Appraisal and revalidation
Eric Bater
9th July 2014
Revalidation:‘The means by which all doctors must
demonstrate on a 5-yearly basis that they
remain up to date and fit to practise’
The purpose of revalidation
• To assure patients and public,
employers and other health care
professionals that licensed
doctors are up to date and fit to
practise
The 2 elements
GMC Revalidation:
“Single-process”
• Relicensure: license to practise on medical register (i.e. NHS doctor, prescribe & death
certification) in accordance with the GMC’s generic standards [GMC driven]
• Recertification (re-accreditation): certificate confirms doctors meet standards appropriate to be
on GMC’s GP Register [RCGP driven]
• Support: As a backstop, to identify for further investigation/remediation, doctors whose practice
is/may be impaired
One-Process Revalidation
License
to Practise
5-Yearly Relicence
Certificate
to be on the GP register
5-Yearly Recertification
Why revalidation?
• James Wisheart
• Senior paediatric cardiac
surgeon, Bristol
• Struck off by GMC 1998 after
failing to note excess mortality
(29 deaths between 1988
&1995)
Why revalidation?
• Harold Shipman
• GP in Hyde,Manchester
• Convicted in 2001 of 15 murders
of patients
• Suspicion of involvement in 250+
deaths
How would you prove a doctor
was ‘up to date’ and ‘fit to
practice’?
?????????
Knowledge test /MCQ
Taking the MRCGP
Simulated surgery
Masterpiece video
Secret patients
Self report
Completion of postgrad education
Annual appraisals (guided self reflection)
Prescribing / referral data
Patient satisfaction questionnaire
Finally commenced 3rd December 2012
1) Annual appraisal
2) Portfolio of defined supporting information
3) Statement from responsible body of
absence of performance issues
Annual Appraisal
Over 5-year period with
local appraiser
Responsible Officer
Receives feedback on
appraisal
Responsible Officer
Makes revalidation
recommendation to GMC
GMC: Doctor Revalidated
Supporting Information:
• Colleague & Patient Feedback
• CPD records
• Clinical Audit
Medical Royal College / Faculty:
• Define standards for appraisal &
supporting information
• Providing speciality guidance &
advice for appraisers, appraisees and
Responsible Officers
Quality Assurance
• Royal Colleges
• System regulators (e.g. The
Care Quality Commission)
• GMC
GMC ‘Good Medical Practice’ 2013
• Domain 1: Knowledge, skills and performance
• Domain 2: Safety and quality
• Domain 3: Communication, partnership and teamwork
• Domain 4: Maintaining trust
Domain 1: Knowledge, skills and performance
•Develop and maintain your professional
performance (para 7-13)
•Apply knowledge and experience to practice (para
14-18)
•Record your work clearly, accurately and legibly
(para 19-21)
Domain 2: Safety and quality
•Contribute to and comply with
systems to protect patients (para 2223)
•Respond to risks to safety (para 2427)
•Protect patients and colleagues from
any risk posed by your health (para
28-30)
Domain 3: Communication, partnership and teamwork
•Communicate effectively (para 31-34)
•Work collaboratively with colleagues to maintain or
improve patient care (para 35-38)
•Teaching, training, supporting and assessing (para
39-43)
•Continuity and coordination of care (para 44-45)
•Establish and maintain partnerships with patients
(para 46-52)
Domain 4: Maintaining trust
•Show respect for patients (para 53-55)
•Treat patients and colleagues fairly and without
discrimination (para 56-64)
•Act with honesty and integrity (para 65-80)
Good Medical Practice:
Domains and attributes
Domain 1: Knowledge, skills and
performance
Domain 2: Safety and quality
1.1 Maintain your professional
performance
1.2 Apply knowledge and
experience to practice
1.3 Ensure that all documentation
(including clinical records) formally
recording your work is clear,
accurate and legible
2.1 Contribute to and comply with
systems to protect patients
2.2 Respond to risks to safety
2.3 Protect patients and colleagues
from any risk posed by your health
Domain 3: Communication,
partnership and teamwork
Domain 4: Maintaining trust
3.1 Communicate effectively
3.2 Work constructively with
colleagues and delegate effectively
3.3www.revalidationsupport.nhs.uk
Establish and maintain
partnerships with patients
4.1 Show respect for patients
4.2 Treat patients and colleagues
fairly and without discrimination
4.3 Act with honesty and integrity
[14]
Personal Development Plan
RCGP Guide to the Revalidation of GPs. Jan 2010. version 3.0
Supporting information
GMC ‘Supporting information for appraisal
and revalidation’
6 types of supporting information:1) Continuing professional development
2)Quality improvement activities
3) Significant events
4) Feedback from colleagues
5) Feedback from patients
6) Review of complaints and compliments
RCGP – Supporting information for GPs
• Review of completion of last year’s PDP
• 50 credits/ year or exceptional circumstances
statement
• 10 SEAs in 5 years
• 1 clinical audit or project in 5 years
• 1 MSF with reflection in 5 years
• 1 PSQ with reflection in 5 years
• All complaints/ cause for concern, and
compliments
• Statements on probity, health and professional
indemnity
• Information to support extended roles
Introducing……
The MAG form
Knowledge, skills and performance
‘Maintain your professional performance’
Completion of last year’s PDP
Case reviews
Anonymised records
Courses, conferences, seminars, with reflections
Certificates of course attendance
Knowledge, skills and performance
‘Apply knowledge and experience in practice’
Case histories
Audit
Prescribing data
PUNs and DENs
Examples of publications or teaching
Knowledge,skills and performance
‘Ensure all documentation formally recording your work is
clear,accurate and legible’
Anonymised case records
Samples of letters
The appraisal document itself
Examples of material used for presentations
Safety and quality
‘Contribute to and comply with systems to protect patients.
