Liam Brennan Council member & revalidation lead Royal College of Anaesthetists

1. Revalidation for anaesthetists Liam Brennan Council member & revalidation lead Royal College of Anaesthetists Update - June 2012

2. Introduction • Appraisal for revalidation • Timetable for revalidation & transitional arrangements • Supporting information • CPD • Review of clinical outcomes • Patient & colleague feedback • Doctors in training • Remediation • Obtaining advice

3. Why do we need Revalidation?

4. Revalidation: is it really going to happen? • Andrew Lansley’s letter to GMC, June 2010 • Full support for revalidation • Extend piloting for a further year • House of Commons Health Select Committee, Feb 2011 • GMC required to ensure ‘no further delays to late 2012 implementation of revalidation’ • House of Commons Health Select Committee, March 2012 • ‘’In the light of the importance of this process to the quality of services delivered to patients, and of the status of the GMC as an independent regulator, the Committee looks to the GMC to give early and public notice if it concludes that delivery of this timetable is at risk.”

5. What is Revalidation? • It’s about providing assurance that all doctors with a GMC license areup to date and fit to practice

6. What is Revalidation? • It’s about providing assurance that all doctors with a licence areup to date and fit to practice • Based on continuing evaluation of currentpractice in the context of everyday working environment • Based on local systems of annual appraisal that are based on the GMC core guidance Good Medical Practice* • It is not a “point in time” assessment of knowledge & skills * http://www.gmc-uk.org/guidance/good_medical_practice.asp

7. What is Revalidation? • It’s about providing assurance that all doctors with a licence areup to date and fit to practice • Based on continuing evaluation of currentpractice in the context of everyday working environment • Based on local systems of annual appraisal that are based on the GMC core guidance Good Medical Practice • It is not a “point in time” assessment of knowledge & skills A five year process NOT a fifth year event !

8. Appraisal/revalidation…..a continuing cycle One revalidation cycle Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Second revalidation cycle

9. Appraisal/revalidation…..a continuing cycle One revalidation cycle Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Appraisal Second revalidation cycle …..for each and all our professional lifetimes!

10. GMC revalidation model Portfolio of Supporting Information Employer liaison service Specialty-specific advice Five x yearly appraisals Responsible Officer Request deferral Recommend revalidation Failure to engage General Medical Council

11. What is appraisal? • “A professional process of constructive dialogue, in which the doctor being appraised has a formal structured opportunity to reflect on his/her work and consider how his/her effectiveness might be improved” • “A positive process to give someone feedback on their performance, to chart their continuing progress and to identify developmental needs. It is a forward looking process, essential for the development and educational planning needs of the individual” DH December 2002

12. Appraisal: for revalidation Existing appraisal practice • Clinical and non-clinical aspects mapped to GMP • CPD reviewed against • Core topics • Job plan • Match job plan to Trust needs • Increased use of MSF • PDP taking account of the above Appraisal for revalidation • Clinical and non-clinical mapped to four domains of GMP • Judgements on: • Adequacy of supporting informationincluding: • CPD • Audit • MSF • Clinical risks/safety • Progress towards revalidation • Match job plan to Trust needs • PDP taking account of the above Appraisal remains largely a formative process but with summative components

13. www.revalidationsupport.nhs.uk

14. Revalidation: anticipated timetable • Challenge of non-affiliated doctors • GMC ‘ making your connection’ campaign

15. Transitional arrangements • GMC aim to revalidate all doctors by March 2018 • One appraisal minimum requirement • Procedure for selecting doctors for revalidation yet to be announced; process may vary across the UK • Minimum of three months notice anticipated • All designated bodies expected to make some recommendations in first year • GMC revalidation readiness statement (June 2012) available at: http://www.gmc-uk.org/doctors/revalidation/13282.asp

16. Specialty specific supporting information www.rcoa.ac.uk/docs/Revalidation_doh_pilots.pdf Final version published late summer 2012

17. Supporting information General information - providing context about what you do in all aspects of your professional work • Personal details • Scope of whole practice (inc NHS, independent, voluntary) • Anaesthetic/ICM/pain medicine caseload data • Data on complex procedures e.g. central access, regional blocks • Probity statement • Personal declaration of disciplinary, criminal or regulatory sanctions • Competing interests e.g. financial or other • Any declarations of professional conduct/performance of others • Personal health declaration • Self-declaration of health issues that could pose a risk to patients

