Understanding the new CPD scheme& Peer Discussion Review

Cheshire Osteopathic Group26 January 2019

Steven BettlesPolicy Manager

Aims• To refresh knowledge of the new GOsC CPD scheme• To explore the peer discussion in particular, including

principles in relation to giving and receiving constructive feedback

• To undertake a ‘mock’ peer discussion review• To help you navigate the changes and answer any

questions• Anything else?

Overall CPD requirement to undertake a minimum of 90 hours CPD over three years, comprising at least 45 hours learning with others,

and complete a peer discussion review.

Meeting Standard 4Maintain an annual CPD

portfolio with documented evidence

Meeting Standard 3Every three years

undertake a CPD activity in communication/

consent

Meeting Standard 2At least one activity

from:• Patient feedback

• Peer observation

• Clinical audit

• Case-based

discussion

You must be able to demonstrate how this

has influenced your

CPD or practice

Meeting Standard 1Undertake CPD across

the four themes of the Osteopathic Practice

Standards:

• Communication and

patient partnership

• Knowledge, skills and

performance• Safety and quality in

practice

• Professionalism

Standard 2: Objective activities

have contributed to practice

Standard 3: Seek to ensure that

CPD activities benefit patients

Standard 4: Maintain a

continuing record of CPD

Standard 1: CPD activities are relevant

to the full range of osteopathic practice

Towards the end of the three year cycle, complete a peer discussion review in accordance with the CPD requirement.

Dedicated CPD website

http://cpd.osteopathy.org.uk/

Discussion

Hopes about the scheme

Fears about the scheme

Purpose of the CPD scheme

Engagement Community

Support

Engagement• Osteopaths undertake the new features of the CPD

scheme to support the continual enhancement of patient care and patient safety:- CPD in the themes of the Osteopathic Practice Standards

§ Communication and patient partnership§ Knowledge, skills and performance§ Safety and quality in practice§ Professionalism

- Communication and consent- Objective activity

Support• Osteopaths reflect on their

practice with others to get professional and personal support to continually enhance patient care and patient safety

Community• Osteopaths reach out to build broader networks with

osteopaths and others to continually enhance patient care and patient safety

CPD Standard 1

A. Communication and patient partnership

B. Knowledge, skills and performance

C. Safety and quality in practice

D. Professionalism

CPD activities are relevant to the full range of osteopathic practice – CPD across all themes of the Osteopathic Practice Standards

Osteopathic Practice Standards

Current Updated

Click to add text

https://standards.osteopathy.org.uk

Updated Osteopathic Practice StandardsTheme Areas include:

A. Communication and patient partnership

Listening, respecting patients’ concerns and preferences, dignity and modesty , effective communication, providing information, consent, patient partnership

B. Knowledge, skills and performance

Having sufficient knowledge and skills, working within training and competence, keeping up to date, analysing and reflecting on information to enhance patient care

C. Safety and quality in practice

Case history taking and record keeping, patient evaluation management, safeguarding, wider role in enhancing patients’ health and wellbeing

D. Professionalism Ethics, integrity, honesty, duty of candour, responding to complaints, confidentiality, working with others, complying with regulatory requirements

CPD Standard 2At least one ‘objective’ activity to assess the quality of your practice, and you must be able to demonstrate how this has influenced your CPD and improved your practice

Objective activities have contributed to practice

Some objective activities

• Patient feedback• Peer observation• Clinical audit• Case-based discussion• Patient Reported Outcome Measures (PROMs)

(NCOR)* • Opportunity to tailor what you do to your own

practice.*https://www.ncor.org.uk/practitioners/patient-reported-outcomes/prom-app-collecting-prom-data-in-practice/

CPD Standard 3At least one CPD activity in communication and consent

Seek to ensure that CPD activities benefit patients

Types of concernType of concern Number of concerns (% of total)

2016 2015 2014 2013

Conduct 102 (43%) 102 (48%) 100 (40%) 109 (55%)

Clinical Care 128 (54%) 108 (51%) 139 (56%) 86 (43%)

Criminal convictions 1(<1%) 1 (<1%) 6 (2%) 3 (2%)

