…should be the spark that sets alight the comprehensive provision of educational opportunity and support for doctors.

1. Revalidation… …should be the spark that sets alight the comprehensive provision of educational opportunity and support for doctors. Nick Lyons, Education for Primary Care (2011) 22: 360 www.revalidationsupport.nhs.uk [01]

2. [0X-03] Revalidation training for current appraisers Facilitators: RST observers: Organisers: Date, Venue Version 7.0 (August 2012) [02]

3. Housekeeping www.revalidationsupport.nhs.uk [03]

4. The Medical Appraisal Guide v.3.0(Revalidation Support Team, 2012) [04] www.revalidationsupport.nhs.uk

5. Who does what in medical appraisal for revalidation? • Appraisers appraise • Responsible officers make recommendations • The GMC revalidates [5] www.revalidationsupport.nhs.uk

6. Ground rules www.revalidationsupport.nhs.uk • Confidentiality • Listen • Respect • Participate • Punctuality • Have fun! [06]

7. Introductions and active listening www.revalidationsupport.nhs.uk [07]

8. Your aims and objectives [08] www.revalidationsupport.nhs.uk

9. Aims and objectives of training www.revalidationsupport.nhs.uk • By the end of this event you will be: • Familiar with what is new (and not new) about medical appraisal for revalidation; • Clear about the competencies that you need to have developed to be able to deliver robust and consistent appraisals • Able to apply the key principles consistently; and • Confident about your own skills in delivering effective medical appraisals for revalidation [09]

10. Introducing the appraiser competency framework • Exploring the appraiser competency framework • Professional responsibility • Knowledge and understanding • Professional judgement • Communication skills • Organisational skills • See Section 11 in your pack www.revalidationsupport.nhs.uk [10]

11. What’s new about appraisal for revalidation - for appraisers www.revalidationsupport.nhs.uk • Professional judgement – to analyse and synthesise information presented at appraisal and to judge engagement and progress towards revalidation • How to judge engagement, and ensure that the whole scope of practice is covered • Skills in judging the portfolio of supporting information and the pre-appraisal documentation • How to judge progress towards revalidation appropriate for the stage of the revalidation cycle • When to postpone / suspend an appraisal discussion (very rare) • Skills in reviewing the previous PDP and ensuring the new PDP reflects the doctor’s development needs [11]

12. What’s not new about appraisal for revalidation – for appraisers www.revalidationsupport.nhs.uk Professional responsibility – to maintain credibility as a medical appraiser Knowledge and understanding – to understand the role and purpose of the medical appraiser and to be able to undertake effective appraisals Communication skills – to facilitate an effective appraisal discussion, produce good quality outputs and to deal with any issues or concerns that might arise Organisational skills – to ensure the smooth running of the appraisal system, including timely responses and sufficient computer skills to be an effective medical appraiser. [12]

13. What’s new about appraisal for revalidation - processes • Doctors are appraised on the whole of their scope of work • Clinical governance information and information arising from appraisal will be combined to enable the responsible officer to make a recommendation about revalidation to the GMC • The doctor will have to sign off statements about significant events, complaints, probity, health, the appraisal portfolio, and GMC requirements • The appraiser will have to sign off statements about engagement with appraisal, progress with the previous PDP and the appropriateness of the new PDP and GMC requirements [13] www.revalidationsupport.nhs.uk

14. Terms used • Professional judgement – • the equivalent of the clinical judgements that we are all • used to making everyday as clinicians • (not a judicial process) • Reflection – • “Good Medical Practice requires you to reflect on your practice and whether you are working to the relevant standards” • (GMC Supporting information for appraisal and revalidation, Mar 2011) • Summary of appraisal – rather than Form 4 www.revalidationsupport.nhs.uk [14]

15. Key messages 1 www.revalidationsupport.nhs.uk • First, do no harm: • Appraisal should be a positive experience for a doctor • The effort needs to be proportionate • Appraisers must not take on inappropriate roles even if they have the skills [15]

