotland compulsory since 2003
• /- inclusion on Performers List
• Previously
• CPD 360 feedback /-supervision
• NES led with local GP appraisers
• 1-2h Formative session(i.e. Feedback not
  Pass/Fail)

• Now
• Strengthen existing system
• Annual peer-led appraisal
• Continuous process
• Actioned every 5-year cycle
• Current pilots
• Inc nPEP in Dundee
• Phased-in from April 2011

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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

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Good Medical PracticeGMCs 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

• Communication, Partnership, Teamwork
• Communicate effectively
• Works constructively / delegates
• Partnerships with patients

• Maintaining Trust
• Respect for patients
• Treat others without discrimination
• Act with honesty integrity

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• Supporting Information
• Colleague Patient Feedback
• CPD records
• Clinical Audit

Annual Appraisal Over 5-year period with local
appraiser

• Medical Royal College / Faculty
• Define standards for appraisal supporting
  information
• Providing speciality guidance advice for
  appraisers, appraisees and Responsible Officers

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• New role Health and Social Care Act 2008
• Senior doctor within healthcare organisation e.g.
  medical director
• Supported by experienced GP adviser and trained
  lay person
• Review supporting information submitted for
  several thousand doctors
• Thus Appraiser has key-role in informing the
  Responsible Officer

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

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GMC RevalidationSingle-process

• Relicensure license to practise on medical
  register (i.e. NHS doctor, prescribe death
  certification) in accordance with the GMCs
  generic standards GMC driven
• Recertification (re-accreditation) certificate
  confirms doctors meet standards appropriate to be
  on GMCs GP Register RCGP driven
• Support As a backstop, to identify for further
  investigation/remediation, doctors whose practice
  is/may be impaired

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• Supporting Evidence
• CPD credits
• Personal Development Plans
• Appraisal

What do I need to do?
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Portfolio 13 evidence areas

1. Profession Role description of work
2. Special Circumstances e.g. maternity/sick/sabbati
   cal, job change
3. Annual Appraisals Review signed-off
4. PDP PDP for each annual appraisal
5. PDP Reviews
6. 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/Health
13. /- Extended Practice e.g. OOH, GPwSI,
    teaching/research

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Revalidation ePortfolio

• Supporting information (evidence) used for
  annual appraisal
• RCGP College Revalidation ePortfolio
• Most GPs will include information from April 2009
  
• Easy, intuitive data entry to allow easy review
  of progress
• Structured to encourage reflection
• Traffic-light-coded dashboard summary
• Integrate other online-tools
• Essential Knowledge Update (EKU) scenario-based
  learning
• Essential Knowledge Challenge (EKC)
  multiple-choice, voluntary
• PEP, e-GP, RCGP trainee ePortfolio, NHS appraisal
  toolkit

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The Early Years
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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 FACTOR
• Each 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

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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

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Personal Development PlanRCGP Guide to the
Revalidation of GPs. Jan 2010. version 3.0
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Special Consideration

• Maternity leave
• Work Abroad
• Sessional GPs
• GPs in remote or small practices
• GPs in Forces / Prison Service
• GPs in training
• Non-clinical (medical managers)
• ? re-entry portfolio

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Career Breaks RCGP Video May 2010

• Ordinary Portfolio requirements (within 5 year
  period)
• Appraisal 3 years
• Kept up-to-date (CPD) 3 years
• Clinical 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 continued
• Can re-apply when ready to go back
• If sustained period of time will need
  re-orientation
• Assessment
• Re-entry course

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Drawbacks

• Unfair
• Punitive process for wholly independent practice
• Older GPs electronic record and reflective
  practice
• Locums (paper record prescribing, referrals,
  feedback)
• Bureaucracy
• More political form-filling
• Wasted time away from clinical care
• Costs (implementing, carrying out, remediation)
• Uncertainty
• DoH terminating contracts of underperforming
  practices

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BJGP (July 2009476)

• Most doctors see revalidation as a focus for CPD
  to bring regulation and education together
• Some GPs the process seems like a bureaucratic
  nightmare and an inefficient way to weed out
  villains of the profession
• Need 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 accountable
• Collecting evidence of what we do is significant
  part of profession
• Needs to be properly resourced to avoid
  squeezing it in around proper work

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Public Interest

• Increasing climate of general loss of public
  trust increased awareness of medical error
• Bristol enquiry, Shipman, etc
• GMC figures April 2010
• 2,300 patients
• 14 not confident in last Dr seen
• 71 felt revalidation would boost confidence
• Inc 2/3 those quite/very confident

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Information for Patients

• Tell doctors when care is good
• Thank you letters, compliments
• Say when care is not as good as expected
• Talk, letter, formal
• Report when things go wrong
• Give views when asked

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Appraisal PerformanceCentral document
underpinning revalidation supporting GPs
through it

• Performance
• GMP Objectives
• Appraisal Standards
• 3 phases
• Preparation of evidence
• Submission Assessment
• Relicense/Remediate

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The Excellent, Good Unacceptable Dr
Standards

• Clinical Care
• Record keeping
• Access, Availability, OOH
• Resources
• Access to Medical Care
• Emergency Treatment

• Keeping Up To Date
• Training Assessing
• Dr-Pt Relationship
• Team-work
• Probity
• Health

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F

• A doctors certificate and registration cannot
  be restricted or removed, except through due
  process, under the GMCs fitness to practise
  rules and where there is evidence of impaired
  practice

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Remediation

• Small minority
• Early identification of concerns
• Follow up local support /action
• RCGP National Adjudication Panel after 2
  unsatisfactory appraisals
• Next stop GMC (can appeal)
• May defer decision to allow Dr to fill gaps in
  supporting info
• Outcome based on local, National Clinical
  Assessment Service or GMC process
• Re-entry portfolio
• Resourcing is key concern

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Other Countries

• Formal revalidation
• Germany
• Netherlands

• 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

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Summary

• Aims to continually improve
• Professional accountability
• Standards of Care
• Faith in doctors
• Taking into account
• Standards
• Clinical guidelines
• Good Medical Practice

• Accumulate evidence
• Annual appraisals
• Audits / SEA / Complaints
• Record learning hours
• Feedback
• Patients Colleagues
• Responsible officer review
• Every 5 years

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