ARCP Update and Revalidation NHS East of England Multi-Professional Deanery East of England LETB ARCP Update and Revalidation Dr Alys Burns Professor John Howard Dr Deepak Jain February and March 2013

Expectations and Aims

ARCP Process: The Essentials

ARCP Process: The Essentials 1. What is the purpose of an ARCP? Give up to three principles

ARCP Process: The Essentials 2. Which trainees should the ARCP process apply to?

ARCP Process: The Essentials 3. What evidence is required to undertake an ARCP?

ARCP Process: The Essentials 4. What is the minimum number of panel members for an ARCP panel and who should make up the panel?

ARCP Process: The Essentials 5. What is the requirement for lay / external representation on ARCP panels?

ARCP Process: The Essentials 6. Is it a requirement for the trainee to attend an ARCP panel?

ARCP Process: The Essentials 7. If the trainee is present, at what point in the meeting with the panel should they be told of the outcome?

ARCP Process: The Essentials 8. How long can training be extended if there is a recognised requirement for additional time?

ARCP Process: The Essentials 9. What is the role of the ARCP panel in relation to issues arising regarding fitness to practice?

ARCP Process: The Essentials 10. Which ARCP outcomes does the appeal process apply to?

ARCP Update: What’s New! Revalidation Revisions to the Gold Guide and the appeal process ARCP Outcomes U and N ARCP in Foundation GMC Guidance regarding time out of training

Time out of Training ARCP must include a review of absence from 1st April 2013 Absence of a total of 14 days or more in a 12 month period must trigger a review of CCT date ‘Flexible’ implementation of guidance

Revalidation for doctors in training EOE Deanery Revalidation Team

Principles of revalidation The GMC states revalidation: Confirms that a doctor with a licence to practise continues to be fit to practise. Provides confirmation that a doctor with a licence to practise is working within a governed system. Requires all doctors to engage with systems of periodic review. Is not a point in time assessment.

Medical revalidation Annual enhanced NHS appraisal Evidence across 6 areas of practice Whole scope of practice Responsible Officer connection 5 successful appraisals leads to revalidation recommendation

Principles of revalidation Doctors in Training Responsible Officer for all doctors in training is Postgraduate Dean Doctors in training should collect the information required for their current curriculum and assessments UK variation in evidence required

Who are Doctors in Training? All specialty trainees All Foundation 2 doctors holding a full licence to practice having completed Foundation 1 Locums Appointed for Training (LAT)

What is the Process? The new ARCP needs to be equivalent to NHS appraisal Includes full scope of a doctor’s practice Includes Fitness to Practice concerns from Employers/Performers List Information from the ARCP process supports the RO’s recommendation to the GMC

Revalidation recommendations Trainees receive their licence to practice at the end of Foundation Year 1 All Trainees will receive a revalidation recommendation from the Deanery RO: Five years after gaining their licence to practice On applying for a CCT

When does it happen…. Revalidation recommendations start from 1st April 2013 20% of trainees must be revalidated by 1st April 2014 - CCT All trainees should be revalidated by December 2017

Key principles – ARCP panels What stays ARCP panel processes for making decisions on trainee progression The information reviewed by an ARCP panel is confined to the evidence presented Information withheld by a trainee is a probity issue Referral to fitness to practise procedures can occur at anytime, according to circumstances, not just at ARCP.

ARCP panels - What’s New Covers the entire scope of practice for which a trainee holds a licence to practise including: Locum work Voluntary work e.g. St John’s Ambulance, medical officer to rugby club Complaints and compliments arising across full scope of practice Involvement in and learning from investigated significant events arising across full scope of practice

The System and Forms 1 Trainee declares fitness to practice on enhanced Form R before each ARCP Employers/Host training organisations/Primary Care Trusts complete an exception report where there is a concern or investigation as it occurs sent to Deanery Employers/Host training organisations/Primary Care Trusts complete a six monthly collective exit report sent to the Deanery

Definition of “Significant Event” A significant event (also known as an untoward or critical incident) is any unintended or unexpected event, which could or did lead to harm of one or more patients (GMC) This includes incidents which did not cause harm but could have done, or where the event should have been prevented. All doctors as part of revalidation are required to record and reflect on significant events in their work with the focus on what you have learnt as a result of the event/s. On Form R it is not necessary to list any significant events that were not investigated.

The System and Forms 2 Clinical and educational supervisor reports are amended to include questions with regard to fitness to practice The enhanced Form R and reports are compared and correlated at ARCP A new ARCP form records the outcome

The Role of the ARCP Panel Chair To meet trainee revalidation requirements the ARCP panel chair will need to confirm that: A review has taken place that covers the scope of the doctor’s work since the last ARCP Appropriate supporting information has been presented A review of training progression since the last ARCP has been undertaken Agreement has been reached about any necessary actions for the next year There are no outstanding causes for concern about the trainee’s fitness to practise across their full scope of practice

Three categories of RO recommendations Positive affirmation of suitability to continue to hold a licence to practice Deferral request Notification of non-engagement Focuses on the statutory duties of ROs to evaluate doctors’ fitness to practise References the terminology of the RO regulations to reaffirm this statutory duty Refers to a doctor’s engagement with systems and processes which support revalidation Highlights GMC guidance on the supporting information for revalidation, and the GMP Framework for Appraisal and Revalidation Highlights the role of other clinical governance information. Avoids duplicating established channels of communication with the GMC (for example referrals to fitness to practise)

Deferral Requests and Notifications of non-engagement Can be requested if an RO is not ready to make a recommendation by the original due date. Have no effect on the doctor’s licence to practise Appropriate grounds for deferral requests include trainees being on maternity leave, long term sickness, out of programme, or involved in an on-going local investigation or disciplinary process Notifications of non-engagement: Confirm that an RO cannot, or cannot envisage being able, to make an informed recommendation when it falls due, as the doctor has not engaged in processes that support revalidation Not a mechanism for addressing concerns about a doctor’s fitness to practise

Scenarios

Scenario 1 There have been 2 patient complaints about rude behaviour by the trainee. The educational supervisor has discussed these and a plan of action has been agreed and documented in the e portfolio.

Scenario 2 There have been repeated concerns about difficult behaviour with staff and patients. The Clinical Tutor investigated the situation and a plan has been agreed. However complaints were subsequently received from a nurse about poor team working and lack of respect and a trainee colleague following an inadequate hand over.

Scenario 3 A GP ST3 trainee has passed his exams and his ESR shows satisfactory progress. However before his ARCP a significant discrepancy is identified during a CBD between the video record and the written notes made by the trainee from a consultation of a patient with back pain and the trainee admits to writing a fictitious record of the examination.

Scenario 4 A CMT trainee has not completed all their assessments. This has happened persistently and they received an Outcome 2 at their last ARCP. It now emerges they have refused to complete Form R and are still 3 CBDs short.

Scenario 5 A trainee is thought to have had inappropriate sexual relationships with a patient. The GMC interim panel has not suspended the doctor and they have made good educational progress.

Scenario 6 The trainee in 5 is suspended by the GMC for one year.

Questions https://www.eoedeanery.nhs.uk/page.php?area_id=122