18. Supporting information Keeping up to date- Maintaining and enhancing the quality of your professional work • Continuing professional development (CPD) Review of your clinical practice - Evaluating and improving the quality of your professional work • Clinical audit • personal, local, national • Participation in at least one complete audit in a 5 year cycle • Not everyone has to lead an audit but ‘active engagement’ by all • Significant untoward events • Personal reflection and lessons learnt by dept/ whole organisation • Clinical outcome measures

19. Supporting information Feedback on your practice – how others perceive the quality of your professional practice • Colleague multi-source feedback (MSF) • Patient/carer MSF • Feedback from clinical supervision, teaching & training • Formal complaints • Compliments

20. Continuing Professional Development (CPD)

21. GMC principles of CPD • Responsibility for personal learningPersonal responsibility for identifying your CPD needs, planning how they should be addressed and undertaking CPD that will support professional development and practice • ReflectionGood Medical Practice requires you to reflect regularly on your standards of medical practice • Scope of practiceYou must remain competent and up-to-date in all areas of your practice • Individual and team learningCPD activities should aim to maintain and improve the standards of your practice and teams in which you work • Identification of needsCPD activities should be shaped by assessment of your professional needs and the needs of the service and the people who use it • OutcomesYou must reflect on what you have learnt through your CPD and record any impact or expected impact on your performance and practice GMC Guidance on CPD (June 2012)www. gmc-uk.org/education/continuing_professional_development.asp

22. How much CPD is required? • Minimum of 50 credits per year; 250 credits in 5 year revalidation cycle is recommended • Internal • Minimum 20 credits (NB at least 10 from local clinical governance meetings) • External • Minimum 20 credits • RCoA encourages wide range of CPD activities to reflect your whole practice • Full details of RCoA CPD guidance available at: http://www.rcoa.ac.uk/document-store/guidelines-continuing- professional- development

23. RCoA CPD matrix • Resource to assist in planning CPD needs • Regard as a menu rather than a tick box list • Level 1 • Core knowledge expected of all who received their base training as anaesthetists • Easily achievable by review of clinical activity, local meetings, e-learning; some topics included in mandatory training • Level 2 • Knowledge & skills relevant to an anaesthetist’s whole practice (inc on call, independent/voluntary practice) • Achievablevia local meetings, e-learning & some external CPD activity • Level 3 • Knowledge & skills required for a ‘special interest’ area of practice* • Will rely heavily on external CPD activity • Suggestions via relevant Faculty/specialist society website *Special interest areas are as defined in advanced level CCT curriculum although other clinical & non-clinical areas may be suitable for Level 3 CPD

27. CPD & appraisal • Achievable amount of CPD from relevant • matrix levels agreed at appraisal • Include CPD goals as part of PDP • Review evidence of completion at next • appraisal & sign off

28. Providers RCoA Online CPD system Users Searchable database of approved events CPD diary & reflective review Personal development plan Breakdown of CPD credits Integration to eLA Depository for CPD certificates End of year CPD activity report Free to Fellows & Members • Submit applications for CPD approval • Dedicated help line for providers • Addition of event to database • Link to event website for more information & booking • Learning outcomes review by users www.cpd.rcoa.ac.uk

29. Clinical outcomes

30. Review of clinical outcomes • National • NAP projects • ♯ NOF network • Laparotomy network • ICNARC • Local • RCoA audit recipe book may be key (new edition published June 2012) • One or two audits per year in each anaesthetic department • Review areas of core clinical outcome e.g. post op pain relief, PONV, line related sepsis, ICU readmission • Benchmark personal practice against national/local standards whenever possible New initiative - national ‘sprint’ audits

31. Patient & colleague feedback

32. Patient & colleague feedback www.rcoa.ac.uk/docs/peer_patFeedback2011.pdf wwwgmcuk.org/doctors/revalidation/colleague patient_feedback_resources.asp • Patient & colleague MSF should • be collected at least once in each • revalidation cycle • Several validated MSF tools • GMC,RCoA & FICM guidance available

