Appraisal and revalidation

1. Appraisal and revalidation Eric Bater 9th July 2014

2. Revalidation:-‘The means by which all doctors must demonstrate on a 5-yearly basis that they remain up to date and fit to practise’

3. The purpose of revalidation To assure patients and public, employers and other health care professionals that licensed doctors are up to date and fit to practise

4. The 2 elements

5. GMC Revalidation:“Single-process” • Relicensure: license to practise on medical register (i.e. NHS doctor, prescribe & death certification) in accordance with the GMC’s generic standards [GMC driven] • Recertification (re-accreditation): certificate confirms doctors meet standards appropriate to be on GMC’s GP Register [RCGP driven] • Support: As a backstop, to identify for further investigation/remediation, doctors whose practice is/may be impaired License to Practise One-Process Revalidation 5-Yearly Relicence Certificate to be on the GP register 5-Yearly Recertification

6. Why revalidation? • James Wisheart • Senior paediatric cardiac surgeon, Bristol • Struck off by GMC 1998 after failing to note excess mortality (29 deaths between 1988 &1995)

7. Why revalidation? • Harold Shipman • GP in Hyde,Manchester • Convicted in 2001 of 15 murders of patients • Suspicion of involvement in 250+ deaths

8. How would you prove a doctor was ‘up to date’ and ‘fit to practice’? ?????????

9. Knowledge test /MCQTaking the MRCGPSimulated surgery Masterpiece videoSecret patientsSelf reportCompletion of postgrad educationAnnual appraisals (guided self reflection)Prescribing / referral dataPatient satisfaction questionnaire

12. Finally commenced 3rd December 2012

13. 1) Annual appraisal2) Portfolio of defined supporting information3) Statement from responsible body of absence of performance issues

14. Supporting Information: • Colleague & Patient Feedback • CPD records • Clinical Audit Annual Appraisal Over 5-year period with local appraiser • Medical Royal College / Faculty: • Define standards for appraisal & supporting information • Providing speciality guidance & advice for appraisers, appraisees and Responsible Officers Responsible Officer Receives feedback on appraisal Responsible Officer Makes revalidation recommendation to GMC • Quality Assurance • Royal Colleges • System regulators (e.g. The Care Quality Commission) • GMC GMC: Doctor Revalidated

16. GMC ‘Good Medical Practice’ 2013 • Domain 1: Knowledge, skills and performance • Domain 2: Safety and quality • Domain 3: Communication, partnership and teamwork • Domain 4: Maintaining trust

17. Domain 1: Knowledge, skills and performance • Develop and maintain your professional performance (para 7-13) • Apply knowledge and experience to practice (para 14-18) • Record your work clearly, accurately and legibly (para 19-21)

18. Domain 2: Safety and quality • Contribute to and comply with systems to protect patients (para 22-23) • Respond to risks to safety (para 24-27) • Protect patients and colleagues from any risk posed by your health (para 28-30)

19. Domain 3: Communication, partnership and teamwork • Communicate effectively (para 31-34) • Work collaboratively with colleagues to maintain or improve patient care (para 35-38) • Teaching, training, supporting and assessing (para 39-43) • Continuity and coordination of care (para 44-45) • Establish and maintain partnerships with patients (para 46-52)

20. Domain 4: Maintaining trust • Show respect for patients (para 53-55) • Treat patients and colleagues fairly and without discrimination (para 56-64) • Act with honesty and integrity (para 65-80)

21. Good Medical Practice:Domains and attributes www.revalidationsupport.nhs.uk [14]

23. Personal Development PlanRCGP Guide to the Revalidation of GPs. Jan 2010. version 3.0

24. Supporting informationGMC ‘Supporting information for appraisal and revalidation’

25. 6 types of supporting information:-1) Continuing professional development2)Quality improvement activities3) Significant events4) Feedback from colleagues5) Feedback from patients6) Review of complaints and compliments

27. RCGP – Supporting information for GPs • Review of completion of last year’s PDP • 50 credits/ year or exceptional circumstances statement • 10 SEAs in 5 years • 1 clinical audit or project in 5 years • 1 MSF with reflection in 5 years • 1 PSQ with reflection in 5 years • All complaints/ cause for concern, and compliments • Statements on probity, health and professional indemnity • Information to support extended roles

28. Introducing…… The MAG form

30. Knowledge, skills and performance‘Maintain your professional performance’Completion of last year’s PDPCase reviewsAnonymised recordsCourses, conferences, seminars, with reflectionsCertificates of course attendance

31. Knowledge, skills and performance‘Apply knowledge and experience in practice’Case historiesAuditPrescribing dataPUNs and DENsExamples of publications or teaching

32. Knowledge,skills and performance‘Ensure all documentation formally recording your work is clear,accurate and legible’Anonymised case recordsSamples of lettersThe appraisal document itselfExamples of material used for presentations

33. Safety and quality‘Contribute to and comply with systems to protect patients.Significant eventsPersonal involvement in quality improvement programmesMandatory training (safeguarding,BLS)Examples of ‘whistle-blowing’

34. Safety and quality‘Responds to risks to safety’Handover systems and policiesCommunication of test resultsHealth and safety, and manual handlingPersonal immunisation recordSignificant events

35. Communication, partnership,teamwork‘Communicate effectively’Evidence of practice development activity (e.g patient pathways)Reflections on role in the teamMyers Briggs personality inventoryBelbin profile, and reflections

36. Communicating, partnership, teamwork‘Work constructively with colleagues,and delegate effectively’Teaching for students or colleaguesMulti-source feedback

37. Communicating, partnership, teamwork‘Establish and maintain partnership with patients’Patient surveysLetters from patients or relativesInformation and reflection on patient participation groups

38. Maintaining trust‘Show respect to patients’Chaperone policyKnowledge of information governanceManaging requests from patients

39. Maintaining trust‘Treat patients and colleagues fairly and without discrimination’ComplaintsManagement and leadership activitiesFeedback and learning from research

40. Maintaining trust‘Act with honesty and integrity’Declaration of any interest in pharmaceutical companiesManaging of financesProtocol for dealing with giftsMDU /GMC membership

49. What about revalidation of doctors in training?

50. GMC ‘Information for doctors in training’www.gmc-uk.org/reval4trainees‘The responsible officer will make a revalidation recommendation based on participation in the ARCP process’