Dr Sahar Hassan GP Tutor, St Peter’s PGEC 4 th December 2012

1. Revalidation Workshop for Sessional GPs: Collecting Supporting Information for Appraisal and Revalidation Dr Sahar Hassan GP Tutor, St Peter’s PGEC 4th December 2012

2. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation INTRODUCTION • December 2012 start date, notification of revalidation year • Responsible officers RO (role is to recommend you to the GMC for revalidation) first to be revalidated in first 4 months, April 2013 roll out to all doctors • SOME OF US REVALIDATED from our appraisal 2012-2013

3. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation INTRODUCTION • Revalidation requires • RO shown you have participated in an annual appraisal of ALL your medical practice (GPwSI, teaching, etc), AT LEAST ONE APPRAISAL SIGNED OFF BY YOUR APPRAISER with good medical practice as focus • Relevant Supporting information brought to appraisal • No unresolved concerns regarding your performance as a doctor

4. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation INTRODUCTION • General Information • Keeping up to date • CPD • Review of practice • Quality improvement activity QIA- audits, SEA, other examples • Significant events • Feedback on practice • Colleagues, patients, complaints/ compliments

5. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation The Must Do • Register with GMC online and confirm your designated body and your responsible officer • Identify and start the dialogue with your appraiser, find out by contacting Elaine.Rumsby@surreypct.nhs.uk

6. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation GPs in “non standard practice”to maintain your licence to practise • Contact the GMC if you unsure who is your designated body and responsible officer • Must take into account ALL your work when providing supporting information • Examples- peripatetic locum, OOH/ walk in centre, rural GPs, GPs in Defence Medical Services and secure environments, extended career breaks, non clinical roles

7. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation GPs in “non standard practice”to maintain your licence to practise • If “non standard practice” may have difficulty accumulating supporting information in a “standard portfolio” and may have to produce “equivalent portfolio” in discussion with appraiser so speak to your appraisers SOONER RATHER THAN LATER if experiencing difficulties with collecting supporting information • Include in exceptional circumstances rationale for “equivalent portfolio” • Equivalent portfolio reflects working environment of the doctor and should still fit the attribute of each area of supporting information

8. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation Supporting InformationOther considerations- RCGP • Part time and private GPs need to maintain skills at the SAME level as full time/ NHS colleagues • Salaried, retainer, long term locum fixed practice expected to produce “standard portfolio” • Can include notes in portfolio of special circumstances such as ill health or maternity leave which have affected amount information collected or other difficulties

9. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation Other considerations RCGPCareer breaks • Clinical standard portfolio- Can only take out 2 years of a 5 year revalidation cycle, 50 CPD credits per year in the remaining 3 years, demonstrate 200 half day clinical sessions (1/7 per week), 100 in 2 years prior to revalidation • Further guidance page 9 http://www.rcgp.org.uk/revalidation-and-cpd/~/media/Files/Revalidation-and-CPD/Guide%20to%20Revalidation%20v70.ashx

10. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation Supporting information • We are all doing CPD, most of us lack the time or space to document our reflective learning

11. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation How can we collect supporting information? • Register RCGP eportfolio or clarity appraisal toolkit- start collecting supporting information • Practical tips to collecting supporting information “on the hoof”- some suggestions • phone app (evernote, microsoft one note), laptop/ ipad • USB card – word document include reflective log, PUNS/ DENS, open documents during surgery and add reflections in real time/ after the surgery • Try to document reflective learning during/ evening of the event

12. Sessional GPs Collecting Supporting Information for Appraisal and Revalidation Reflective learning • key to success as it underpins appraisal process • Plato’s directive “know thyself”- self knowledge as an outcome of learning • John Dewey “we do not learn from experience…we learn from reflecting on experience” • Jenny Moon’s grades of reflective learning • Reflection can be before, during or after the event

13. Collecting Supporting Information for Appraisal and Revalidation Reflective learning • What did you want to learn? • What did you learn? • How will this change what you do? • Has this highlighted any other learning needs? • 4 domains of good medical practice • Knowledge, skills and performance, Safety and quality, Communication, partnership and teamwork, Maintaining trust

