Revalidation and anaesthesia - The Royal College of Anaesthetists

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Revalidation for anaesthetists
Liam Brennan
Council member & revalidation lead
Royal College of Anaesthetists
Update - June 2012

Introduction

Appraisal for revalidation

Timetable for revalidation & transitional arrangements

Supporting information

CPD

Review of clinical outcomes

Patient & colleague feedback

Doctors in training

Remediation

Obtaining advice
Why do we need Revalidation?
Revalidation: is it really going to happen?

Andrew Lansley’s letter to GMC, June 2010
•
•

House of Commons Health Select Committee, Feb 2011
•

Full support for revalidation
Extend piloting for a further year
GMC required to ensure ‘no further delays to late 2012 implementation of
revalidation’
House of Commons Health Select Committee, March 2012
•
‘’In the light of the importance of this process to the quality of services delivered to
patients, and of the status of the GMC as an independent regulator, the Committee looks
to the GMC to give early and public notice if it concludes that delivery of this timetable is
at risk.”
What is Revalidation?

It’s about providing assurance that all doctors with a
GMC license are up to date and fit to practice
What is Revalidation?

It’s about providing assurance that all doctors with a
licence are up to date and fit to practice

Based on continuing evaluation of current practice in the
context of everyday working environment

Based on local systems of annual appraisal that are based on the
GMC core guidance Good Medical Practice*

It is not a “point in time” assessment of knowledge & skills
* http://www.gmc-uk.org/guidance/good_medical_practice.asp
What is Revalidation?

It’s about providing assurance that all doctors with a
licence are up to date and fit to practice

Based on continuing evaluation of current practice in the
context of everyday working environment

Based on local systems of annual appraisal that are based on the
GMC core guidance Good Medical Practice

It is not a “point in time” assessment of knowledge & skills
A five year process NOT a fifth year event !
Appraisal/revalidation…..a continuing cycle
One
revalidation
cycle
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Second
revalidation
cycle
Appraisal/revalidation…..a continuing cycle
One
revalidation
cycle
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Appraisal
Second
revalidation
cycle
…..for each and all our professional
lifetimes!
GMC revalidation model
Portfolio of Supporting Information
Five x yearly appraisals
Employer liaison service
Specialty-specific advice
Responsible Officer
Recommend
revalidation
Request
deferral
Failure to engage
General Medical Council
What is appraisal?


“A professional process of constructive dialogue, in
which the doctor being appraised has a formal structured
opportunity to reflect on his/her work and consider how
his/her effectiveness might be improved”
“A positive process to give someone feedback on their
performance, to chart their continuing progress and to
identify developmental needs. It is a forward looking
process, essential for the development and educational
planning needs of the individual”
DH December 2002
Appraisal: for revalidation
Existing appraisal practice
Appraisal for revalidation

Clinical and non-clinical aspects
mapped to GMP


CPD reviewed against



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Core topics
Job plan
Clinical and non-clinical mapped to
four domains of GMP
Judgements on:
 Adequacy of supporting
information including:

Match job plan to Trust needs

Increased use of MSF

PDP taking account of the above


CPD
Audit
MSF
Clinical risks/safety
 Progress towards revalidation
Match job plan to Trust needs
PDP taking account of the above



Appraisal remains largely a formative
process but with summative components
www.revalidationsupport.nhs.uk
Revalidation: anticipated timetable
May/June 2012
Final organisational state of readiness
assessment (ORSA)
Summer 2012
Assessment of readiness and business case
prepared for Ministers
Sept/Oct 2012
Ministerial decision
By end of 2012
Enablement of necessary legislation
By 31 March 2013
All ROs to have revalidated
By 31 March 2014
~20% of doctors to have revalidated
By 31 March 2016
The ‘vast majority’ of doctors to have
revalidated
By 31 March 2018
All remaining doctors revalidated
• Challenge of non-affiliated doctors
• GMC ‘ making your connection’ campaign
Transitional arrangements

GMC aim to revalidate all doctors by March 2018

One appraisal minimum requirement

Procedure for selecting doctors for revalidation yet to be
announced; process may vary across the UK

Minimum of three months notice anticipated

All designated bodies expected to make some
recommendations in first year

GMC revalidation readiness statement (June 2012) available at:
http://www.gmc-uk.org/doctors/revalidation/13282.asp
Specialty specific supporting information
www.rcoa.ac.uk/docs/Revali
dation_doh_pilots.pdf
Final version published
late summer 2012
Supporting information
General information - providing context about what you do in all
aspects of your professional work
 Personal details
 Scope of whole practice (inc NHS, independent, voluntary)



