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Revalidation by fdshsdhs

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									Revalidation: What Is It?
New unified system of Reflective CPD & feedback to improve:
 Awareness of educational/professional needs
 Quality of care
 Confidence (patients, public, employers, colleagues)
 Addresses Current inconsistencies in re-mediation


 Incorporates relicenship & recertification
  for all UK-licensed doctors
Revalidation: Why & When?
NHS Plan 2001                         Now
 Annual appraisal GMS                 Strengthen existing system
  contractual obligation               Annual peer-led appraisal
 Scotland: compulsory since 2003      Continuous process
 +/- inclusion on Performer’s List    Actioned every 5-year cycle

Previously                            Current pilots
 CPD + 360° feedback +/-              Inc nPEP in Dundee
  supervision                          Phased-in from April 2011
 NES led with local GP appraisers
 1-2h Formative session(i.e.
  Feedback not Pass/Fail)
Key Documents

 “Trust, Assurance & Safety – The Regulation of Health Professionals in
  the 21st Century” Feb 2007

 “Good Medical Practice for General Practitioners” 2008

 “Medical revalidation – Principles & Next Steps” 2008
 “GMC Licence to Practice” Nov 2009
 “RCGP Guide to Revalidation” Jan 2010

 “Revalidation: The Way Ahead. Consultation Document” March 2010
    Good Medical Practice
    GMC’s standards of Professional Duty for all doctors
    4 domains, 12 attributes
Knowledge, Skills & Performance

 Maintain Professional Performance    Safety & Quality
 Apply Knowledge & Experience to
  Practice
                                        Systems to protect patients & improve care
 Clear, accurate, legible records
                                        Respond to safety risks
                                        Protect others from risks of own health

Communication, Partnership,
    Teamwork
                                       Maintaining Trust
•   Communicate effectively
•   Works constructively / delegates   •   Respect for patients
•   Partnerships with patients         •   Treat others without discrimination
                                       •   Act with honesty & integrity
                                Supporting Information:
                          • Colleague & Patient Feedback
                          • CPD records
  Annual Appraisal
                          • Clinical Audit
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
                                                Supporting Information:
                                          • Colleague & Patient Feedback
                                          • CPD records
       Annual Appraisal
                                          • Clinical Audit
     Over 5-year period with
         local appraiser
                                            Medical Royal College / Faculty:
                                          • Define standards for appraisal &
                                          supporting information
                                          • Providing speciality guidance &
      Responsible Officer
                                          advice for appraisers, appraisees and
      Receives feedback on                Responsible Officers
            appraisal


   New role [Health and Social Care Act 2008]
   Senior doctor within healthcare organisation e.g. medical director
   Supported by experienced GP adviser and trained lay person
   Review supporting information submitted for several thousand doctors
   Thus Appraiser has key-role in informing the Responsible Officer
                                Supporting Information:
                          • Colleague & Patient Feedback
                          • CPD records
  Annual Appraisal
                          • Clinical Audit
Over 5-year period with
    local appraiser
                            Medical Royal College / Faculty:
                          • Define standards for appraisal &
                          supporting information
                          • Providing speciality guidance &
  Responsible Officer
                          advice for appraisers, appraisees and
  Receives feedback on    Responsible Officers
        appraisal



   Responsible Officer
   Makes revalidation              Quality Assurance
recommendation to GMC        • Royal Colleges
                             • System regulators (e.g. The
                             Care Quality Commission)
                             • GMC
GMC: Doctor Revalidated
                 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
                                         One-Process Revalidation
               License                       5-Yearly Relicence
             to Practise


              Certificate
                                          5-Yearly Recertification
       to be on the GP register
   What do I need to do?

 Supporting Evidence
 CPD credits


 Personal Development
 Plans




 Appraisal
      Portfolio: 13 evidence areas
1.    Profession Role            description of work
2.    Special Circumstances      e.g. maternity/sick/sabbatical, job change
3.    Annual Appraisals Review   signed-off
4.    PDP                        PDP for each annual appraisal
5.    PDP Reviews
6.    Continuing Education       ≥50 learning credits/year
7.    Multi-Source Feedback      2 x MSF every 5 years
8.    Patient Feedback           2 x PSQs every 5 years / 1 + video-analysis
9.    Formal Complaint Review    if any
10.   Significant Event Audits   5 x SEA every 5 years
11.   Clinical Audits            2 x full-cycle audits every 5 years
12.   Probity/Health
13.   +/- Extended Practice      e.g. OOH, GPwSI, teaching/research
Revalidation ePortfolio
 “Supporting information” (evidence) used for annual appraisal
 RCGP College Revalidation ePortfolio
 Most GPs will include information from April 2009

 Easy, intuitive data entry to allow easy review of progress
 Structured to encourage reflection
 Traffic-light-coded ‘dashboard’ summary

 Integrate other online-tools
    Essential Knowledge Update (EKU): scenario-based learning
    Essential Knowledge Challenge (EKC): multiple-choice, voluntary
    PEP, e-GP, RCGP trainee ePortfolio, NHS appraisal toolkit
 The
Early
Years
Learning Credits
 All colleges agree - record continuing education in the form of learning credits
 At least 50/year = 250 over a full 5-year revalidation cycle