14. Collecting Supporting Information for Appraisal and Revalidation Supporting Information- General • Personal details • Scope of practice- clinical/ non clinical • Record of annual appraisals • PDP and their reviews • Probity-honest, trustworthy, acting with integrity • Health- register with a GP, Immunisation, serious medical conditions

15. Collecting Supporting Information for Appraisal and Revalidation PDP- keep it fun + don’t make a rod for your own back • SMART (Specific, measurable, achievable, realistic, time scaled) • 5 Ps (personal, patient, practice, population, problems) • No limit but keep it to 2 or 3 • Goals - clinical , leadership, managerial, teaching • Statement of development, how this will be addressed, date of completion, intended outcome, review by appraiser

16. Collecting Supporting Information for Appraisal and Revalidation Continuing Professional Development – continuous learning process • GMC • Personal, reflects scope of practice, REFLECTION, outcomes, needs based, clinical governance processes • RCGP • 50 credits / year, “1 hour of education accompanied by a reflective record” = 1 credit, if learning implemented in practice with positive benefit (you/patient/ practice)- claim 2 credits • Credits SELF ASSESSED and verified at appraisal with your appraiser

17. Collecting Supporting Information for Appraisal and Revalidation Continuing Professional Development – examples • Reflect ALL working life- GPwSI, teaching, commissioning etc. • VARIETY educational activity- local/ national lectures, on line learning modules (BMA, e-GP), reading, learning new skill (IUDs, joint injections), reflective log, PUNS/DENS, discussions with colleagues • http://www.rcgp.org.uk/revalidation-and-cpd/~/media/Files/Revalidation-and-CPD/Credit-Based-System-for-CPD-2nd%20version-10110.ashx

18. Collecting Supporting Information for Appraisal and Revalidation QIASignificant Event Audits/ Case reviews (any event which you can learn from) • 2 SEA each appraisal year, directly involving you • Serious incident/ significant event/ serious untoward event – actual or potential effect on patient safety must be included • Headings for writing up event- anonymous • title, date, date discussion and roles of team present, description of event, what went well, what could have been done differently, reflections (4 domains good medical practice), agreed changes, implemented changes and their effect

19. Collecting Supporting Information for Appraisal and Revalidation SEAs- sessionals • Peer group – chambers, educational group, forum to exchange/ discuss SEAs, support, learn from each other • Regular locum cover GP practice- ask to attend their SEA sessions • SEA in an Ad hoc session in GP practice - ask practice if consider holding SEA session including you

20. Collecting Supporting Information for Appraisal and Revalidation Quality Improvement Activity- Audit • Audit, separate hand out, during this early phase of revalidation can state you’ve started a 2 cycle audit and plan to complete full cycle in PDP for next year • RCGP “can be a team audit if individual clearly shows how they contributed properly to the choice of topic, standards set, directly involved in care delivery in first and second cycle, states changes made and effects of changes” • RCGP- if not possible to do audit must at least have 2 SEAs/ year (page 8 http://www.rcgp.org.uk/revalidation-and-cpd/~/media/Files/Revalidation-and-CPD/Supporting%20information%20for%20appraisal%20and%20revalidation%20for%20GPs.ashx

21. Collecting Supporting Information for Appraisal and Revalidation Quality Improvement Activity- Audit • Standard audit and the sessional GP- often not feasible or appropriate • Constant moving between practices- thus not able to follow changes through • Dr’s role does not include the ability to influence or improve systems outside their own personal practice (locums, most salaried GPs) • Unable to access medical records outside consultation time (locums, OOH)

22. Collecting Supporting Information for Appraisal and Revalidation Sessionals – ideas for audit and other options for QIAs • Audits for non clinical work- use same headings • Based in a practice-easier to utilise guidelines from a standard audit • QOF, NICE guidelines, NHS Surrey Medicines Management • Options for peripatetic/ OOH/ walk-in GP • SOAR examples antibiotic prescribing, analgesia prescribing, investigations • List provided- topics in admin, referrals, antibiotic/ COC prescribing, febrile child

23. Collecting Supporting Information for Appraisal and Revalidation Other QIAs for sessional GPs • Reviews- Surgery cases, referrals, referral letters, challenging cases, follow up patients and reflective learning of outcomes • Random Case analysis/ Action audit- review 20 cases (random or defined clinical nature), assess (clinical decision making, record keeping, standards of care) with peer group / experienced colleague- document reflections, agreed improvements, demonstrate change