Adjunctive therapy 1(<1%) 1 (<1%) 3 (1%) 2 (1%)

Health 3 (1%) 1 (<1%) n/a n/a

Total 235 213 248 200

False/misleading advertising 175 156 9 3

Types of concernType of concern about conduct Number of concerns (% of total)*

2016 2015 2014 2013

Failure to communicate effectively 18 (18%) 17 (17%) 15 (15%) 12 (11%)

Communicating inappropriately 18 (18%) 12 (12%) 5 (5%) 15 (14%)

Failure to treat the patient considerately/politely 7 (7%) 4 (4%) 3 (3%) 3 (3%)

Failure to obtain valid consent – no shared decision-making with the patient

13 (13%) 8 (8%) 14 (14%) 20 (18%)

Communication and consent

• Case studies• Specific events• Group discussions• Reflections on practice• Journal articles• National Council for Osteopathic Research

(https://www.ncor.org.uk/)

CPD Standard 4Keep an ongoingrecord of CPD activities

An ongoing record

• Online portfolio • Written notes• Your own reflections in Word,

Pages or Google Drive (for example)

• Aim is to be able to share with a peer your development planning, activities and reflections as evidence of your engagement with the scheme

Peer discussion review

A structured conversation with a peer to demonstrate that you’ve met the requirements of the scheme

Peer discussion review

Osteopathic Practice Standards and Reflection

Objective Activity and Reflection

Communication and Consent and Reflection

Keeping a record (may involve range of different methods –

diaries, e-portfolios, recordings, photos)

Structured conversation showing engagement with

the CPD scheme

What is peer discussion review?• Where osteopaths discuss their CPD and practice and

show that they have engaged and complied with the CPD scheme and the CPD Standards using a combination of their CPD record (comprising CPD undertaken and impact on practice) and discussion.

• It is important for the peer discussion review to be conducted in a supportive way that emphasises and encourages engagement and enhances practice.

The Peer Discussion Review

• Identifying a peer – any regulated health professional of your choosing

• Good to identify someone early• Could be someone you do an objective activity with

– eg peer observation, case-based discussion (but doesn’t have to be)

Any concerns about this process?

Culture – what will you need?• supportive approach• apply these skills:– listen carefully – give and receive constructive and helpful feedback – show an attitude of curiosity– willing to embrace opportunities to learn from

every encounter – value new knowledge and insights that all peers

and colleagues can bring

Talking about practice with others

• Being comfortable/trust – where people trust their peers to give helpful, critical feedback on the questions they raise, and the doubts and uncertainties they have.

• Uncertainty and mistakes are viewed by everyone as an opportunity for learning and development

• Feel safeSee Toby Lowe, Learning Communities: https://www.ncl.ac.uk/kite/social-renewal/learning-communities/#about

Things to consider

• Who is in the room?• When and where will you meet?• What ground rules will apply for the session?• What questions/issues do you want to address?• How will you present your CPD?

Examples of possible questions

Questions for the peer to ask the osteopath (if you want to explore more than the template questions....)• What happened?• What were you worried about? Why?• What did you want to achieve? (for this or future

patient(s)?• What do the OPS or other references say? • What would you do differently? How? When?• What can I do to help?

Things for the osteopath to consider

• What do I think I do well? • Should I consider changing anything?• How would I prepare differently next time?• How could I make such a change? • How do I evaluate the impact of any changes?

Completing a PDR

• Today – we are practising the completion of the peer discussion review in pairs to help understand how it will work and to identify any questions we have

• Don’t worry – you’re not expected to have completed all of the aspects of the scheme at this stage (though you may be surprised at how much you have done....)