33. Patient & colleague feedback www.rcoa.ac.uk/docs/REV-Statement-03.02.12.pdf

34. Patient & colleague feedback • GMC commissioned survey for feedback showed: • Colleague MSF straightforward • 75% >14 questionnaires • Patient feedback more difficult for perioperative anaesthetist • 51% >21 questionnaires • Difficulties with timing, distribution & collection of patient feedback • Further work by RCoA with patient groups to consider: • Logistical difficulties of patient MSF • Quality of care • Despite difficulties RCoA recommend engaging with patient MSF

35. Doctors in training

36. Doctors in training • All trainees will need to revalidate • Postgraduate deaneries in England or equivalent in devolved nations will be the ‘designated body’ • Recommendation to revalidate based on participation in ARCP/RITA process • Most supporting information already be part of training portfolio • Some new documentation likely • Pilot exercise completed and will report soon • Timing: five years after full registration or at add award of CCT whichever is sooner

37. Remediation

38. Remediation • Revalidation likely to identify increased numbers of doctors with fitness to practice issues • ~ 1000 remediation cases in progress in England • 2,800 (~2%) of all doctors in England subjected to investigation annually • Remediation provision will need to be enhanced & increased • DH report on remediation published Dec 2011

39. Remediation: what is meant? ‘The overall process agreed with the practitioner to redress identified aspects of underperformance. Remediation is a broad concept varying from informal agreements to carrying out some re-skilling, to more formal programmes including supervised remediation and/or rehabilitation.’

40. Remediation: DH report 2011 • Highlights lack of: • consistency in how organisations tackle doctors with performance issues • clarity about where a PDP stops and remediation starts • clarity as to who has responsibility for the remediation process • clarity on what constitutes acceptable clinical competence and capability • clarity about when the remediation process is complete and successful • clarity about when the doctor’s clinical capability is not remediable • capacity to deal with the remediation process

41. Remediation: DH report • Key recommendations: • Wherever possible, performance problems including clinical competence and capability issues, should be managed locally • Local processes need to be strengthened to try and avoid performance problems occurring and reduce their severity at the point of identification • The capacity of staff within organisations to deal with performance concerns needs to be increased with access to external expertise as required • 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 

42. Remediation: DH report • Key recommendations (cont’d): • The medical royal colleges should produce guidance and also provide assessment and specialist input into remediation programmes • 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

43. Remediation: Clinical Directors view • Much should be managed locally • College should be involved • ‘A supportive rather than driving role’ • Setting standards - consistency • Providing advice on assessment and processes • Help make it happen • Concerns about funding of remediation programmes

44. Remediation: Regional advisors view • College should be involved in: • Setting standards and establishing framework • Assessment: both advice and doing • Helping make it happen – organise external placements • Training for specialty needs

45. Remediation: General consensus • Preferable to identify performance concerns early • Ensure robust local appraisal and clinical governance processes are in place • Act on information obtained • Majority of issues should be manageable locally • Work with national organisations e.g. NCAS • Work with Academy of Medical Royal Colleges to produce consistent approach across the profession

46. Obtaining information & advice

47. Sources of information& advice • GMC website • http://www.gmc-uk.org/doctors/revalidation.asp • RCoA & FICM website • http://www.rcoa.ac.uk/revalidation-cpd • http://www.ficm.ac.uk/cpd-and-revalidation • RCoA Bulletin articles • http://www.rcoa.ac.uk/bulletin • Specialty advisors

48. Revalidation specialty advice • Common model for delivery of specialty advice agreed by AoMRC • Central contact point for all specialty advice via the College: • revalidation@rcoa.ac.uk

49. Revalidation specialty advice • Demand for specialty advice for anaesthesia unclear • Requests likely from all revalidation stakeholders • Uncomplicated process queries dealt with by College staff • Commence with a small (15-20) team of advisors • Membership includes representation from: • FICM & FPM • All home nations • All major sub-specialties • SAS grade • Retired/ independent practice • All advisors will receive appropriate training

50. Comments or questions to: revalidation@rcoa.ac.uk