Probity statement

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
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Anaesthetic/ICM/pain medicine caseload data
Data on complex procedures e.g. central access, regional blocks
Personal declaration of disciplinary, criminal or regulatory sanctions
Competing interests e.g. financial or other
Any declarations of professional conduct/performance of others
Personal health declaration

Self-declaration of health issues that could pose a risk to patients
Supporting information
Keeping up to date- Maintaining and enhancing the quality of
your professional work
 Continuing professional development (CPD)
Review of your clinical practice - Evaluating and improving
the quality of your professional work
 Clinical audit
personal, local, national
 Participation in at least one complete audit in a 5 year cycle
 Not everyone has to lead an audit but ‘active engagement’ by all


Significant untoward events


Personal reflection and lessons learnt by dept/ whole organisation
Clinical outcome measures
Supporting information
Feedback on your practice – how others perceive the quality
of your professional practice
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Colleague multi-source feedback (MSF)
Patient/carer MSF
Feedback from clinical supervision, teaching & training
Formal complaints
Compliments
Continuing Professional
Development (CPD)
GMC principles of CPD
•
Responsibility for personal learning
Personal responsibility for identifying your CPD needs, planning how they should be addressed and undertaking CPD
that will support professional development and practice
•
Reflection
Good Medical Practice requires you to reflect regularly on your standards of medical practice
•
Scope of practice
You must remain competent and up-to-date in all areas of your practice
•
Individual and team learning
CPD activities should aim to maintain and improve the standards of your practice and teams in which you work
•
Identification of needs
CPD activities should be shaped by assessment of your professional needs and the needs of the service and the
people who use it
•
Outcomes
You must reflect on what you have learnt through your CPD and record any impact or expected impact on your
performance and practice
GMC Guidance on CPD (June 2012)
www. gmc-uk.org/education/continuing_professional_development.asp
How much CPD is required?

Minimum of 50 credits per year; 250 credits in 5 year revalidation
cycle is recommended




Internal

Minimum 20 credits (NB at least 10 from local clinical governance meetings)

Minimum 20 credits
External
RCoA encourages wide range of CPD activities to reflect your
whole practice
Full details of RCoA CPD guidance available at:
http://www.rcoa.ac.uk/document-store/guidelines-continuing- professional- development
RCoA CPD matrix


Resource to assist in planning CPD needs
Regard as a menu rather than a tick box list

Level 1
Core knowledge expected of all who received their base training as
anaesthetists
 Easily achievable by review of clinical activity, local meetings, e-learning; some
topics included in mandatory training


Level 2
Knowledge & skills relevant to an anaesthetist’s whole practice (inc on call,
independent/voluntary practice)
 Achievable via local meetings, e-learning & some external CPD activity


Level 3



Knowledge & skills required for a ‘special interest’ area of practice*
Will rely heavily on external CPD activity
Suggestions via relevant Faculty/specialist society website
*Special interest areas are as defined in advanced
level CCT curriculum although other clinical &
non-clinical areas may be suitable for Level 3 CPD
CPD & appraisal
• Achievable amount of CPD from relevant
matrix levels agreed at appraisal
• Include CPD goals as part of PDP
• Review evidence of completion at next
appraisal & sign off
RCoA Online CPD system
Users
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•
•
•
•
•
•
•
Providers
Searchable database of approved
events
CPD diary & reflective review
Personal development plan
Breakdown of CPD credits
Integration to eLA
Depository for CPD certificates
End of year CPD activity report
Free to Fellows & Members
•
•
•
•
•
Submit applications for CPD approval
Dedicated help line for providers
Addition of event to database
Link to event website for more
information & booking
Learning outcomes review by users
www.cpd.rcoa.ac.uk
Clinical outcomes
Review of clinical outcomes

National
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


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NAP projects
♯ NOF network
Laparotomy network
ICNARC
Local

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RCoA audit recipe book may be key (new edition published June 2012)
One or two audits per year in each anaesthetic department
Review areas of core clinical outcome e.g. post op pain relief, PONV,
line related sepsis, ICU readmission

