The Changing Face of Revalidation

1. The Changing Face of Revalidation Ian Starke, Medical Director, Revalidation, Royal College of Physicians, London February 28th 2012

2. Overview • Revalidation – definition and process • Supporting Information • How medical appraisal will work • The Medical Appraisal Guide • Current issues • Timetable for revalidation.

3. What is Revalidation? • Revalidation is the means by which, every five years, licensed doctors will demonstrate that they remain up to date and fit to practice. • The purpose of revalidation is to assure patients and the public, employers and other healthcare professionals that this is so.

4. The Revalidation Process

5. The Revalidation Process Personal Development Plan CPD Responsible Officer Supporting information Annual appraisal X 5 Recommendation to GMC

6. The Revalidation Process Clinical Governance information Personal Development Plan CPD Responsible Officer Supporting information Annual appraisal X 5 Recommendation to GMC

7. The Revalidation Process Professional excellence. Clinical Governance information Personal Development Plan CPD Responsible Officer Supporting information Annual appraisal X 5 Recommendation to GMC

8. Supporting Information.

9. General Information • A description of your whole practice since your last appraisal • Record of previous appraisals • Previous PDPs and their review • Current job plan (for reference) • Probity and Health • Self-declaration that you comply with the obligations of Good Medical Practice

10. Keeping up to date • Continuing Professional Development • Minimum average of 50 hours per year • Systems and credit categories vary • Cover all areas of your professional work. • Address the agreed PDP objectives

11. Review of your practice – 1 Quality Improvement Activity • Clinical Audit • One full cycle per five years • Clinical Outcomes • Robust, attributable and validated • Case review or discussion • Two per year if used instead of audit

12. Review of your practice – 2 Significant Events • Your involvement in SUIs • Summary of clinical incidents in which you have been involved • Emphasis on learning and practice change • Self-declaration if no such involvement

13. Feedback on your practice • Colleague Feedback • Validated multi-source feedback tool • Patient Feedback • Validated patient questionnaire • Feedback on Teaching and Training • Complaints and Compliments • Summary of all formal complaints since last appraisal, • How managed, what was learned • Self-declaration if no complaints.

14. Supporting Information. http://www.aomrc.org.uk/revalidation/revalidation-publications-and-documents/item/speciality-frameworks-and-speciality-guidance.html

15. How appraisal will work The Medical Appraisal Guide(under development)

16. Appraisal for Revalidation • Effective appraisal and revalidation will: • satisfy the requirements of GMP • support the doctor’s professional development • The Responsible Officer will inform the GMC of any concerns • Concerns should be addressed as they arise.

17. Appraisal for Revalidation Predominantly formative Striving for professional excellence Summative element for revalidation Up to date and fit to practice Different systems in UK nations Medical Appraisal Guide – England Scottish Online Appraisal Resource On-line system in Wales

18. Purposes of Medical Appraisal To enable doctors: to demonstrate that they meet the principles and values of GMP to enhance their quality of care by planning their professional development to consider their own professional development needs to ensure that they are working productively and in line with organisational requirements

19. The stages of medical appraisal

20. Description of the doctor’s scope of work Supporting Information (SI) with additional comments from doctor Doctor’s PDP Post appraisal sign off by doctor and appraiser Summary of appraisal discussion Review by appraiser of appraisal Portfolio Confidential appraisal discussion Review of last year’s PDP and summary of appraisal Other information from doctor including; achievements, challenges and aspirations Appraiser’s statements Outputs Inputs The stages of medical appraisal

21. Appraiser’s Statements - 1 These should confirm that: • Appraisal has taken place, reflects the scope of work, and addresses the principles and values of GMP • Appropriate SI has been presented according to the GMP Framework, and this reflects the nature and scope of the doctor’s work • Appropriate progress against last year’s PDP has taken place • Agreement has been reached about a new PDP and any associated actions for the coming year.

22. Appraiser’s Statements - 2 “I understand that I must protect patients from risk of harm posed by another colleague’s conduct, performance or health. If I have concerns that a colleague may not be fit to practice, I am aware that I must take appropriate steps without delay, so that concerns are investigated and patients protected where necessary”. No information has been presented or discussed in the appraisal that raises a concern about the doctor’s fitness to practice.

23. Tools for Revalidation

24. Tools for revalidation MSF colleague and patient questionnaires http://www.rcplondon.ac.uk/resources/clinical-resources/revalidation-practice/multi-source-feedback-msf-colleague-and-patient-q Personal Clinical Audit Tool (pCAT) www.p-cat.org.uk Supporting Information, guidance and FAQs on AoMRC and College websites http://aomrc.org.uk/revalidation.html Revalidation e-system – June 2012

25. Outstanding issues • Training, advice and support • Quality assurance • Remediation

26. Training • Responsible Officers • Training provided by RST • Appraisers • “Top-up” training by RST • Specialty advisers • Training by Academy and Colleges • Consistency essential • between individuals • between specialties

27. Advice and support Legal responsibility on the RO to make a recommendation Local advice based on written guidance and FAQs Otherwise routed through Colleges NCAS and ELAs

28. Quality Assurance GMC guidance [CQC, SHAs, RO networks] http://www.gmc-uk.org/doctors/revalidation/9613.asp QA of RO recommendations? RST on QA of medical appraisal http://www.rcpsg.ac.uk/Education/Revalidation_CPD/Documents/Revalidation%20Papers%2009/NHS%20AQMAR.pdf RO responsible for QA of appraisal process in the organisation

29. Remediation and re-skilling Academy report – Dec 2009 http://www.gmc-uk.org/Item_6e___Annex_E_AoMRC_Remediation_Report.pdf_28987523.pdf DH (England) report – 2011 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131814.pdf Academy working party now set up.

30. Remediation: DH report • Performance problems should be managed locally wherever possible • Local processes need to be strengthened • The capacity of staff to be increased with access to necessary external expertise • A single organisation is required to co-ordinate • The medical Royal Colleges to provide guidance, assessment and specialist input • Deaneries to develop their assessment processes to address any problems arising during training.

31. Proposed Definitions Remediation: The overall process agreed with the practitioner Re-skilling: Provision of support, training and education to address identified needs Supervised remediation programme: A formal programme, usually including both re-skilling and supervised clinical placement, Rehabilitation: The process for restoring a practitioner to independent practice by managing physical or mental health problems

32. Remediation and re-skilling Personal Development Plan RO / Appraiser RO / GMC RO / NCAS Appraiser Need for support / remediation Fitness to Practice Specialty expert advice Enhanced PDP Targeted learning Specialty support available Directed remediation activity Specialty expert advice Developmental PDP Employer ‘in-house’ support Specialty advice available

33. Summary Supporting information as simple as possible SI will cover domains / attributes of GMP CPD increasingly focussed on learning Appraisal is the key to revalidation Mechanisms for advice and support Quality assurance Remediation and re-skilling

34. AoMRC, RST and GMC websites http://aomrc.org.uk/revalidation/revalidation-publications-and-documents/item/academy-reports-and-resources.html http://www.revalidationsupport.nhs.uk/medical_appraisal_guide/draft_core.asp http://www.gmc-uk.org/Supporting_information.pdf_42293176.pdf http://www.gmc-uk.org/doctors/revalidation.asp