• Aim is to experience talking to a colleague about your CPD

The PDR form

CPD Standard 1 – OPS• Demonstrate that activities are relevant to the full

range of osteopathic practice (Osteopathic Practice Standards and breadth of practice)– Met: activities fit under all four themes of the

Osteopathic Practice Standards and appear to cover all aspects of their osteopathic practice (e.g. clinical practice, teaching responsibilities, research, management)

– Not met: if the osteopath has not undertaken CPD in all the themes of the Osteopathic Practice Standards

CPD Standard 2 – objective activity• Demonstrate that objective activities have

contributed to practice and the quality of care– Met: showing that feedback gathered objectively

and then analysed or considered has informed their practice and their CPD ... genuine attempts to improve their practice through the use of information or data generated objectively

– Not met: if the osteopath has not undertaken any activities to gather objective feedback during the three-year cycle

CPD Standard 3 – communication• Sought to ensure that CPD benefits patients (CPD in

communication and consent)– Met: able to show they have • undertaken CPD activity relating to communication and

consent with patients• have reviewed the guidance in the OPS and • that this has informed their learning and has been

applied in practice – Not met: if the osteopath is unable to show that

they have undertaken an activity relating to communication and consent

CPD Standard 4 – record• Showing documented CPD for the activities that are

discussed in the course of the Peer Discussion Review – their CPD folder. – Met: when the osteopath is able to show

documented evidence of compliance with the CPD scheme

– Not met: when the osteopath is unable to show documented evidence of compliance with the CPD scheme

Summary

• Overview – this section allows the peer and the osteopath to summarise their overall views of the osteopath’s CPD and practice.

• Overall discussion and feedback– Comments:– Strengths:– Areas for development:

CPD Action Plan for the next three-year cycle

• This section should consolidate the earlier discussions by identifying potential CPD activities to address areas of development during the next three-year CPD cycle. It will normally be completed by the osteopath.– Comments:– Plans for CPD over the next three years – practitioner

directed:– Plans for CPD over the next three years – to meet areas for

development identified during the most recent three-year cycle?

Declaration by peer

“I confirm that I have conducted this peer discussion review and that, in my opinion, the CPD standards have been met and that the osteopath I am reviewing appears to provide good quality and safe patient care on the basis of the information that we have discussed. I confirm that all information provided on this form is correct to the best of my knowledge.”

Declaration by osteopath

“I confirm that I have participated in this Peer Discussion Review, and that the information provided on this form is correct to the best of my knowledge. I confirm that I will retain a copy of this form in my CPD folder.”

Reporting CPD under new scheme

• No more annual CPD summary returns to GOsC• But some additional questions around CPD when

renewing registration annually (hours undertaken, aspects of the scheme met)

Reporting CPD under new scheme

• GOsC to provide feedback on activities (eg where you are in relation to others, areas still to be undertaken etc)

• At end of cycle, confirmation supplied to GOsC that PDR has taken place and all requirements of the scheme have been met.

Mock peer discussion review

• Please select a partner and agree who will be ‘peer’ and who will be ‘osteopath’

• Go through the peer discussion review template together making brief notes as you go

• It’s fine to focus on key aspects – you probably haven’t complied with all the requirements yet

• Swap over if you have time• Plenary feedback session

The updated Osteopathic Practice Standards

Osteopathic Practice Standards

• Implemented from 1 September 2012

• 37 standards• Separates Standards of

Proficiency and Code of Practice

Updated OPS

• The Standard of Proficiency and Code of Practice combined into one set of standards.

• Overall standards reduced from 37 to 29• Reduced repetition and combined some standards

where appropriate• Some standards moved to guidance• Some standards moved to another theme• Reviewed language throughout

Standards and guidance

Standards Guidance‘Must’ ‘May’Expected to comply Have a choice – use your professional

discretion

‘Should’Used to indicate how standard can be met, or where relevant duty won’t apply in all circumstances or situations

Updated Osteopathic Practice StandardsTheme Areas include:

A. Communication and patient partnership

Listening, respecting patients’ concerns and preferences, dignity and modesty , effective communication, providing information, consent, patient partnership

B. Knowledge, skills and performance

Having sufficient knowledge and skills, working within training and competence, keeping up to date, analysing and reflecting on information to enhance patient care

C. Safety and quality in practice

Case history taking and record keeping, patient evaluation management, safeguarding, wider role in enhancing patients’ health and wellbeing

D. Professionalism Ethics, integrity, honesty, duty of candour, responding to complaints, confidentiality, working with others, complying with regulatory requirements

Communication and patient partnership

‘This theme sets out the standards relating to communication, the formation of effective patient partnerships, and consent. Patients must be at the centre of healthcare and must be given the information that they need in order to make informed choices about the care they receive. These standards support therapeutic relationships built on good communication, trust and confidence.’

