Preparing for revalidation: evidence is the key Dr Cliona Ni Bhrolchain

What is the GMC? 13. The GMC is the independent regulator for doctors in the UK. Our purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine a. By controlling entry to and maintaining the list of registered and licensed medical Practitioners b. By setting the educational standards for medical school c. By determining the principles and values that underpin Good Medical Practice d. By taking firm but fair action against doctors’ registration where the standards of Good Medical Practice have not been met

What is revalidation? 14. The purpose of revalidation is to assure patients and the public, employers and other healthcare professionals that licensed doctors are up to date and are practising to the appropriate professional standards. Although it is widely understood that the delivery of medical care to patients will always involve an element of risk, revalidation will help doctors, employers and the GMC to provide further assurance to patients and the public that doctors working in the UK are fit to practise.

What standard is required?

What will happen? 5-year cycle Based on annual appraisal Performance against  professional standards from GMC and Royal College  Clinical governance information Paper based exercise for majority Decision by Trust’s Responsible Officer

Producing the evidence Too many standards for individual evidence! Reduced to 4 domains:  Knowledge, skills and performance  Safety and quality  Communication, partnership and teamwork  Maintaining trust Each domain has attributes

Collating the evidence Portfolio for appraisal Electronic appraisal/revalidation pilots MUST START NOW!!

What do I collect?

To what standard? Independent evidence where possible Triangulation important, avoid multiple use Enough evidence to make a judgement Much more reflective practice

Standard of evidence Mapped to domains and attributes Self assessment of evidence and practice Appraiser assessment of evidence and practice All domains/attributes covered over 5 years

What tools do I have…? (Very similar to trainee requirements) Patient feedback)1 per 5 yrs + Colleague feedback (MSF/360))before Y3 Personal Development Planevery yr CPD record incl reflective notes*every yr Significant events) 2 per yr Case reviews) Audit data 1 per yr * Now includes electronic recording and GMP domains

And…… Complaints (all) every yr Teamwork e.g. peer review meetings, audit meetings Performance dataevery yr Job planevery yr Probity (self declaration)every yr Health (self declaration)every yr Teaching

What do I need to do? Continue with usual appraisal, but make sure evidence is more robust Are you registered somewhere for CPD?  If not, are you collecting evidence?

Worked example: case review Learning point from clinical practice Identified learning need (DEN) How I will meet that learning need

Aide memoire Knowledge, skills and performance  Maintain your professional performance  Apply knowledge and experience to practice  Keep clear, accurate and legible records Safety and quality  Put into effect systems to protect patients and improve care  Respond to risks to safety  Protect patients and colleagues from any risk posed by your health Communication, partnership and teamwork  Communicate effectively  Work constructively with colleagues and delegate effectively  Establish and maintain partnerships with patients Maintaining trust  Show respect for patients  Treat patients and colleagues fairly and without discrimination  Act with honesty and integrity

Aide memoire Knowledge, skills and performance  Maintain your professional performance  Apply knowledge and experience to practice √  Keep clear, accurate and legible records Safety and quality  Put into effect systems to protect patients and improve care  Respond to risks to safety  Protect patients and colleagues from any risk posed by your health Communication, partnership and teamwork  Communicate effectively  Work constructively with colleagues and delegate effectively  Establish and maintain partnerships with patients Maintaining trust  Show respect for patients  Treat patients and colleagues fairly and without discrimination  Act with honesty and integrity

Aide memoire Knowledge, skills and performance  Maintain your professional performance  Apply knowledge and experience to practice √  Keep clear, accurate and legible records Safety and quality  Put into effect systems to protect patients and improve care  Respond to risks to safety  Protect patients and colleagues from any risk posed by your health Communication, partnership and teamwork  Communicate effectively  Work constructively with colleagues and delegate effectively √  Establish and maintain partnerships with patients Maintaining trust  Show respect for patients  Treat patients and colleagues fairly and without discrimination  Act with honesty and integrity

Colleague and patient feedback Trusts will have to set up systems GMC will define standards but not stipulate providers RCPCH piloted tool with peer comparison WUTH using commercial company Patients  Usually recommend minimum of 20 or so for analysis  Will child feedback be addressed?