24. Collecting Supporting Information for Appraisal and Revalidation Other QIAs for sessional GPs • Records Audit- review record keeping in a series of consultations, highlighting key elements of information which could be improved, e.g. safety netting/ red flags/ READ coding, RCGP can not use this as only evidence of QIA • Condition based review- choose clinical area which learning need (e.g. from PUN/DEN, SEA- which common and has evidence based guidelines, e.g. asthma- collect 10 prospective cases, assess management in context guidelines, learning points, aspects of diagnosis/ care omitted or needs improvement

25. Collecting Supporting Information for Appraisal and Revalidation QIA • MUST BRING ANY INFORMATION ON CLINICAL GOVERNANCE THAT YOU HAVE BEEN ASKED TO BRING TO YOUR APPRAISAL • Commissioning • Demonstrate cost aware, efficient use of resources • Our role through referrals and prescribing

26. Collecting Supporting Information for Appraisal and Revalidation Feedback- colleague and patient • GMC- 1 every 5 year revalidation cycle • Questionnaires • http://www.gmc-uk.org/colleague_questionnaire.pdf_48212261.pdf • http://www.gmc-uk.org/patient_questionnaire.pdf_48210488.pdf • On line RCGP or clarity or manually collate via colleague/buddy- keep anonymous • Written summary in portfolio • Reflect on the feedback- implement changes+ PDP, CPD opportunities, cover whole practice, results benchmarked – compare to peers similar scope of work

27. Collecting Supporting Information for Appraisal and Revalidation Feedback • Colleagues- distribute 20 – hope to have 15 responses • Junior peer, senior peer, nurse, receptionist, pharmacist, admin staff, practice manager, consultant, sessional support group • Reflect multiple roles • Patients- distribute 45 – hope to have 37 responses • Reflect multiple roles

28. Collecting Supporting Information for Appraisal and Revalidation Feedback – issues for sessionals • Colleagues- Inform appraiser of difficulties experienced • On line if possible, manual may be only option peripatetic • Rural practices- insufficient number • Walk in / OOH/ peripatetic – not known for a length of time • Think broadly on who can give feedback

29. Collecting Supporting Information for Appraisal and Revalidation Feedback – issues for sessionals • Patients- inform appraiser difficulties • On line may not be option- OOH, walk in centres • Less able to develop long term patient relationship • Think broadly on who can give feedback (carers, families, customers, suppliers) • Inform practice/ nurse manager – ask for support, receptionist role (handing out questionnaires, pens, collecting forms) • Keeping anonymous- ideas, buddy system to formulate results • Patient groups- e.g. secure environments may not be suitable

30. Review of Complaints and Compliments Reflection discussed appraisal- lessons learnt, changes made, future implications GMC- Another type of feedback, aware complaint procedures, GMC good medical practice advice, actions taken (personal/ practice), opportunities, MPS guide handing complaints- add to CPD RCGP - description event, assessment, resulting actions, outcome, reflection Sessionals- Difficulty access, log of verbal complaints, compliments, if none- declare in portfolio Collecting Supporting Information for Appraisal and Revalidation

31. Collecting Supporting Information for Appraisal and Revalidation Avoiding isolation  peer support keeping up to speed with your revalidation • Working environments (GP practices, walk in centres, OOH organisations) should support the conduct of patient surveys, inform you of any complaint/ SEA relating to your work, access to patient records for audit/ QIA • Educational groups – GP Lunch Club, ASPH meetings, locum groups, St Peter’s sessional GP support meetings (term time, monthly), peer group support • Professional organisations NASGP

32. Collecting Supporting Information for Appraisal and Revalidation Resources for Sessionals • SOAR Scottish On Line Appraisal Resource http://www.scottishappraisal.scot.nhs.uk/appraisal-preparation/sessional-gps.aspx • SOAR OOH GPs http://www.scottishappraisal.scot.nhs.uk/appraisal-preparation/ooh-gps.aspx • NEPCSA guidance on supporting information for non standard GPs -http://www.gpappraisals.nepcsa.nhs.uk/nepcsa-guidance-for-sessional-gps/

33. Collecting Supporting Information for Appraisal and Revalidation Questions? Future Topics?