Knowledge, skills and performance

‘All osteopaths must have the knowledge and skills to support their practice as primary healthcare professionals, and must maintain and develop these throughout their careers. They must always work within the limits of their skills and experience. The standards in this theme set out the requirements in this respect.’

Safety and quality in practice

‘Osteopaths must deliver high-quality and safe healthcare to patients. This theme sets out the standards in relation to the delivery of care, including evaluation and management approaches, record keeping, safeguarding of patients, and public health.’

Professionalism

‘Osteopaths must act with honesty and integrity and uphold high standards of professional and personal conduct to ensure public trust and confidence in the profession. The standards in this theme deal with such issues and behaviours, including the establishment of clear professional boundaries with patients, the duty of candour, and the confidential management of patient information. These contribute to ensuring that trust is established and maintained within therapeutic relationships.’

Communication

A1 You must have well-developed interpersonal communication skills and the ability to adapt communication strategies to suit the specific needs of a patient.A5 Work in partnership with patients to find the best treatment for them.

Current

Communication

UpdatedA2 You must work in partnership with patients, adapting your communication approach to take into account their particular needs, and supporting patients in expressing to you what is important to them.

Communication

CurrentA2 Listen to patients and respect their concerns and preferences.C4 Be polite and considerate with patientsC5 Acknowledge your patients’ individuality in how you treat them

UpdatedA1 You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients, and treat them with dignity and courtesy.

Provide information

Current A3 Give patients the information they need in a way that they can understand.

UpdatedA3 You must give patients the information they want or need to know in a way they can understand.

Consent

CurrentA4 You must receive valid consent before examination and treatment.

UpdatedA4 You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

Supporting patients

CurrentA6 Support patients in caring for themselves to improve and maintain their own health.

UpdatedA5 You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

Knowledge and skills

CurrentB1 You must understand osteopathic concepts and principles, and apply them critically to patient care.B2 You must have sufficient knowledge and skills to support your work as an osteopath.

UpdatedB1 You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

Principles now covered in guidance to B1 …

• These should include:– an understanding of osteopathic philosophy,

principles and concepts of health, illness and disease, and the ability to apply this knowledge critically, in the care of patients…

Working within limits of competence

CurrentB3 Recognise and work within the limits of your training and competence.

UpdatedB2 You must recognise and work within the limits of your training and competence.

Keeping skills and knowledge up to date

CurrentB4 Keep your professional knowledge and skills up to date.

UpdatedB3 You must keep your professional knowledge and skills up to date

Delivery of careCurrentC1 You must be able to conduct an osteopathic patient evaluation sufficient to make a working diagnosis and formulate a treatment plan.C2 You must be able to formulate and deliver a justifiable osteopathic treatment plan or an alternative course of action.

Updated

C1 You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.

Care for patients

CurrentC3 Care for your patients and do your best to understand their condition and improve their health.

UpdatedA2.2 (Guidance) You must care for your patents and do your best to understand their symptoms and support their health.

Be polite and considerate

CurrentC4 Be polite and considerate with patients. C5 Acknowledge your patients individuality in how you treat them

UpdatedA1 You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy.

Dignity and modesty

CurrentC6 Respect your patients’ dignity and modesty

UpdatedA6 You must respect your patients’ dignity and modesty.

Provide appropriate care

CurrentC7 Provide appropriate care and treatment

UpdatedThis one has been deleted – it was felt that the provision of appropriate care was adequately covered within many other standards.

Records

Current C8 Ensure that your patient records are full, accurate and completed promptly.

UpdatedC2 You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.

Keep patients from harm

CurrentC9 Act quickly to help patients and keep them from harm.

UpdatedC4 You must take action to keep patients from harm.

Other health professionals

CurrentD1 You must consider the contributions of other healthcare professionals to ensure best patient care.

