Revalidation Presented by: Dr Brendan Mason Regional Epidemiologist Communicable Disease Surveillance Centre 29th January 2013

The Odd One Out ?

In February 1999 Council of the GMC decided that: “The regular demonstration by all registered doctors that they remain fit to practice in their chosen field is best assured by a link with continued registration” Source: http://www.gmc-uk.org/Progress_report_to_Council.pdf_25397760.pdf

The Odd One Out ? Sir Donald Irvine Dr Harold Shipman Dame Janet Smith President GMC 1995 – 2001 Dr Harold Shipman Arrested 7/9/98 Found guilty 31/1/00 Dame Janet Smith 5th Report 9/12/04 Safeguarding Patients: Lessons from the Past - Proposals for the Future Sir Liam Donaldson Report 14/7/06 Good doctors, safer patients: Proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients The Odd One Out ?

The term revalidation used to describe: “the regular demonstration by registered doctors that they remain fit to practice in their chosen field(s)” Source: General Medical Council. (2000). Revalidating Doctors: Ensuring standards, securing the future. London, General Medical Council. The General Medical Council asked the Government to start the process to put the legislation in place for the introduction of revalidation in May 2001. Revalidation definition

Original GMC Model for revalidation Source: General Medical Council. (2000). Revalidating Doctors: Ensuring standards, securing the future. London, General Medical Council.

April 2001 Consultant Appraisal December 2003 Consultant Contract February 1999 April 2001 Consultant Appraisal December 2003 Consultant Contract 13 years 10 months The General Medical Council (Licence to Practise and Revalidation) Regulations 2012 December 2012 Nearly 14 years!

Responsible Officer (RO) recommendations to GMC a positive recommendation that a doctor is up to date and fit to practise a request by the RO to defer the date of their recommendation submission a notification of the doctor’s non-engagement in revalidation Source: General Medical Council. (2012). Making revalidation recommendations: the GMC responsible office protocol. London, General Medical Council.

Evidence considered by RO: participation in annual appraisals supporting information collected by doctor for appraisal the systems of clinical and corporate governance that are in place within the doctor’s workplaces information from all organisations in which the doctor has undertaken medical practice doctor’s compliance with a GMC conditions or undertakings the doctor’s compliance with any locally agreed conditions on the doctor’s practice any unaddressed concerns about the doctor’s practice Source: General Medical Council. (2012). Making revalidation recommendations: the GMC responsible office protocol. London, General Medical Council.

Responsible Officer: Revalidation Recommendation to GMC Responsible Officer: Review of evidence Revalidation Appraisal Job planning Mechanisms resolving employment or contractual disputes PHW Clinical and Corporate Governance Systems: Significant event (untoward or critical incident) Complaints process Monitoring compliance local conditions or remediation Monitoring compliance GMC conditions or undertakings Other clinical governance systems PHW Procedure Professional Conduct/Competence Medical Staff GMC Fitness to Practice Process

Mason’s view of the world (wrt revalidation) Responsible Officer: Revalidation Recommendation to GMC Responsible Officer: Review of evidence Separate from revalidation Revalidation Appraisal Job planning Information other organisations Mechanisms resolving employment or contractual disputes Information only: NOT a mechanism to formally resolve Unlikely and would represent failure PHW clinical governance systems PHW Clinical and Corporate Governance Systems: Significant event (untoward or critical incident) Complaints process Monitoring compliance local conditions or remediation Monitoring compliance GMC conditions or undertakings Other clinical governance systems PHW Procedure Professional Conduct/Competence Medical Staff GMC Fitness to Practice Process Mason’s view of the world (wrt revalidation)

Criteria for positive recommendation: the doctor is participating in an annual appraisal process with Good Medical Practice as its focus the doctor has collected the required information for revalidation as outlined in the GMC’s guidance Supporting information for appraisal and revalidation in your judgement, the doctor has collected and reflected on supporting information drawn from across the whole of their practice you have considered the relevant information from local clinical and corporate governance systems based on the information available to you, there are no unaddressed concerns about the doctor’s fitness to practise that need to be raised with the GMC. Source: General Medical Council. (2012). Making revalidation recommendations: the GMC responsible office protocol. London, General Medical Council.

