REVALIDATION “Just what you’ve been waiting for”

1. REVALIDATION“Just what you’ve been waiting for” • What is revalidation • Why the wait • 12 years of waiting- what now • Latest time table • Prof Hugo Mascie-Taylor report • Revalidation pathway • Good medical Practice Framework • Check list for appraisal & revalidation • Issues to be resolved • What should I do now

2. Bristol Scandal1991 to 1995 significant mortality than other centres in England

3. Alder Hey inquiry and the Donaldson report recommendations • The Alder Hey inquiry report saysProfessor Dick van Velsen, the doctor at the heart of the Alder Hey scandal, is to be referred to the General Medical Council (GMC), the doctor's regulatory body. He should never be allowed to practice in the NHS again.

4. Dr Howard Martin ShipmanShipman murdered at least 215 victims by giving lethal morphineinjections during a killing spree lasting from 1975 to 1998.

5. Recommendations Shipman Inquiry • Five-yearly checks - known as medical revalidation • More GMC members to be lay people GMC to be directly accountable to parliament. • Patients to be told when their doctors have been disciplined. It is now possible to see if a doctor has been suspended or investigated on the GMC website. • Disciplinary and criminal records of doctors to be held centrally and shared with staff in healthcare organisations. The government has yet to decide how this information would be disseminated.

6. Closer scrutiny of doctors with a history of drug misuse. new fitness to practise procedures have been in place since 2004. • Checks for abnormally high death rates at GP practices. this has been implemented. • Whistleblower helpline to advise NHS staff and public on making complaints. this has been implemented

7. What is Revalidation? “A single process by which all doctors with a licence to practice in the UK will need to satisfy the GMC of their continued fitness to practice …and for specialist doctors, to demonstrate that they meet the standards that apply to their particular medical specialty”

8. What is Revalidation? • “Contribution to quality of care” • “Competence assurance” • Threat or opportunity? • 232,000 licensed doctors • > 700 “designated” organisations providing healthcare • Deaneries are designated orgs. for doctors in training

9. Why the wait? • Lots of stakeholders • Circular progress • Change in legislation • Reports from pilot sites • Appointment and training of ROs • Enhanced appraisal training • Generic and Specialty standards • Lots of trees

10. After 12 years of waiting—what now?

11. The “latest” time table • May/June 2012: Final organisational state of readiness assessment • Summer 2012: Assessment of readiness and business case prepared for ministers • Sept/Oct 2012: Ministerial decision • End of 2012: Enablement of necessary legislation • 31 March 2013: All ROs to have been revalidated • 31 March 2014: At least 20% of doctors revalidated with all designated bodies having begun the process • 31 March 2016: All remaining doctors revalidated ie 40% each year

12. Remediation ReportProf Hugo Mascie-Taylor Dec 2011 Performance problems, including clinical competence and capability issues, should normally be managed locally wherever possible. Local processes need to be strengthened to avoid performance problems wherever possible, and to reduce their severity at the point of identification

13. 3.The capacity of staff within organisations to deal with performance and concerns needs to be increased with access to necessary external expertise as required. 4. A single organisation is required to advise and when necessary to co-ordinate the remediation process and case management so as to improve consistency across the service

14. 5. The medical royal colleges should produce guidance and also provide assessment and specialist input into remediation programmes 6. 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

16. Good Medical Practice Framework 4 Domains: • Knowledge, skills and performance • Safety and quality • Communication, partnership and teamwork • Maintaining trust Each has 3 attributes

17. Knowledge, skills and performance • 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

18. Safety and quality • 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

19. Communication, partnership and teamwork • 3.1 Communicate effectively • 3.2 Work constructively with colleagues and delegate effectively • 3.3 Establish and maintain partnerships with patients

20. Maintaining trust • 4.1 Show respect for patients • 4.2 Treat patients and colleagues fairly and without discrimination • 4.3 Act with honesty and integrity

21. Principles for Supporting Information • Must be relevant to your scope of practice, including non NHS work • Consultants are required to substantiate not only the quality of care they give to individuals but also those seen by other doctors within the departments for which they share responsibility

22. SUPPORTING INFORMATION FOR APPRAISAL AND REVALIDATION CHECKLIST Annual  Confirm continuation of GMC number /License to practice Medical qualifications Confirm unchanged / provide commentary on changes Description of practice Confirm unchanged / provide commentary on changes Description of voluntary roles or additional work undertaken in capacity as a doctor Confirm unchanged / provide commentary on changes Description of indemnity Appraisal documentation Signed –off summary of previous year’s appraisal/s (for all relevant organisations )

23. CHECKLIST Personal development plans Submit for review the previous year’s PDP. Any learning and development needs / goals for inclusion in forthcoming PDP Complaints / concerns (if any) and their resolution Self-declaration confirming that you are unaware of any complaints / concerns ideally with written confirmation from employing authority(ies) If complaint(s) or concern(s); statement indicating how resolved and whether completed or on-going Self-declaration statements Probity including interests and gifts; Health to confirm ability to undertake practice as described; Registration with G.P.

24. CHECKLIST Record of educational provision with feedbackNecessary only if you are an educational supervisor or have any formal teaching or training responsibilities Incidents – including contributions to NPSA, confidential enquiries and relevant coroner’s inquests Self-declaration of no involvement in serious untoward or critical incidents and/or adverse events that triggered a formal process or record of management required if any involved Record of clinical activity Evidence of numbers and case mix of patients seen, including those as senior “sign-off”. Availability will be dependent on trust/department IT systems Evidence of ability to lead resuscitation teams ATLS/ALS/APLS certificates or equivalent. Alternatively evidence of competence in appropriate skills by WBA

25. CHECKLIST Guidelines – compliance Self-declaration statement and (if available) examples of incorporation of national guidelines into local/departmental documents Clinical audit Evidence of participation in departmental/personal audit  Medical records review Can be done as part of departmental audit. 10 sets of notes should be included. (suggested frequency every 2 years) Continuing professional development Certificate of meeting CEM CPD requirements (minimum of 50 hours per year/250 per 5 years - can include e learning) and activities related to job plan and PDP Evidence of reflection on learning gained

26. CHECKLIST Local mandatory training Evidence of participation Meetings – attendance and participation in departmental and trust clinical governance and relevant committees Evidence in the form of action logs or minutes Documentation demonstrating activity to improve quality of care E,g. 2 detailed case reviews per year / relevant audit / details of any guidelines, protocols, patient pathways or information documents you have been involved in developing If available Outcomes and performance data based on individual and team practice with reflection and commentary on personal input

27. CHECKLIST Departmental complaints and resulting changes Compliments Personal and/or Departmental During each revalidation cycle Multisource feedback, including patient questionnaires Appropriate forms should be provided by employing trusts and meet GMC criteria, an alternative MSF questionnaire will be available on CEM web site Completed audit cycle Participation in minimum of one completed cycle over 5 year period

28. Issues to be resolved • E portfolio • Funding for remediation • Future of NCAS • Method of “roll out” uncertain • Orphans / Locums / Retired • Overseas / Prolonged absence • Conflict of interest for ROs

29. What should I do now? • Set up a GMC on line account. (GMC number, e mail, bank account details details) • Start gathering “stuff” • Populate “Enlighten me” dashboard • Develop departmental portfolio for common, shared information • Go to : www.collemergencymed.ac.uk www.gmc-uk.org/revalidation

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