Medical Revalidation
Ros Crowder, Primary Care Continuing Professional
Development Tutor, NHS Berkshire West &
Programme Manager, South Central Revalidation
Pilot, NHS South Central
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
The
initial
proposed
model
Revalidation
Re-Licensing
ReCertification
Is this doctor fit to practice
as a medical practitioner
in the UK?
Is this doctor fit to practice
as a specialist or
generalist?
General Medical Council
Royal Colleges & Faculties
Local Responsible Officer
General Medical
Council
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
Registration
Trainin
g
The
current
proposed
model
Qualification
Licence to
Practice
Changes in
role and
interests
Renewal of
Licence
Registration
(Specialist or GP)
Revalidation
Lifelong
General Medical Council
GMC
Affiliate
Professional
Board
Royal Colleges &
Faculties
Lay
Local
Responsible
Officer
Specialty
Specific
Assessments
Local Processes
Strengthened
Appraisal
Job Planning
Performance
Management
Clinical Audit
Clinical
Governance
‘r’ - low level
remedial support
‘R’ - high level
remedial support
Local Responsible Officer
Appraisal x 5
Portfolio of Evidence
Satisfactory
College/Faculty Quality
Assurance (audit of sample)
Query
College/Faculty (full
evidence review)
Satisfactory
Regulator
Positive Statement of Assurance
General Medical
Council
Informal Support
College/Faculty Plus
Local Responsible
Officer
Self-Help
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
The Appraisal
Balance
Challenge
Support
Personal
Development
Strengthened Medical Appraisal
1. 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 Information
Min. Required
in 5 Years
Comments
1
Significant Event Review/Case
Review
10
Minimum 2 per year
2
Review of Complaints
All
3
Audit (of which some may be less
formal data review)
5
Minimum 1 per year
4
Patient Feedback Survey and
Review
1
To be presented no later than yr 5
5
Colleague Feedback Survey and
Review
1
To be presented no later than yr 5
6
New PDP and Review of Previous
Year’s PDP
5
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 & Standards
GMC, 2005
4 Domains:
Knowledge skills & performance
Safety & quality
Communication, partnership & team
work
Maintaining trust
12 Attributes
70+ ‘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 and
resources
• To identify problems arising at
organisation and individual level in
implementing the proposed arrangements
• To identify any benefits related to the
appraisal and revalidation process eg
patient care and clinical outcomes
Whole system sites:
Isle of Wight
Milton Keynes
Royal Berkshire Foundation Trust
Voluntary 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 consultation
http://www.gmc-uk.org/doctors/licensing/5786.asp
• NHS South Central
http://www.southcentral.nhs.uk/page.php?id=433
• Revalidation Support Team
www.revalidationsupport.nhs.uk
• RCGP
http://www.rcgp.org.uk/_revalidation.aspx
• South Central Revalidation Pilot
http://www.southcentral.nhs.uk/page.php?id=433
• Ros Crowder / Maggie Woods, CPD Tutors
ros.crowder@southcentral.nhs.uk
Maggie.woods@southcentral.nhs.uk