16. The Appraisal Balance Patient Care ---------------- Patient Safety Revalidation Professional Development Quality Improvement [16]

17. Key messages 2 www.revalidationsupport.nhs.uk • If in doubt – ask • Appraisers should have a low threshold for seeking advice (and know the appropriate contact details) • Appraisers need access to professional support structures • The doctor being appraised is the expert • Supporting information needs to be set in context [17]

18. Providing a professional appraisal www.revalidationsupport.nhs.uk [18]

19. Duties of a doctor (from GMC Good Medical Practice, 2006) • 43. You must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times. If you have concerns that a colleague may not be fit to practise, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary. This means you must give an honest explanation of your concerns to an appropriate person from your employing or contracting body, and follow their procedures. www.revalidationsupport.nhs.uk [19]

20. Rehearsing an introduction www.revalidationsupport.nhs.uk [20]

21. Handling unexpected serious concerns arising during the appraisal discussion www.revalidationsupport.nhs.uk • Discussion: • Has anyone here had to suspend an appraisal discussion because of a serious concern? • Exercise: • A chance to try out different ways of reacting to a doctor who reveals something for the first time during appraisal that raises serious concerns about their conduct, capability, or health. [21]

22. Coffee [22] www.revalidationsupport.nhs.uk

23. Knowledge and Understanding:The purpose of revalidation www.revalidationsupport.nhs.uk • 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 [23]

24. Medical appraisal can be used for four purposes: www.revalidationsupport.nhs.uk 1. To enable doctors to discuss their practice and performance with their appraiser in order to demonstrate that they continue to meet the principles and values set out in Good Medical Practice and thus to inform the responsible officer’s revalidation recommendation to the GMC. 2. To enable doctors to enhance the quality of their professional work by planning their professional development. 3. To enable doctors to consider their own needs in planning their professional development. and may also be used: 4. To enable doctors to ensure that they are working productively and in line with the priorities and requirements of the organisation they practise in. [24]

25. The Responsible Officer (RO) - Regulations and Guidance • Ensuring doctors have appropriate qualifications and experience • Assuring the quality of the appraisal system • Assuring the quality of the clinical governance system • Monitoring conduct and performance • Evaluating fitness to practise • Responding to concerns – ensuring appropriate investigation and retraining is undertaken • Making recommendations to the GMC www.revalidationsupport.nhs.uk [25]

26. The Responsible Officer (RO) - Recommendations • To make one of the following recommendations, based on the triangulation of information from appraisal, clinical governance and any other source, to the General Medical Council: • Positive recommendation • Request a deferral • Notify the GMC of failure to engage • The Responsible Officer Dashboard (RST, March 2012) allows responsible officers and their staff to track the doctors they are responsible for and see at a glance how they are progressing towards revalidation and where any concerns may lie.  www.revalidationsupport.nhs.uk [26]

27. The roll out of revalidation • Year 0 – 2012/13 • (Secretary of State sign off, Legislation, Responsible Officers) • Year 1 – 2013/14 (20%) • Year 2 – 2014/15 (40%) • Year 3 – 2015/16 (40%) • The starting gun has sounded… www.revalidationsupport.nhs.uk [27]

28. Good Medical Practice:Four Domains • Knowledge, skills and performance • Safety and Quality • Communication, partnership and teamwork • Maintaining trust www.revalidationsupport.nhs.uk [28]

29. Appraisal covers the whole of the doctor’s practice I N P U T S O U T P U T S Personal information Doctor’s personal development plan Scope and nature of work Summary of appraisal Supporting information Appraiser’s statements Review of last year’s personal development plan Achievements, challenges and aspirations The Process of Medical Appraisal Confidential appraisal discussion Post-appraisal sign-off by doctor and appraiser www.revalidationsupport.nhs.uk[29]

