RCGP International

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RCGP International
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• Differences of habit and language are nothing
  at all if our aims are identical and our hearts
  are open
• J. K. Rowling,
• Harry Potter and the Goblet of Fire

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The role of the general practitioner

• has not changed. It is open-ended, inclusive
  rather than exclusive, dealing in wholes not
  parts.
• It is personal, it is continuing, it means
  making the patients feel you care about each one
  of them, it is about respect, trust, independence
  and personal integrity.

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The role of the general practitioner

• .It is founded on science, and yes, yes,
  evidence, but it also involves the reconciliation
  of incompatibles, irrationalities and impossible
  expectations.
• It rejects the inhuman and the formulaic. It
  involves privileged access to other peoples
  deepest secrets, their bodies, and yes, their
  homes.

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General Practice the Jewel in the NHS Crown

• Almost one million people visit their GP every
  day
• Almost 90 of problems are dealt with in general
  practice
• About 350 million consultations with general
  practitioners per year
• 78 of people consult their general practitioner
  at least once during the year
• 1.5 million prescriptions issued on average on a
  daily basis

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• that academic GPs and researchers in the UK are
  doing brilliant work that helps all GPs raise the
  standards of care we provide for our patients. 

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RCGP International
RCGP GP Federations
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• Change will not come
• if we wait for
• some other person
• or some other time

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• "It is not the strongest
• of the species that survive,
• not the most intelligent,
• but the one most responsive to change."
• Charles Darwin

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GP Federations
The RCGP GP Federations

• The RCGP Roadmap (Sept 2007)
• introduced the concept of Primary Care
  Federations, with practices working to share
  resources, expertise and services. (before
  Polyclinics!!)
• Primary Care Federations putting patients
  first (June 2008)
• builds on and preserves the strengths of general
  practice
• shows how services can be extended to meet the
  new challenges ahead. 

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Federations and Teams without walls
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Paul Corrigan's Slide which asserts.London can
build a new delivery model using 6 types of
institution
LOX-LN4682-20061203-BVSJ
Darzi NHS Next Stage Review
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Direction of travel NHS reforms
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The RCGP GP Federations
Diagnosis, enhanced services and ambulatory
care provided by specialists and generalists
Systematic functions of a federated model in
2015 Improving health and equity Early
diagnosis and problem definition Comprehensive
and accessible services Navigation
and integration of care Quality and
safety systems Commissioning and
Resource management Teaching and research
Aggressive long-term condition management
Practice Team
Practice Team
Practice Team
Community Network Facility
Practice Team
Practice Team
Practice Team
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GP Federations
The RCGP GP Federations

• Strength in collective working between GP
  Practices to benefit Patients
• Better access to GP services (cf opening hours)
• Different ways of accessing services (unscheduled
  / pre-booked)
• Services closer to home in GP settings
• Strong patient representation and involvement
• Tailored services designed to address very local
  needs
• Improved choice and access to a wider range of
  services
• A greater emphasis upon health promotion
• Continuity of care, with links to patients own GP

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GP Federations
The RCGP GP Federations

• Strength in collective working between GP
  Practices to benefit Practices and GPs
• Help ensure the continued viability of primary
  care reduce isolation, shared learning,
  improved quality and mutual support for
  regulation
• Enable GPs to maintain a high degree of autonomy
  to drive the agenda pro-actively
• Economies of scale management, Admin, premises
• Effective care referrals, service range,
  Integration, EBM
• Cost effectiveness service delivery,
  maximising income c.f. Recession
• Commissioning and beyond

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GP Federations
The RCGP GP Federations

• Barriers to collective working between GP
  Practices
• Herding Cats!
• Opinionated individualism / self importance?
• Corporate working?
• Strategic outlook?
• Leadership qualities ?
• Implementing Innovation not invented here
  syndrome
• Small business corner shop mentality?
• Invest to save speculate to accumulate?
• Are we other GPs greatest critics?

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Towards High Quality Responsive General Practice

• Established November 2007
• 16 self selected GP Practices
• 140,000 registered population
• from different parts of Croydon work
  collaboratively
• To explore new models of working to deliver more
  improvements more rapidly.

