Preparing for revalidation:
evidence is the key
Dr Cliona Ni Bhrolchain
What is the GMC?
13. The GMC is the independent regulator for doctors in the UK. Our
purpose is to protect, promote and maintain the health and safety of
the public by ensuring proper standards in the practice of medicine
a. By controlling entry to and maintaining the list of registered
and licensed medical Practitioners
b. By setting the educational standards for medical school
c. By determining the principles and values that underpin
Good Medical Practice
d. By taking firm but fair action against doctors’ registration
where the standards of Good Medical Practice have not
been met
What is revalidation?
14. The purpose of revalidation is to assure patients and the public,
employers and other healthcare professionals that licensed
doctors are up to date and are practising to the appropriate
professional standards.
Although it is widely understood that the delivery of medical care
to patients will always involve an element of risk, revalidation will
help doctors, employers and the GMC to provide further
assurance to patients and the public that doctors working in the
UK are fit to practise.
What standard is required?
What will happen?
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5-year cycle
Based on annual appraisal
Performance against
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professional standards from GMC and Royal
College
Clinical governance information
Paper based exercise for majority
Decision by Trust’s Responsible Officer
Producing the evidence
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Too many standards for individual evidence!
Reduced to 4 domains:
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Knowledge, skills and performance
Safety and quality
Communication, partnership and teamwork
Maintaining trust
Each domain has attributes
Collating the evidence

Portfolio for appraisal

Electronic appraisal/revalidation pilots

MUST START NOW!!
What do I collect?
To what standard?
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Independent evidence where possible

Triangulation important, avoid multiple use

Enough evidence to make a judgement

Much more reflective practice
Standard of evidence

Mapped to domains and attributes
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Self assessment of evidence and practice

Appraiser assessment of evidence and
practice
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All domains/attributes covered over 5 years
What tools do I have…?
(Very similar to trainee requirements)
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Patient feedback)
Colleague feedback (MSF/360))
1 per 5 yrs +
before Y3
Personal Development Plan
CPD record incl reflective notes*
Significant events)
Case reviews)
Audit data
* Now includes electronic recording and GMP domains
every yr
every yr
2 per yr
1 per yr
And……
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Complaints (all)
every yr
Teamwork e.g. peer review meetings, audit
meetings
Performance data
every yr
Job plan
every yr
Probity (self declaration)
every yr
Health (self declaration)
every yr
Teaching
What do I need to do?

Continue with usual appraisal, but make sure
evidence is more robust

Are you registered somewhere for CPD?

If not, are you collecting evidence?
Worked example:
case review
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Learning point from clinical practice
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Identified learning need (DEN)

How I will meet that learning need
Aide memoire

Knowledge, skills and
performance




Maintain your professional
performance
Apply knowledge and
experience to practice
Keep clear, accurate and
legible records
Safety and quality




Put into effect systems to
protect patients and improve
care
Respond to risks to safety
Protect patients and
colleagues from any risk posed
by your health
Communication, partnership
and teamwork




Communicate effectively
Work constructively with
colleagues and delegate
effectively
Establish and maintain
partnerships with patients
Maintaining trust



Show respect for patients
Treat patients and colleagues
fairly and without discrimination
Act with honesty and integrity
Aide memoire

Knowledge, skills and
performance




Maintain your professional
performance
Apply knowledge and
experience to practice √
Keep clear, accurate and
legible records
Safety and quality




Put into effect systems to
protect patients and improve
care
Respond to risks to safety
Protect patients and
colleagues from any risk posed
by your health
Communication, partnership
and teamwork




Communicate effectively
Work constructively with
colleagues and delegate
effectively
Establish and maintain
partnerships with patients
Maintaining trust



Show respect for patients
Treat patients and colleagues
fairly and without discrimination
Act with honesty and integrity
Aide memoire

Knowledge, skills and
performance




Maintain your professional
performance
Apply knowledge and
experience to practice √
Keep clear, accurate and
legible records
Safety and quality




Put into effect systems to
protect patients and improve
care
Respond to risks to safety
Protect patients and
colleagues from any risk posed
by your health
Communication, partnership
and teamwork




Communicate effectively
Work constructively with
colleagues and delegate
effectively √
Establish and maintain
partnerships with patients
Maintaining trust



Show respect for patients
Treat patients and colleagues
fairly and without discrimination
Act with honesty and integrity
Colleague and patient feedback
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Trusts will have to set up systems
GMC will define standards but not stipulate
providers
RCPCH piloted tool with peer comparison
WUTH using commercial company
Patients
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Usually recommend minimum of 20 or so for
analysis
Will child feedback be addressed?
Worked example:
patient feedback
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Participated in RCPCH pilot
1st patient feedback since 2003
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Different attributes
Peer comparison
Reflection on results
Aide memoire

Knowledge, skills and
performance




Maintain your professional
performance
Apply knowledge and
experience to practice
Keep clear, accurate and
legible records
Safety and quality




Put into effect systems to
protect patients and improve
care
Respond to risks to safety
Protect patients and
colleagues from any risk posed
by your health
Communication, partnership
and teamwork




Communicate effectively
Work constructively with
colleagues and delegate
effectively
Establish and maintain
partnerships with patients
Maintaining trust