UpdatedD10 You must consider the contributions of other health and care professionals, to optimise patient care.

Production of written material

CurrentD2 You must respond effectively to requirements for the production of high-quality written material and data.

UpdatedC3 You must respond effectively and appropriately to requests for the production of written material and data.

Retrieving and analysing information

CurrentD3 You must be capable of retrieving, processing and analysing information as necessary.

UpdatedB4 You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

Beliefs and values

CurrentD4 Make sure your beliefs and values do not prejudice patient care.

UpdatedB4 You must make sure your beliefs and values do not prejudice your patients’ care.

Equality

CurrentD5 You must comply with equality and anti-discrimination laws.

UpdatedD6 You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

Confidentiality

CurrentD6 Respect your patients’ rights to privacy and confidentiality.

UpdatedD5 You must respect and your patients’ rights to privacy and confidentiality, and effectively maintain and protect patient information.

Complaints and candour

CurrentD7 Be open and honest when dealing with patients and colleagues and respond quickly to complaints.

UpdatedD3 You must be open and honest with patients, fulfilling your duty of candour. D4 You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

Supporting colleagues

CurrentD8 Support colleagues and cooperate with them to enhance patient care.

UpdatedD9 You must support colleagues and cooperate with them to enhance patient care.

Comments about other health professionals

Current D9 Keep comments about colleagues or other healthcare professionals honest, accurate and valid.

UpdatedD10 You must consider the contributions of other health and care professionals, to optimise patient care.Includes guidance:any comments that you make about other healthcare professionals should be honest, valid and accurate

Osteopaths own health

CurrentD10 Ensure that any problems with your own health do not affect your patients.

Updated D11 You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.

Promotion of health

CurrentD11 Be aware of your role as a healthcare provider to promote public health.

UpdatedC6 You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.

Guidance to C6 now much clearer

‘C6.1 You should be aware of public health issues and concerns, and be able to discuss these in a balanced way with patients, or guide them to resources or to other healthcare professionals to support their decision-making regarding these.’

Spread of communicable diseases

CurrentD12 Take all necessary steps to control the spread of communicable diseases. D13 Comply with health and safety legislation.

UpdatedC5 You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

Integrity

CurrentD14 Act with integrity in your professional practice.

UpdatedD1 You must act with honesty and integrity in your professional practice.

Integrity

• Guidance to this now includes:‘D1.3 You must have a professional indemnity insurance arrangement which provides appropriate cover in accordance with the requirements of the Osteopaths Act (1993) and the current Professional Indemnity Insurance Rules.’

Advertising

• This is covered in the guidance to D1, and other than the reference to promotional and website material, is unchanged from the current version:You should not allow misleading advertising or information about you and your practice. You should make sure that:– Your advertising and promotional material, including

website content, is legal, decent, honest and truthful as defined by the advertising standards authority (ASA) and conforms to current guidance, such as the UK Code of Non-broadcast Advertising and Direct and Promotional Marketing (the CAP code).

Honesty

CurrentD15 Be honest and trustworthy in your financial dealings, whether personal or professional.

UpdatedD8 You must be honest and trustworthy in your professional and personal financial dealings.

Boundaries

CurrentD16 Do not abuse your professional standing.

UpdatedD2 You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

Reputation of the profession

CurrentD17 Uphold the reputation of the profession through your conduct.

UpdatedD7 You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

Keeping GOsC informed

CurrentD18 You must provide to the GOsC any important information about your conduct and competence.

UpdatedD12 You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation, and must comply with all regulatory requirements.

Dedicated OPS site

https://standards.osteopathy.org.uk/

Any questions

Feedback• What went well?• What could be improved?• Suggestions for next time (what can be included,

improved or removed)?• Would you consider facilitating these sorts of

sessions for your colleagues? If so, what support would you need to do that?

• Can we share your experience with others?• Anything else?

Thank you

If you have any questions or comments, please feed these back to:• Steven Bettles – sbettles@osteopathy.org.uk• For The Osteopath magazine – Clare Conley

(cconley@osteopathy.org.uk)• For general communications queries – Stacey Towle

(stowle@osteopathy.org.uk)