30. Declarations before the appraisal discussion (from MAG v.3.0) • Doctors should make a declaration that is visible to the appraiser that demonstrates: • Acceptance of the professional obligations placed on doctors in Good Medical Practice in relation to probity and confidentiality • Acceptance of the professional obligations placed on doctors in Good Medical Practice in relation to personal health • Personal accountability for accuracy of the supporting information and other material in the appraisal portfolio. [30] www.revalidationsupport.nhs.uk

31. Outputs of appraisal:Statements one and two • An appraisal has taken place that reflects the whole of a doctor’s scope of work and addresses the principles and values set out in Good Medical Practice. • Agree / Disagree • 2. Appropriate supporting information has been presented in accordance with the Good Medical Practice Framework for Appraisal and Revalidation and this reflects the nature and scope of the doctor’s work. • Agree / Disagree [31]

32. Outputs of appraisal:Statements three and four • A review that demonstrates progress against last year’s personal development plan has taken place. • Agree / Disagree • An agreement has been reached with the doctor about a new personal development plan and any associated actions for the coming year. • Agree / Disagree [32]

33. Outputs of appraisal:Statement five • 5. No information has been presented or discussed in the appraisal that raises a concern about the doctor’s fitness to practise. • Agree / Disagree [33]

34. Outputs of appraisal:Additional information for the RO The appraiser should record any comments that will assist the responsible officer to understand the reason for the statements that have been made. The appraiser should record any other issues that the responsible officer should be aware of that may be relevant to the revalidation recommendation. The doctor may use this space to respond to the above comments made by the appraiser. The responsible officer will review comments made in this space. [34]

35. Confirmation of understanding of GMP obligations • Both the doctor and the appraiser are asked to read and • sign the following statements to confirm their acceptance: • I confirm that the information presented within this submission is an accurate record of the documentation provided by the doctor and used in the appraisal. • I understand I must protect patients from risk of harm posed by another colleague’s conduct, performance or health. The safety of patients must come first at all times. If I have concerns that a colleague may not be fit to practise, I am aware that I must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary. [35]

36. GMC guidance www.revalidationsupport.nhs.uk [36]

37. GMC supporting information principles • General information – providing context about • what you do in all aspects of your work • Keeping up to date – maintaining and enhancing • the quality of your professional work • Review of your practice – evaluating the quality • of your professional work • Feedback on your practice – how others perceive • the quality of your professional work www.revalidationsupport.nhs.uk [37]

38. GMC supporting information requirements • There are six types of supporting information: • 1. Continuing professional development • 2. Quality improvement activity • 3. Significant events • 4. Feedback from colleagues • 5. Feedback from patients (where applicable) • 6. Review of complaints and compliments www.revalidationsupport.nhs.uk [38]

39. Significant Events(from MAG Model Appraisal Form) • The GMC states that a significant event (also known as an untoward, critical or patient safety incident) is any unintended or unexpected event, which could or did lead to harm of one or more patients. This includes incidents which did not cause harm but could have done, or where the event should have been prevented. [39] www.revalidationsupport.nhs.uk

40. Levels of supporting information Revalidation Personal Aspirations Professional development Supporting information defined by the employing organisation or specialist body (Fitness for purpose) Supporting information defined by the General Medical Council (Fitness to practise) Supporting information that promotes reflection , may be about the current working environment or areas for future growth and development Organisational and individual information Mandatory requirements may be made contractually by the employing organisation GMC guidance is the essential basis for all revalidation decisions [40] www.revalidationsupport.nhs.uk

41. Supporting information scenarios www.revalidationsupport.nhs.uk • Exercise: • Looking at the supporting information scenarios given. In pairs, consider the decision point and decide on your course of action. Write it down. • Review your answers with the supporting information algorithm and teaching points as an aide memoire • Share your answers with your table / the wider group [41]