Show respect for patients
Treat patients and colleagues
fairly and without discrimination
Act with honesty and integrity
Aide memoire

Knowledge, skills and
performance




Maintain your professional
performance
Apply knowledge and
experience to practice
Keep clear, accurate and
legible records
Safety and quality




Put into effect systems to
protect patients and improve
care
Respond to risks to safety
Protect patients and
colleagues from any risk posed
by your health
Communication, partnership
and teamwork




Communicate effectively
Work constructively with
colleagues and delegate
effectively
Establish and maintain
partnerships with patients √
Maintaining trust



Show respect for patients
Treat patients and colleagues
fairly and without discrimination
Act with honesty and integrity
Aide memoire

Knowledge, skills and
performance




Maintain your professional
performance
Apply knowledge and
experience to practice
Keep clear, accurate and
legible records
Safety and quality




Put into effect systems to
protect patients and improve
care
Respond to risks to safety
Protect patients and
colleagues from any risk posed
by your health
Communication, partnership
and teamwork




Communicate effectively
Work constructively with
colleagues and delegate
effectively
Establish and maintain
partnerships with patients √
Maintaining trust



Show respect for patients √
Treat patients and colleagues
fairly and without discrimination
Act with honesty and integrity
Aide memoire

Knowledge, skills and
performance




Maintain your professional
performance √
Apply knowledge and
experience to practice
Keep clear, accurate and
legible records
Safety and quality




Put into effect systems to
protect patients and improve
care
Respond to risks to safety
Protect patients and
colleagues from any risk posed
by your health
Communication, partnership
and teamwork




Communicate effectively
Work constructively with
colleagues and delegate
effectively
Establish and maintain
partnerships with patients √
Maintaining trust



Show respect for patients √
Treat patients and colleagues
fairly and without discrimination
Act with honesty and integrity
Colleague multisource feedback (MSF/360)

Provides the opportunity for



non-medical co-workers
medical colleagues (including trainees and
juniors)
to reflect on the professional skills and
behaviour of a doctor
Colleague multisource feedback (MSF/360)
Suggestions for community paediatricians

Require 1 per 5 year cycle, 1st before Y3
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If working in isolated situation might wish to
consider doing more
Usually recommend minimum of 11 or so
replies for analysis
Questionnaires need to comply with guidance
issued by GMC
Who should I ask?
Suggestions for community paediatricians
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Clinical colleagues
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Medical
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Consultant colleagues
SAS/trainees
CD/lead clinician
Nursing
Therapists
Non-clinical
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A&C staff
Secretary
Head teachers/SENCOs
Ed Psych
Social care
If statutory role
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Senior managers in
CYPD, HPA, PCT
Worked example:
teaching/training

Devised a ‘return to work’ programme for UKtrained comm paed returning to UK practice
after 10-yr break

Evidence

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Anonymised copy of programme
Comments from NCAS on programme
Aide memoire

Knowledge, skills and
performance




Maintain your professional
performance
Apply knowledge and
experience to practice
Keep clear, accurate and
legible records
Safety and quality




Put into effect systems to
protect patients and improve
care √
Respond to risks to safety
Protect patients and
colleagues from any risk posed
by your health
Communication, partnership
and teamwork




Communicate effectively
Work constructively with
colleagues and delegate
effectively √
Establish and maintain
partnerships with patients
Maintaining trust



Show respect for patients
Treat patients and colleagues
fairly and without discrimination
Act with honesty and integrity
Other possibilities for teaching/training

GMC/PMETB annual trainee survey
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Dept results
Deanery quality assurance
Feedback forms from teaching/training
activity
Example of a presentation, e-learning
material prepared
Worked example:
performance
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Very little official performance data
Clinic numbers compared with hospital peers
so hard to interpret
MDTs, CP etc not counted electronically
Evidence

Use diary to collect information on MDTs
Or another strategy…

Move to Derby where Fawzia Rahman will do
it all for you!!
Aide memoire

Knowledge, skills and
performance




Maintain your professional
performance √
Apply knowledge and
experience to practice √
Keep clear, accurate and
legible records
Safety and quality




Put into effect systems to
protect patients and improve
care √
Respond to risks to safety
Protect patients and
colleagues from any risk posed
by your health
Communication, partnership
and teamwork




Communicate effectively
Work constructively with
colleagues and delegate
effectively
Establish and maintain
partnerships with patients
Maintaining trust



Show respect for patients
Treat patients and colleagues
fairly and without discrimination
Act with honesty and integrity √
Worked example: record keeping

GMC standard



3(f) Keep clear, accurate and legible records,
reporting the relevant clinical findings, the
decisions made, the information given to patients,
and any drugs prescribed or other investigation or
treatment
3(g) Make records at the same time as the events
you are recording or as soon as possible
afterwards
51 When you refer a patient, you should provide
all relevant information about the patient, including
their medical history and current condition
What evidence might be available?

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Medical record audits
CP peer review
SEN(M) reports compliance with code of practice
Anonymised letters to patients/colleagues
Colleague MSF
Any comments received from colleagues on
quality of records/letters
SAIL instrument
Copying letters to patients (NHS standard)
Summary

We will need a more structured approach to
collecting evidence but…..

Most of it is already there and can be
collected as we go along