Revalidation for SAS doctors John Bache FRCS RST Associate NHS Revalidation Support Team SASG Annual Conference Manchester 13th January 2010

How did we get here? … 1999 Supporting Doctors, Protecting Patients - CMO 2004 Shipman Inquiry Report (plus Bristol, Alder Hey etc..) 2006 Good Doctors, Safer Patients – CMO 2007 Trust, Assurance and Safety – White Paper on ‘Regulation of Health Professionals in 21 st century’ 2008 Medical Revalidation - Principles and Next Steps - CMO

2008 Medical Revalidation – Principles and Next Steps “In the NHS, appraisal is patchy geographically and is not fit for the purpose of re-licensing. …To address this will require a standardised module of appraisal, agreed by the GMC, to be included in all appraisal systems. This module will be derived from Good Medical Practice… and will inform a judgment on whether the evidence presented supports revalidation or not over a five year cycle…”

Purpose of medical revalidation 4 To confirm that licensed doctors practise in accordance with the GMC’s generic standards (re-licensure) For doctors on specialist or GP register, to confirm that they meet the standards appropriate for their speciality (re-certification) To identify for further investigation, and remediation, poor practice where local systems are not robust enough or do not exist

What is needed for revalidation? 5 The key elements required for implementation are: a revised system of appraisal a regional network of GMC Affiliates a network of Responsible Officers the issuing of licences to practise - done! standards for assessment and evaluation methods for specialist recertification (+ generic standards for all doctors)

Changes needed … Piloted introduction of revalidation through careful introduction of ‘new’ appraisal: - new appraisal forms - electronic support Standards for assessment (Royal Colleges) Improvements in Trust/PCT/etc infrastructure to support ‘new’ appraisal

GMC, RST, NCAS, Royal Colleges GMC Ultimate decision on whether doctor revalidated Concerns about fitness to practise RST Design, support and piloting for strengthened appraisal NCAS Advice to RO in support of local remediation Royal Colleges Specialty standard setting + formal assessment

The legislation - ensures that there is investment in systems of clinical governance, audit, and multi-source feedback - ensures that RO decision making is rigorous, high quality, and consistent - ensures that appraisal systems are mandatory, high quality, and consistent

GMC: Good Medical Practice  4 Domains – insufficiently sensitive for comprehensive assessment  12 Attributes – pragmatic level on which to base reasonable assessment  75 Standards – too complex to expect all doctors to present evidence on each one

Domain 1 Knowledge, skills and performance Maintain your professional performanceApply knowledge and experience to practice Keep clear, accurate and legible records Domain 2 Safety and quality Put into effect systems to protect patients and improve care Respond to risks to safety Protect patients and colleagues from any risks posed by your health Domain 3 Communication, partnership and teamwork Communicate effectivelyWork constructively with colleagues and delegate effectively Establish and maintain partnerships with patients Domain 4 Maintaining trust Show respect for patientsTreat patients and colleagues fairly and without discrimination Act with honesty and integrity Good Medical Practice Attributes

Type of Information Number required in five yearsProvided by 1Significant event review/Case review10Dr/RO 2Formal complaints reviewAllDr/RO 3Audit/data collection and review5Dr/RO 4Patient feedback survey and review1RO/RC 5Colleague feedback survey and review1RO/RC 6New PDP and review of previous PDP5Dr/Appraiser 7CPD completion5RC 8Specialist skills/knowledge assessment5RC 9Probity self-declaration/review5Dr 10Health self-declaration/review5Dr 11Other information defined by organisation/RCAllDr/RO/RC 12Review of all items in the context of GMP5Dr/Appraiser ‘Generic’ Portfolio

Multi-source (“360”) feedback  From colleagues  From patients (where appropriate)  Appraiser must know how MSF works, including statistical validity  Feedback of results must be done well

Timetable  Licenses issued to all doctors who requested them and on the GMC register in November 2009  Re-licensing will be based on future participation in appraisal  Re-certification proposals to be piloted in all specialities in 2010/11, to start probably in 2011  Guidance on approved MSF tools shortly

What do I need to do now? 1. Gather detailed evidence  CPD  Workload - hospital episode statistics  Audits  Teaching and other roles  Reviews of significant events or interesting cases  Complaints or concerns  MSF - colleagues (and patients)  Health - and reflect!

What do I need to do now? 2. Establish contact with relevant Royal College  Website  Colleagues  Direct They are defining standards and methods of evaluation

What do I need to do now? 3. Keep up to date with developments  GMC  Royal Colleges  Revalidation Support  Websites  Literature  Colleagues  Direct

Any questions? ?