REVALIDATION AND
PUBLIC HEALTH
PROFESSIONAL APPRAISAL
INTRODUCTION
• Purpose of Revalidation/Professional
Appraisal
• Revalidation/ORSA standards
• RO/Designated Bodies
• Appraisal standards/ supporting
information
• Recent RO guidance
• East Midlands approach
The Purpose of Revalidation
• To provide patients, public, employers
and other health care professionals
with the assurance that licensed
doctors (RST) are up to date and fit to
practise
The Purpose of
Medical/Professional Appraisal
• Enable doctors to discuss their practice
and demonstrate they continue to meet
GMP/GPH practice and inform RO’s
recommendation to GMC
• Enable doctors to improve their quality of
work and PDP
• Consider their own needs for PDP
• In line with employers priorities
GMC or UKPHR?
• Revalidation is not a FPH process
• It is a process of the GMC and UKPHR
for people who want to retain their
license to practise
Revalidation Process
• GMC requires local systems of
professional appraisal and clinical
governance to effectively and fairly
distinguish between satisfactory and poor
performance
• Responsible officers (RO) appointed for
employers (Designated Bodies) to oversee
local systems and make recommendations
to GMC on whether each doctor should
continue to practise
Revalidation Process cont.
• Doctors to be revalidated every 5 years
and provide a portfolio of supporting
information at annual professional
appraisal
• Launch nationally in late 2012
ORSA – Organisational
Readiness Self-Assessment
• New standards are identified by ORSA
• ORSA – developed by the DH
Revalidation Support Team (RST)
• Standards apply to Designated Bodies
• New systems to be set up during
2011/12 and 2012/13 and functioning
(with evidence) by March 2013
Who is my RO? - GMC
• Laid down in law – no choice
(prescribed connection)
• Usually Medical Director of employer
• GMC will write to you but find out
now…
• GMC on-line account (GMC
homepage – click on “GMC online for
doctors”)
Designated Bodies
1.
2.
3.
4.
5.
6.
7.
8.
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10.
11.
12.
13.
Primary Care Trusts
Local Health Boards
National Health Service Trusts
NHS Foundation Trusts
Strategic Health Authorities
Health Boards
The Department of Health
The Scottish Ministers
The Welsh Ministers
Postgraduate medical deaneries in England and Wales
Any Scottish training governance body
The Royal Navy
The regular army within the meaning of section 374 of the
Armed Forces Act 2006
14. The Royal Air Force
Designated Bodies
15.
16.
17.
18.
Special Health Boards
Special Health Authorities
The Common Services Agency for the Scottish Health Service
Bodies which provide independent health care services
within the meaning of section 2(5) of the Regulation of Care
(Scotland) Act 2001(2) A Government department or any
executive agency of a Government department
19.
The following locum agencies: (a) limited companies with
shares owned wholly by the Secretary of State for Health,
which are concerned with the contracting of locum
doctors(3);
and (b) locum agencies in England and Wales
which are
participants in the NHS Purchasing and
Supply Agency’s national framework agreement for the supply of
medical locums(4)
20.
A non-departmental public body
21.
Any body whose principal office is located in the United
Kingdom and whose President or Dean is a member of the
Academy of Medical Royal Colleges (e.g. FPH)
Overall Aim of UKPHR
To ensure a system of revalidation that is
• rigorous
• timely
• effective
• affordable
• appropriate to its multidisciplinary and
multi-professional membership
• equivalent where possible to those in
public health being revalidated by other,
mainly statutory, regulators, such as the
GMC
UKPHR Key Issues
• Many of the definitions can be adapted
and used
• Aim is for the majority of registrants to be
revalidated through their employer with
recommendation to UKPHR
• RO system is likely to be implemented –
need to consider the options
• Ambition is to have the system starting
end of December
• Need public health specialists to be
trained as appraisers
Employed by a Local Authority?
• Many PH consultants in England will be
employed by local authorities
• DH has proposed that local authorities
in England will be ‘designated bodies’
(results of consultation due in Autumn)
• Arrangements for academics with
honorary PCT contracts and CCGs tbc as
above
Dual Specialties
• ‘Work in progress’ - being pursued
nationally
• You only have one RO, who must make
a recommendation to the GMC about
the totality of your work
• One session per week of GP (on a
'performers list') trumps a further nine
sessions in public health (discuss with
your RO)
What if I can’t be bothered?