RCGP:
 1 credit = 1 hr education (learning, planning, reflecting)
 Self-assessed then reviewed at appraisal

IMPACT FACTOR
 Each hour of education that can been shown to lead to improvement in
  care or practice will qualify for 2 credits
 Impact on
       Patients e.g. Implement new guideline / initiate new drug
       Individual e.g. new / further developing skill
       Service e.g. new service / becoming training practice
       Others e.g. Teaching, training, NHS services
                                                       1 credit

HF Meeting (1h)                                  Impact Factor x 2



Dr A:
 Logs learning (knowledge & relevance)                       1 credit

Dr B:
 As Dr A
 2 case studies of appropriate B-blockers use in HF          2 credits

Dr C:
 As Dr A + plans an audit (1h) + discusses findings (1h)    6 credits
 Change implemented & 2nd cycle demonstrates change
Personal Development Plan
RCGP Guide to the Revalidation of GPs. Jan 2010. version 3.0
Special Consideration
 Maternity leave
 Work Abroad

   Sessional GPs
   GPs in remote or small practices
   GPs in Forces / Prison Service
   GPs in training
   Non-clinical (medical managers)


 ? re-entry portfolio
Career Breaks RCGP Video May 2010
Ordinary Portfolio requirements (within 5 year period)
 Appraisal ≥3 years
 Kept up-to-date (CPD) ≥ 3 years
 Clinical Activity ≥ 200 half-day clinical sessions
    Otherwise Responsible Officer may d/w RCGP / GMC

Out-of-practice at time licence up for revalidation...
 License may not be continued
 Can re-apply when ready to go back
 If “sustained” period of time will need “re-orientation”
    Assessment
    Re-entry course
Drawbacks
“Unfair”
 Punitive process for wholly independent practice
 Older GPs & electronic record and reflective practice
 Locums (paper record prescribing, referrals, feedback)

“Bureaucracy”
 More political form-filling
 Wasted time away from clinical care
 Costs (implementing, carrying out, remediation)
 Uncertainty
 DoH terminating contracts of underperforming practices
BJGP (July 2009:476)
 Most doctors see revalidation as a focus for CPD to bring regulation
    and education together
   Some GPs the process seems like a bureaucratic nightmare and an
    inefficient way to weed out villains of the profession
   Need to move away from this idea if revalidation is to reach its
    potential (improve care, reassure public/profession, support)
   Society wants doctors to be more accountable
   Collecting evidence of what we do is significant part of profession
   Needs to be properly resourced to avoid “squeezing it in” around
    “proper work”
Public Interest
 Increasing climate of general loss
  of public trust & increased
  awareness of medical error
    Bristol enquiry, Shipman, etc


 GMC figures April 2010
    2,300 patients
    14 % not confident in last Dr seen
    71% felt revalidation would boost
     confidence
        Inc 2/3 those quite/very confident
“Information for Patients”
 Tell doctors when care is good
    Thank you letters, compliments


 Say when care is not as good as expected
    Talk, letter, formal


 Report when things go wrong


 Give views when asked
Appraisal Performance
“Central document underpinning revalidation & supporting GPs through it”
Performance
 GMP Objectives =
  Appraisal Standards

3 phases:
 Preparation of evidence
 Submission &
  Assessment
 Relicense/Remediate
Standards
The Excellent, Good & Unacceptable Dr
 Clinical Care             Keeping Up To Date
 Record keeping            Training & Assessing
 Access, Availability,     Dr-Pt Relationship
  OOH                       Team-work
 Resources                 Probity
 Access to Medical Care    Health
 Emergency Treatment
“A doctor’s certificate and
  registration cannot be
  restricted or removed, except
  through due process, under
  the GMC’s fitness to practise
  rules and where there is
  evidence of impaired
  practice”
Remediation
Small minority
 Early identification of concerns
 Follow up local support /action
 RCGP National Adjudication
  Panel after 2 unsatisfactory
  appraisals

Next stop GMC (can appeal)
 May defer decision to allow Dr to
  fill gaps in supporting info
 Outcome based on local,
  National Clinical Assessment
  Service or GMC process
 Re-entry portfolio
 Resourcing is key concern
Other Countries
Formal revalidation   Netherlands
 Germany              ‘Herregistratie’
 Netherlands           (recertification) 2001
                       OOH mandatory, thus older
                        GPs felt discriminated against

                       Initially required GPs
                        complete whole 3 y of GP-
                        training again

                       2002 1-year programme
                        started 4 days/week
                        supervised work + 1 day
                        education
Summary
Aims to continually improve:    Accumulate evidence:
 Professional accountability
 Standards of Care              Annual appraisals
 Faith in doctors               Audits / SEA / Complaints
                                 Record learning hours
Taking into account              Feedback
 Standards                         Patients & Colleagues
   Clinical guidelines          Responsible officer review
   Good Medical Practice           Every 5 years

								
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