Criteria for NOT making a positive recommendation: the doctor has not provided all of the required elements set out in the GMC’s guidance Supporting information for appraisal and revalidation you wish to consider the outputs of an ongoing or recently concluded local process there are unaddressed concerns about the doctor’s fitness to practise the doctor’s fitness to practise is being investigated by the GMC the doctor has not engaged in local processes that underpin revalidation Source: General Medical Council. (2012). Making revalidation recommendations: the GMC responsible office protocol. London, General Medical Council.

Supporting information for appraisal and revalidation: 1. Continuing professional development (CPD) 2. Quality improvement activity 3. Significant events 4. Feedback from colleagues 5. Feedback from patients 6. Review of complaints and compliments Source: General Medical Council. (2012). Supporting information for appraisal and revalidation. London, General Medical Council.

Minimum requirements first cycle: CPD, review significant events and complaints in past 12 months. Participation quality improvement activity relevant to current practice. Team-based information OK if doctor has reflected on what it means for their practice Feedback from patients and colleagues relevant to current practice in last 5 years Collection not fully compliant GMC standards Source: General Medical Council. (2012). How doctors can meet the GMC’s requirements for revalidation in the first cycle London, General Medical Council.

Supporting information for appraisal and revalidation: 1. Continuing professional development (CPD) 2. Quality improvement activity 3. Significant events 4. Feedback from colleagues 5. Feedback from patients 6. Review of complaints and compliments Source: General Medical Council. (2012). Supporting information for appraisal and revalidation. London, General Medical Council.

Quality improvement activity Clinical audit Review of clinical outcomes Case review or discussion Audit and monitor the effectiveness of a teaching programme Evaluate the impact and effectiveness of a piece of health policy or management practice Source: General Medical Council. (2012). Supporting information for appraisal and revalidation. London, General Medical Council.

Quality improvement activity College/Faculty Guidance on Supporting Information for Appraisal and Revalidation: Guidance for Public Health. http://www.fph.org.uk/uploads/FPH%20Guidance%20on%20Supporting%20Information%20for%20Revalidation%20FINAL%20_Aug%2012_.pdf Guidance on Supporting Information for Appraisal and Revalidation: Guidance for Pathologists. http://www.rcpath.org/Resources/RCPath/Migrated%20Resources/Documents/C/Core_Guidance_on_Supporting_InformationFINAL.pdf Other Quality Indicators for appraisal documentation to support revalidation in Wales http://revalidation.walesdeanery.org/index.php/resources-for-appraisers/quality-indicators Further guidance

Worth while? Revalidation Appraisal Revalidation Mechanism to ensure that doctors reflect on and change practice No summative judgement on FTP Only a requirement to meaningfully engage Revalidation Mechanism to ensure RO collates and forms judgement on all available information

Worth while? Yes, if we make it so Revalidation Appraisal Revalidation Mechanism to ensure that doctors reflect on and change practice No summative judgement on FTP Only a requirement to meaningfully engage Revalidation Mechanism to ensure RO collates and forms judgement on all available information Yes, if we make it so

References / further information GMC December 2012 Making revalidation recommendations: the GMC responsible officer Protocol: Guide for responsible officers http://www.gmc-uk.org/static/documents/content/Responsible_Officer_Protocol.pdf GMC March 2012 Supporting information for appraisal and revalidation. http://www.gmc-uk.org/static/documents/content/Supporting_information_for_appraisal_and_revalidation.pdf GMC April 2012 How doctors can meet the GMC’s requirements for revalidation in the first cycle. http://www.gmc-uk.org/static/documents/content/Meeting_our_requirements_in_the_first_cycle.pdf

Original GMC Model for revalidation Source: General Medical Council. (2000). Revalidating Doctors: Ensuring standards, securing the future. London, General Medical Council.