Worked example: patient feedback Participated in RCPCH pilot 1st patient feedback since 2003  Different attributes  Peer comparison Reflection on results

Aide memoire Knowledge, skills and performance  Maintain your professional performance  Apply knowledge and experience to practice  Keep clear, accurate and legible records Safety and quality  Put into effect systems to protect patients and improve care  Respond to risks to safety  Protect patients and colleagues from any risk posed by your health Communication, partnership and teamwork  Communicate effectively  Work constructively with colleagues and delegate effectively  Establish and maintain partnerships with patients Maintaining trust  Show respect for patients  Treat patients and colleagues fairly and without discrimination  Act with honesty and integrity

Aide memoire Knowledge, skills and performance  Maintain your professional performance  Apply knowledge and experience to practice  Keep clear, accurate and legible records Safety and quality  Put into effect systems to protect patients and improve care  Respond to risks to safety  Protect patients and colleagues from any risk posed by your health Communication, partnership and teamwork  Communicate effectively  Work constructively with colleagues and delegate effectively  Establish and maintain partnerships with patients √ Maintaining trust  Show respect for patients  Treat patients and colleagues fairly and without discrimination  Act with honesty and integrity

Aide memoire Knowledge, skills and performance  Maintain your professional performance  Apply knowledge and experience to practice  Keep clear, accurate and legible records Safety and quality  Put into effect systems to protect patients and improve care  Respond to risks to safety  Protect patients and colleagues from any risk posed by your health Communication, partnership and teamwork  Communicate effectively  Work constructively with colleagues and delegate effectively  Establish and maintain partnerships with patients √ Maintaining trust  Show respect for patients √  Treat patients and colleagues fairly and without discrimination  Act with honesty and integrity

Aide memoire Knowledge, skills and performance  Maintain your professional performance √  Apply knowledge and experience to practice  Keep clear, accurate and legible records Safety and quality  Put into effect systems to protect patients and improve care  Respond to risks to safety  Protect patients and colleagues from any risk posed by your health Communication, partnership and teamwork  Communicate effectively  Work constructively with colleagues and delegate effectively  Establish and maintain partnerships with patients √ Maintaining trust  Show respect for patients √  Treat patients and colleagues fairly and without discrimination  Act with honesty and integrity

Colleague multisource feedback (MSF/360) Provides the opportunity for  non-medical co-workers  medical colleagues (including trainees and juniors) to reflect on the professional skills and behaviour of a doctor

Colleague multisource feedback (MSF/360) Suggestions for community paediatricians Require 1 per 5 year cycle, 1 st before Y3  If working in isolated situation might wish to consider doing more Usually recommend minimum of 11 or so replies for analysis Questionnaires need to comply with guidance issued by GMC

Who should I ask? Suggestions for community paediatricians Clinical colleagues  Medical Consultant colleagues SAS/trainees CD/lead clinician  Nursing  Therapists Non-clinical  A&C staff  Secretary  Head teachers/SENCOs  Ed Psych  Social care If statutory role  Senior managers in CYPD, HPA, PCT

Worked example: teaching/training Devised a ‘return to work’ programme for UK- trained comm paed returning to UK practice after 10-yr break Evidence  Anonymised copy of programme  Comments from NCAS on programme

Aide memoire Knowledge, skills and performance  Maintain your professional performance  Apply knowledge and experience to practice  Keep clear, accurate and legible records Safety and quality  Put into effect systems to protect patients and improve care √  Respond to risks to safety  Protect patients and colleagues from any risk posed by your health Communication, partnership and teamwork  Communicate effectively  Work constructively with colleagues and delegate effectively √  Establish and maintain partnerships with patients Maintaining trust  Show respect for patients  Treat patients and colleagues fairly and without discrimination  Act with honesty and integrity

Other possibilities for teaching/training GMC/PMETB annual trainee survey  Dept results Deanery quality assurance Feedback forms from teaching/training activity Example of a presentation, e-learning material prepared

Worked example: performance Very little official performance data Clinic numbers compared with hospital peers so hard to interpret MDTs, CP etc not counted electronically Evidence  Use diary to collect information on MDTs

Or another strategy… Move to Derby where Fawzia Rahman will do it all for you!!

Aide memoire Knowledge, skills and performance  Maintain your professional performance √  Apply knowledge and experience to practice √  Keep clear, accurate and legible records Safety and quality  Put into effect systems to protect patients and improve care √  Respond to risks to safety  Protect patients and colleagues from any risk posed by your health Communication, partnership and teamwork  Communicate effectively  Work constructively with colleagues and delegate effectively  Establish and maintain partnerships with patients Maintaining trust  Show respect for patients  Treat patients and colleagues fairly and without discrimination  Act with honesty and integrity √

Worked example: record keeping GMC standard  3(f) Keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given to patients, and any drugs prescribed or other investigation or treatment  3(g) Make records at the same time as the events you are recording or as soon as possible afterwards  51 When you refer a patient, you should provide all relevant information about the patient, including their medical history and current condition

What evidence might be available?  Medical record audits  CP peer review  SEN(M) reports compliance with code of practice  Anonymised letters to patients/colleagues  Colleague MSF  Any comments received from colleagues on quality of records/letters  SAIL instrument  Copying letters to patients (NHS standard)

Summary We will need a more structured approach to collecting evidence but….. Most of it is already there and can be collected as we go along