Significant events
Personal involvement in quality improvement programmes
Mandatory training (safeguarding,BLS)
Examples of ‘whistle-blowing’
Safety and quality
‘Responds to risks to safety’
Handover systems and policies
Communication of test results
Health and safety, and manual handling
Personal immunisation record
Significant events
Communication, partnership,teamwork
‘Communicate effectively’
Evidence of practice development activity (e.g
patient pathways)
Reflections on role in the team
Myers Briggs personality inventory
Belbin profile, and reflections
Communicating, partnership, teamwork
‘Work constructively with colleagues,and delegate
effectively’
Teaching for students or colleagues
Multi-source feedback
Communicating, partnership, teamwork
‘Establish and maintain partnership with patients’
Patient surveys
Letters from patients or relatives
Information and reflection on patient participation
groups
Maintaining trust
‘Show respect to patients’
Chaperone policy
Knowledge of information governance
Managing requests from patients
Maintaining trust
‘Treat patients and colleagues fairly and
without discrimination’
Complaints
Management and leadership activities
Feedback and learning from research
Maintaining trust
‘Act with honesty and integrity’
Declaration of any interest in
pharmaceutical companies
Managing of finances
Protocol for dealing with gifts
MDU /GMC membership
Supporting Information for Annual Appraisal
This Checklist must be submitted with the MAG Form
Date of
Appraisal
Appraisee
Name and
Birth month
Appraisee
GMC
number
Apprais
ee RO
Revalid
Date
Appraiser
Name
CNTWear
or
DD Tees
Basic Supporting information required for appraisal
Frequency
Quality Improvement Activity – Evidence of a review
and evaluation of your clinical work, with learning and
action points. This can include full cycle audits, smaller
scale condition based or practice system reviews ,
follow up of referrals , random case analysis, or
challenging case reviews etc
Once every
5 years for
a full auditAND /OR
smaller
activities on
an annual
basis
Every year
Log or diary of educational activities throughout
including reflections, with estimated number of CPD
Credits
Credits
SEAs (2 each year) –review of any situation where care
was sub-optimal and could have been better, or where
care was exemplary —written up using a template
including reflection–discussed with PHCT/ learning
group or colleague. Two Challenging cases are an
alternative if no SEAs
Review of any complaints-all formal complaints must
be discussed, reviewed and learning and actions
identified
Every year
Colleague and patient survey – approved tools include
One every 5
years
Patient
survey
Colleague
survey
Every year
Edgecumbe
http://www.edgecumbehealth.co.uk/
CFEP Surveys
http://www.cfepsurveys.co.uk/products/general-practice/
Clarity and RCGP also acceptable , both use GMC
questionnaires
Review of all roles undertaken as a doctor –additional
clinical roles, CCG work ,teaching, training, sports
medicine, management, research, appraisal, OOH.etc
Please identify any roles NOT reviewed
*Certificate of CPR training
Appraiser
GMC number
Every year
18 months
Seen
Comments
1.Clinical Audit report
Title of Audit
Date of Audit
Who was involved in the audit?
(List of people including designation)
Background
(This should include a brief description of the reason for selecting the topic)
Aim of the Audit
(This should identify what you need the audit to tell you e.g. is current practice compliant with a
particular piece of guidance i.e. NICE guidance/local PCO policy etc )
Criteria
(This section identifies the aspects of care which you are going to measure and should be clearly
defined)
Preparation and planning
(How you intend to carry out the audit e.g. records search)
Initial standard setting
(What are you aiming for 100% , 90% etc )
Analysis and Findings
(This section should outline the level of compliance achieved against the audit standard and if full
compliance not achieved an explanation of why. What was learnt from the data collection? )
Conclusions and reflections from the first cycle of the audit
(What changes are needed to meet the standards set in this audit? How will the changes be
implemented and who will do this and when?
How was this communicated to the team if appropriate? When will the re-audit occur?)
Re-audit findings
(The re-audit report should include the date of second data collection, the Standard achieved and
whether further action is required)
Reflection on other Quality Improvement Activities
Description of the activity - eg review of telephone triage from OOH,
review of referrals or prescribing or small scale quality improvement
activities that are not full audit cycles
Why did you pick this TOPIC/ DATA SET case (eg to reflect on your
practice and identify learning needs, to demonstrate application of
learning, to identify areas for improvement –SEA, other)
Are there any external bench marks/standards against which you can
compare your activity/ performance in this area?