Benchmark personal practice against national/local standards
whenever possible
New initiative - national ‘sprint’ audits
Patient & colleague
feedback
Patient & colleague feedback
www.rcoa.ac.uk/docs/peer_
patFeedback2011.pdf
wwwgmcuk.org/doctors/revalidation/colleague
patient_feedback_resources.asp
• Patient & colleague MSF should
be collected at least once in each
revalidation cycle
• Several validated MSF tools
• GMC,RCoA & FICM guidance
available
Patient & colleague feedback
www.rcoa.ac.uk/docs/REV-Statement-03.02.12.pdf
Patient & colleague feedback

GMC commissioned survey for feedback showed:

Colleague MSF straightforward


Patient feedback more difficult for perioperative anaesthetist
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

51% >21 questionnaires
Difficulties with timing, distribution & collection of patient feedback
Further work by RCoA with patient groups to consider:



75% >14 questionnaires
Logistical difficulties of patient MSF
Quality of care
Despite difficulties RCoA recommend engaging with
patient MSF
Doctors in training
Doctors in training

All trainees will need to revalidate

Postgraduate deaneries in England or equivalent in devolved nations
will be the ‘designated body’

Recommendation to revalidate based on participation in
ARCP/RITA process

Most supporting information already be part of training portfolio

Some new documentation likely

Pilot exercise completed and will report soon

Timing: five years after full registration or at add award of CCT
whichever is sooner
Remediation
Remediation

Revalidation likely to identify increased numbers of doctors
with fitness to practice issues

~ 1000 remediation cases in progress in England

2,800 (~2%) of all doctors in England subjected to investigation
annually

Remediation provision will need to be enhanced & increased

DH report on remediation published Dec 2011

Remediation: what is meant?
‘The overall process agreed with the practitioner to
redress identified aspects of underperformance.
Remediation is a broad concept varying from informal
agreements to carrying out some re-skilling, to more
formal programmes including supervised remediation
and/or rehabilitation.’
Remediation: DH report 2011

Highlights lack of:
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
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consistency in how organisations tackle doctors with performance
issues
clarity about where a PDP stops and remediation starts
clarity as to who has responsibility for the remediation process
clarity on what constitutes acceptable clinical competence and capability
clarity about when the remediation process is complete and successful
clarity about when the doctor’s clinical capability is not remediable
capacity to deal with the remediation process
Remediation: DH report
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Key recommendations:

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
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Wherever possible, performance problems including clinical competence
and capability issues, should be managed locally
Local processes need to be strengthened to try and avoid performance
problems occurring and reduce their severity at the point of identification
The capacity of staff within organisations to deal with performance
concerns needs to be increased with access to external expertise as
required
A single organisation is required to advise and, when necessary, to coordinate the remediation process and case management so as to improve
consistency across the service
Remediation: DH report

Key recommendations (cont’d):

The medical royal colleges should produce guidance and also provide
assessment and specialist input into remediation programmes
Postgraduate deaneries and all those involved in training and assessment need to
assure their assessment processes so that any problems arising during training are
fully addressed

Remediation: Clinical Directors view


Much should be managed locally
College should be involved

‘A supportive rather than driving role’
Setting standards - consistency
 Providing advice on assessment and processes
 Help make it happen


Concerns about funding of remediation programmes
Remediation: Regional advisors view

College should be involved in:
Setting standards and establishing framework
 Assessment: both advice and doing
 Helping make it happen – organise external placements
 Training for specialty needs

Remediation: General consensus

Preferable to identify performance concerns early

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
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Ensure robust local appraisal and clinical governance processes
are in place
Act on information obtained
Majority of issues should be manageable locally
Work with national organisations e.g. NCAS
Work with Academy of Medical Royal Colleges to
produce consistent approach across the profession
Obtaining information &
advice
Sources of information & advice

GMC website


http://www.gmc-uk.org/doctors/revalidation.asp
RCoA & FICM website


http://www.rcoa.ac.uk/revalidation-cpd

http://www.ficm.ac.uk/cpd-and-revalidation
RCoA Bulletin articles


http://www.rcoa.ac.uk/bulletin
Specialty advisors
Revalidation specialty advice
Common model for delivery of specialty advice agreed by AoMRC
• Central contact point for all specialty advice via the College:
•
[email protected]
Revalidation specialty advice
•
•
•
•
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Demand for specialty advice for anaesthesia unclear
Requests likely from all revalidation stakeholders
Uncomplicated process queries dealt with by College staff
Commence with a small (15-20) team of advisors
Membership includes representation from:
• FICM & FPM
• All home nations
• All major sub-specialties
• SAS grade
• Retired/ independent practice
• All advisors will receive appropriate training
Comments or questions to:
[email protected]
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