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Towards High Quality Responsive General Practice

• Croydon Federation is underpinned by a legal
  accountability agreement between member
  practices
• a not for profit organisation
• It is not a Practice Based Commissioning (PBC)
  Group / Consortium, Limited Company, Limited
  Liability Partnership, Social Enterprise, nor is
  it a provider organisation
• The underpinning accountability agreement allows
  individual practices to lead and tender for
  services on behalf of the Croydon Federation

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GP Federations
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GP Federations

• November 2007 Croydon Federation formed
• February 2008 diagnostics in the Community
  Pilot went live
• Ultrasound Echo from six GP surgeries direct
  access to MRI
• less than 3months from conception to
  implementation (an NHS first??)
• April 2008 Integrated community leg ulcer
  clinic commenced
• May 2008 Pathway re-design
• Heart failure availability of echo and
  involvement of the Heart Failure nurse in the
  pathway
• Low back pain pathway due to availability of
  direct access MRI
• Musculoskeletal pathway supported by
  availability of ultrasound of Joints and direct
  access MRI
• Gynaecology Pathway due to convenient and easy
  access to Transvaginal ultrasound scanning

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GP Federations
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GP Federations

• June 2008 Clinical Champions Programme started
• Heart Failure, Learning Difficulties, Cardiac
  Arrythymias, COPD, Paediatrics
• July 2008 visit by RCGP Chair, enquires from
  PMDU and mentioned in Hansard.
• September 2008 Funding secured by Learning
  Difficulties Clinical Champion for a pilot study
  involving Learning Difficulties and the patients
  in a range Federation Practices
• November 2008 Further Clinical Champion
  Palliative Care appointed
• December 2008 HSJ Award Improving Access
  Category Winners

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GP Federations

• January 2009 - Rt Hon Alan Johnson, Secretary of
  State for Health visits to congratulate the
  Croydon Federation
• February 2009 concept of ST4 trainees attached
  to the Croydon Federation under consideration by
  London Deanery
• March 2009 3 month Improving GP access and the
  In Hours Urgent Care response and Patient Survey
  completed (To be presented at the KINGs FUND in
  June 2009)
• March 2009 Teledermatology pilots being scoped
• April 2009 Rapid Intervention Psychological
  Therapies pilot being scoped

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We must becomethe changewe wantto see in the
world

• Mahatma Ghandi

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RCGP International
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RCGP International
Revalidation
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Revalidation an update
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• Shipman Inquiry
• Very critical of appraisal and GMCs proposals
  for revalidation
• House of Commons Public Accounts Committee Report
• Clinical governance is not as well established in
  primary care
• Lack of clarity between PCTs and their
  contractors as regards accountability for
  ensuring quality and safety
• CMOs Revalidation Working Group / KPMG
• Description of Clinical Governance and appraisal
  being patchy
• In primary care, structures also by and large in
  place though concerns re contractual status and
  to extent by which they large number of
  relatively small organisational units provide
  specific information about individual
  practitioners
• Formative system problem of partiality and
  selectivity and doesnt routinely draw on hard
  data from clinical governance systems

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The CMOs proposals
The CMOs proposals

• Revalidation i
• Needs to support doctors to meet their personal
  professional commitment to continually sustaining
  and developing their skills
• Include strong element of patient participation
  and evaluation of the work of their doctors
• Should be a supportive process to raise standards
  across the board not simply a way to identify a
  few poor performing doctors

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The CMOs proposals
The CMOs proposals

• Revalidation ii
• The appraisal system is the key
• Sound local clinical governance systems are
  essential but must avoid bureaucracy
• Needs remediation and rehabilitation system
• Rolling process over 5 years, not one single
  event
• Introduced incrementally piloting
• Need consistency across the UK

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Revalidation
The RCGP Revalidation for GPs

• The RCGP Prototype

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The purpose of Revalidation

• Relicensing To demonstrate that licensed doctors
  practise in accordance with the GMCs generic
  standards
• Recertification For GPs on the GP register,
  confirm that they continue to meet the standards
  that apply to the discipline of general practice)
• Also. To identify those doctors who need further
  investigation or remediation (as a backstop where
  local systems are not robust or dont exist)  

