February 28th 2012

The Changing Face of Revalidation

Ian Starke,Medical Director, Revalidation,Royal College of Physicians, London

Overview

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

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.

The Revalidation Process

The Revalidation Process

Annual appraisal

Supporting information

ResponsibleOfficer

X 5

PersonalDevelopment

PlanCPD

Recommendationto GMC

The Revalidation Process

Annual appraisal

Supporting information

ResponsibleOfficer

X 5

PersonalDevelopment

PlanCPD

Recommendationto GMC

ClinicalGovernanceinformation

The Revalidation Process

Annual appraisal

Supporting information

ResponsibleOfficer

X 5

PersonalDevelopment

PlanCPD

Recommendationto GMC

ClinicalGovernanceinformation

Professional excellence.

Supporting Information.

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

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

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

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

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.

Supporting Information.

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

How appraisal will work

The Medical Appraisal Guide (under development)

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.

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

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

The stages of medical appraisal

Confidentialappraisal

discussion

Review by appraiser

ofappraisalPortfolio

Other information from doctor

including; achievements, challenges and

aspirations

Review of last year’s PDP and

summary ofappraisal

Supporting Information (SI) with additional comments from

doctor

Inputs Outputs

Doctor’s PDP

Summary of appraisal discussion

Appraiser’s statements

Post appraisal

sign off bydoctor andappraiser

Description of the doctor’s

scope of work

The stages of medical appraisal

Appraiser’s Statements - 1These 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.

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.

Tools for Revalidation

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

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

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

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

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

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.

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.

Proposed DefinitionsRemediation: The overall process agreed with

the practitionerRe-skilling: Provision of support, training and

education to address identified needsSupervised 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

Remediation and re-skilling

Need for support / remediation

Personal Development Plan

RO / GMC

Directed remediation activity

Specialty expert advice

Enhanced PDP

Targeted learning

Specialty support available

Developmental PDP

Employer ‘in-house’ support

Specialty advice available

Fitness to Practice

Specialty expert advice

RO / NCASRO / Appraiser Appraiser

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

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