Failure to engage
Will affect
Fitness to practise
and RO recommendation
Fitness to Practise
Issues that will impact on fitness to practise
include:
• Patient safety concerns
• Failure to engage in revalidation
• Undermine confidence in the profession
• Conduct (which includes fraud and
dishonesty among many other factors)
• Performance
• Health
ORSA
New Appraisal Standards
• Formal Professional Appraisal Policy
agreed by relevant organisations
• Appraisal Lead in place
• Accredited training for appraisers (and
appraisees)
• Appraiser Support Network ( at least
annual)
ORSA
New Appraisal Standards
• New eligibility criteria for appraisers
• Been through at least 3 appraisal
cycles as appraisee
• Received accredited appraiser training
• Academic colleagues covered by
organisation holding honorary contract
ORSA
New Appraisal Standards
• Increased quality assurance process
• Consultant database - centralised
• Central Storage of appraisal papers
meeting information governance
standards
• Formal appraiser feedback via appraisee
questionnaires and aggregation of
appraiser development needs
• 3 yearly appraisal of appraisers
• Complaints process
ORSA
New Appraisal Standards
• Managed exemption process
• Exception audit (for appraisals not
completed within 28 days)
• Annual report and Action plan
• Aggregation of regional CPD needs via
Summary Appraisal (Form 4) and PDP
audit
The Process of Medical Appraisal
Appraisal covers the whole of the doctor’s practice
INPUTS
Personal
information
OUTPUTS
Scope and nature
of work
Doctor’s personal
development plan
Supporting
information
Review of last
year’s personal
development plan
Achievements,
challenges and
aspirations
Confidential
appraisal
discussion
Summary of
appraisal
Appraiser’s
statements
Post-appraisal
sign-off by doctor
and appraiser
What’s New about Appraisal
for Revalidation - Processes
• Includes whole scope of work
• RO will use
• Appraisal outcome
• Plus other information (clinical governance)
• Appraiser/Appraisee:
• Sign off statements
• Engagement
• Portfolio/supporting information
• Progress since last appraisal
• Health/probity
• New Summary and PDP
Revalidation: a five year cycle
Organisational and individual information
Levels of supporting information
Personal
Aspirations
Supporting information that promotes reflection ,
may be about the current working environment or areas for future growth and development
Professional development
Mandatory requirements may be made contractually by the employing organisation
Supporting information defined by the
employing organisation or specialist body
(Fitness for purpose)
•Revalidation
GMC guidance is the essential basis for all revalidation decisions
Supporting information defined by the General Medical
Council
(Fitness to practise)
Good Medical/Public Health Practise – GMC
Domains/Attributes
Supporting Information
1. Knowledge, skills and performance
2. Safety and Quality
Attribute 1
Maintain your professional development
Attribute 2
Apply knowledge and experience to practise
Attribute 3
Keep clear, accurate and legible records
Attribute 1
Systems to protect patients and improve care
Attribute 2
Respond to risks to patient safety
Attribute 3
Protect patients from risks posed by your health
3. Communication, partnership and
teamwork
4. Maintaining Trust
Attribute 1
Communication skills
Attribute 2
Work constructively with colleagues and
delegation
Attribute 3
Establish and maintain partnerships with
patients
Attribute 1
Show respect for patients
Attribute 2
Treat patients fairly and without discrimination
Attribute 3
Act with honesty and integrity
Summary of GMC supporting
information requirements
There are six types of supporting
information:
1. Continuing professional development
2. Quality improvement activity
3. Significant events
4. Feedback from colleagues
5. Feedback from patients (where
applicable)
So:•
•
•
•
•
•
Keep up to date
Review and improve your practise
Demonstrate learning/reflection
PH Audit
Get feedback
MSF/360° Appraisal
Public Health Audit
• FPH has developed examples of audit and
case review (see Faculty website)
Examples :
• DPH annual report
• Commissioning reports and impact
• Screening annual reports
• Health Equality Impact Assessments
• Case Review/Reflection
• SUI involvement
Feedback
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•
Colleague
Supervision / training feedback
Formal Complaints
Patient feedback only required for those
who have direct patient contact
• Multi source feedback
– At least once in the revalidation cycle
– What tool to use? – RO decision
GMC Timeline
July 12
GMC/ROs confirm their
doctors
Sept 12
GMC/ROs confirm doctors
recommendation dates
Sept – Nov 12 GMC confirms submission
dates
Dec 12
GMC issue first notices to
doctors and ROs (9 months
notice)
Implementation Years
Year Dates
Who
0
April 12 – March 13 RO’s, ? Doctors
in leadership
1
April 13 – March 14 20% all doctors
2
April 14 – March 15 60% all doctors
3
April 15 – March 16 100% all
doctors
Year 1 – Selection Process
• Random selection
or
Local criteria
• RO decision
RO Recommendations
• Positive recommendation – continue to
license
• Deferral request
• Notification of non-engagement
Deferral Request
• Engaged but insufficient evidence, gaps
identified, anticipate able to make
informed recommendation once
collected
• Engaged, but participating in on-going
process (HR, remediation, investigation)
anticipate able to make informed
recommendation once concluded
• Length of deferral:
– 3-6 months
– 6-9 months
– 9-12 months
– More than 12 months
Notification of
Non-Engagement
• Not engaged
• Does not meet deferral criteria
• Doctor had sufficient opportunity and
support
• All local processes exhausted
Current East Midlands PH
Appraisal System
• In place since 2002/03
• Recognised by Faculty of PH as example of
good practise
• Includes all PH Consultants – regardless of
background
• Includes those on UKPHR but not in
consultant post
• Covers PCTs, SHA, Universities
• HPA has own system
• Co-ordinated annually Sept-Mar
East Midlands
Approach/Framework
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Systematic /structured/QA approach
Meets all ORSA standards
QA central database
Appraiser training/network
Allocation/choice of appraiser
MDS – submissions/RO link
Evaluation/Feedback
East Midlands
Framework – Resource Pack
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National guidance
Local guidance/policies/processes
Portfolio checklist
Structured Line Manager letter
Outline agenda for appraisal interview
Handling difficult appraisal guidance
MDS for central database
SUMMARY
Revalidation
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•
GMC/UKPHR process
5 year cycle
Find your RO
RO uses appraisal plus other
information
SUMMARY
Appraisal
• Do engage annual enhanced appraisal
by approved appraiser
• Systematic/QA’d process
• Quality supporting
information/portfolio is paramount
• Demonstrate learning/reflection
• Sensible PDP