What have you learnt from this activity?
For yourself
For the practice [if appropriate]
What changes or actions have arisen from review of this activity?
.
For yourself
For the practice [if appropriate]
Have you reviewed these changes yet –if not when/how will you do so?
Significant Event Report
Significant Event Analysis - Title:
Date of incident:
Date of meeting when event was discussed – this can be in your
practice or in a self-directed learning group.
Description of event - what actually happened and what was your direct
involvement in the event?
What went well?
And what could have been done better?
What were the learning outcomes?
For yourself
For the practice [if appropriate]
What changes have been agreed?
This should clearly identify who is responsible for each action and a date that
the action is to be completed. The initials and job title can be used to
maintain confidentiality.
For yourself
For the practice [if appropriate]
How and when will the effect of these changes be reviewed?
Case review
Description of the clinical event–this may be a personally challenging
case or a complex diagnosis
Why did you pick this case (eg to reflect on your practice and identify
learning needs, to demonstrate application of learning, to identify areas
for improvement –SEA, other)
What went well?
And what could have been done better?
What was the root causes of the incident?
What learning needs have arisen from this case?
For yourself
For the practice [if appropriate]
[if you have not had the opportunity to discuss the case in depth this
can be done in the appraisal meeting]
What changes or actions have arisen from review of this case?
.
For yourself
For the practice [if appropriate]
Have you reviewed these changes yet –if not when/how will you do so?
Complaint Report
Date of complaint:
DESCRIPTION of complaint:
What actions were taken to investigate and resolve the complaint?
Involvement of other bodies: eg PCSA / SHA / NCAA / GMC / Medical
defence organisation, Other
Status of complaint: On-going / resolved:
If on-going-what are current actions?
If resolved, what were the findings?
Was the complaint discussed :
-within the PHC Team?
With a colleague?
With a learning group?
With anyone else?
How will my practice change?
Templates for reflection on Patient and Colleague
feedback
Name of doctor:
Date of patient survey:
Which survey tool did you use –CFEP/Edgecumbe/Clarity/RCGP
What issues did you identify from the exercise?
Hints: Look at your positive findings just as carefully as the most negative.
Compare your self assessment with that of your patients is it similar or quite different –why might that be?
What actions might you undertake as a result of the survey results?
Hints: These might include: improving communication techniques, restructuring, negotiating changes to the
consulting environment, developing skills with respect to specific cohorts of patients, learning more about
how to learn from patient surveys
Name of doctor:
Date of colleague survey:
Which survey tool did you use –CFEP/Edgecumbe/Clarity/RCGP
What issues did you identify from the exercise?
Hints: Look at your positive findings just as carefully as the most negative.
Compare your self assessment with that of your colleagues is it similar or quite different –why might that
be?
Discuss and seek advice from colleagues both peer and senior, if possible. If you have difficulty identifying
learning needs from the survey, be frank about this. Skills in interpreting such information can then be
considered as your first learning need in this regard.
What actions might you undertake as a result of the survey results?
Hints: These might include: improving communication techniques, restructuring, improving
teamwork/leadership skills, learning more about how to learn from colleague surveys (as above).
Learning Diary
Learning Events and activities
Duration/TI CPD credits
Date Title
ME
claimed
Topics
Reflections
covered
Further actions
What about revalidation of doctors in
training?
GMC ‘Information for doctors in training’
www.gmc-uk.org/reval4trainees
‘The responsible officer will make a
revalidation recommendation based on
participation in the ARCP process’
What is a ‘responsible officer’
•Dr Mike Prentice
(HENE LETB)
When will you revalidate?
CCT
First revalidation
• Between 1st April 2014 & 31st
March 2018
• After 31st March 2018, and
those trainees who do not
currently have a CCT date
• At point of eligibility for CCT
• Between 1st April 2016 and 31st
March 2018
Appraisal for ST3s
See HENE website ‘A brief appraisal
guide for ST3 GPRs’
Aim is for all ST3s to have experienced an appraisal and formed a PDP
Evidence come from e-portfolio
Appraisal done using MAG form
Appraiser will be trainer, or other trained appraiser in the practice
Introducing the MAG form
www.revalidationsupport.nhs.uk/CubeCore/.u
ploads/documents/pdf/MAGmodelappraisalf
ormv3.pdf
MAG form sections
4) Roles as a doctor
6) PDP from last year
7) CPD
8) Quality improvement activities
9) SEAs (don’t upload)
10) Complaints (leave blank)
12) Challenges and aspirations
15) Proposed PDP
17) Reflections on domains of ‘Good Medical Practice’
Future appraisals related to birth month (617 months from ST3 appraisal)
Next revalidation 5 years after leaving VTS
unless prolonged absence (>2 years) from
practice
Other possible formats:RCGP revalidation e-portfolio
Clarity website