42. Looking at the Personal Development Plan (PDP) www.revalidationsupport.nhs.uk [42]

43. Personal development planning www.revalidationsupport.nhs.uk [43]

44. Key messages – a recap www.revalidationsupport.nhs.uk [44]

45. Key messages – a recap www.revalidationsupport.nhs.uk • First, do no harm • Appraisal should be a positive experience for a doctor • The effort needs to be proportionate • Appraisers must not take on inappropriate roles even if they have the skills • If in doubt – ask • Appraisers should have a low threshold for seeking advice (and know the appropriate contact details) • Appraisers need access to professional support structures • The doctor being appraised is the expert • Supporting information needs to be set in context [45]

46. Useful resources - websites www.revalidationsupport.nhs.uk • BMA’s webpages on revalidation: http://www.bma.org.uk/employmentandcontracts/doctors_performance/professional_regulation/index.jsp • GMC’s webpages on revalidation: http://www.gmc-uk.org/doctors/revalidation.asp • GMC’s webpages on good practice: http://www.gmc-uk.org/guidance/index.asp • NHS Revalidation Support Team (RST) website: www.revalidationsupport.nhs.uk • RST’s webpages specifically for Appraisers: http://www.revalidationsupport.nhs.uk/Appraiser.php • NHS Employers’ webpages on revalidation: http://www.nhsemployers.org/PlanningYourWorkforce/MedicalWorkforce/MedicalRevalidation/Pages/Medical-revalidation.aspx • DH’s webpages on implementation of revalidation: http://www.dh.gov.uk/health/2011/10/implementation-of-medical-revalidation/ • Academy of Medical Royal Colleges (AoMRC) Specialty Guidance: http://www.aomrc.org.uk/news-a-publications/208-speciality-frameworks-and-speciality-guidance-.html [46]

47. Useful resources - documents www.revalidationsupport.nhs.uk • Good Medical Practice, GMC, 2006 http://www.gmc-uk.org/static/documents/content/GMP_0910.pdf • The Good Medical Practice framework for appraisal and revalidation, GMC, 2011 http://www.gmc-uk.org/GMP_framework_for_appraisal_and_revalidation.pdf_41326960.pdf • Supporting information for appraisal and revalidation, GMC, 2011 http://www.gmc-uk.org/Supporting_information.pdf_42293176.pdf • Medical Appraisal Guide: A guide to medical appraisal for revalidation, RST, v3.0 March 2012, http://www.revalidationsupport.nhs.uk/CubeCore/.uploads/RSTMAGforReval0312.pdf • Quality Assurance of Medical Appraisers: Recruitment, training, support and review of medical appraisers in England, RST, v3.1, March 2012 http://www.revalidationsupport.nhs.uk/CubeCore/.uploads/Documents/RSTQAMAforReval0312.pdf • MAG Model Appraisal Form http://www.revalidationsupport.nhs.uk/CubeCore/.uploads/PDFForm/MAG/MAGmodelappraisalformv3.pdf • Medical revalidation - principles and next steps: the Report of the Chief Medical Officer for England's Working Group. Department of Health; July 2008. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086430 • Joint University and NHS Appraisal Scheme for Clinical Academic Staff (Universities and Colleges Employers Association, 2002) • A Review of Appraisal, Disciplinary and Reporting Arrangements for Senior NHS and University Staff with Academic and Clinical Duties (Department for Education and Skills, 2001) http://www.academicmedicine.ac.uk/uploads/folletreview.pdf [47]

48. Questions and answers www.revalidationsupport.nhs.uk [48]

49. Evaluation Forms • We welcome all constructive feedback • If anything is unclear and you wish us to get back to you, please put your name and contact details on the form • Remember that you need to look again at the self assessment of competencies and mark whether your confidence has changed as a result of the training today • Thank you for your participation. www.revalidationsupport.nhs.uk [49]

50. Supporting and challenging doctors www.revalidationsupport.nhs.uk [50]