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The main tasks for the RCGP

• Work with key partners to
• Define the general standards against which
  revalidation will be assessed
• Define the specific criteria, standards and
  evidence to be used in revalidation
• Describe a system for revalidation
• Undertake pilots
• Gain GMC approval and launch in 2010/11

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Good Medical Practice for GPs

• The foundation stone
• Published July 2008
• Wide consultation
• RCGP GPC support
• Defined the general standards against which
  revalidation will be assessed
• www.rcgp.org.uk

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The second task for the RCGP

• Define the specific criteria, standards and
  evidence to be used in revalidation
• Mapped to GMC Framework
• Consultation completed in January 2009
• Over 400 responses, mostly positive

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The second task for the RCGP

• Ten criteria
• Clinical and communication skills
• Maintenance of knowledge and skills
• Reflective practice and quality assurance
• Relationship with colleagues
• Record keeping
• Trained and fit for all roles undertaken
• Good delegation
• Training, teaching and research
• Probity
• Health

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The 13 items of evidence

• 1. A description of all the professional roles
  undertaken by the general practitioner and
  demographic data
• presented in year one and updated annually
  reflecting any change in roles
• 2. Exceptional Circumstances
• E.g. prolonged absence, sickness etc

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The 13 items of evidence

• 3. Evidence of active and effective participation
  in a cycle of five annual appraisals over the
  five year revalidation cycle.
• 4. A personal development plan (PDP) for each
  year agreed with the appraiser
• presented annually year one to five

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The 13 items of evidence

• 5. A review of the previous years PDP, with
  reflection on whether educational needs
  identified have been met or reasons as to why
  they have not been or only partially been met
• 6. Self-accreditation of a minimum of 250
  learning credits over the 5 year revalidation
  cycle, normally at least 50 credits each year,
  discussed and agreed at annual appraisal

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The 13 items of evidence

• 7. Results of at least two multi-source feedbacks
  from colleagues, with evidence of reflection,
  appropriate change and discussion in appraisal
• 8. Results of at least two patient surveys of
  their consultations and care during the
  revalidation cycle, with evidence of reflection,
  appropriate change and discussion in appraisal

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The 13 items of evidence

• 9. A review of any formal complaint in which the
  doctor has been directly involved, with a
  description of the circumstances, lessons learnt,
  and appropriate actions taken, and evidence of
  discussion in appraisal. In cases where there
  have been no complaints this should be recorded
• 10. A minimum of five significant event audits
  involving the GP that demonstrate reflection and
  change, with evidence of discussion in appraisal
  can be presented at any point during the five
  year cycle

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The 13 items of evidence

• Audits of your care in at least two significant
  clinical areas of your practice, with standards,
  re-audit and evidence of both appropriate
  improvement, compliance with best practice
  guidelines and discussion in appraisal
• 12. Statements of probity, health and
  appropriate use of health care, including
  registration with an independent GP evidence of
  appropriate insurance or indemnity cover

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The 13 items of evidence

• There will be additional evidence required if you
  are
• Teacher or trainer
• In any extended clinical role (such as GP with
  Special Interest)
• Appraiser
• Researcher etc

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The third task for the RCGP

• Describe a system for revalidation
• E-Portfolio extension of the Appraisal
  portfolio
• Submission to Responsible Officer
• RO does initial assessment into 3 categories
• RO, RCGP Assessor and Lay Assessor meet
• Recommendation to GMC for revalidation OR
  referral to RCGP centrally
• RCGP sampling for quality assurance

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The third task for the RCGP

• Managed CPD scheme
• E learning
• E Portfolio
• Essential General Practice
• EGP Knowledge Challenge
• Accredited CPD 50 Credits
• Quality awards
• Practice Accreditation / QPA

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The remaining tasks for the RCGP are to.

• Publish and evolve full revalidation guidance
  done
• Undertake pilots started
• Gain GMC approval
• Launch in 2010/11

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• If you're walking
• down
• the right path and
• you're willing
• to keep walking,
• Eventually you'll
• make progress

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RCGP International
The RCGP the heart and voice of general practice