1. 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

2. Expectations and Aims

3. ARCP Process: The Essentials

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

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

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

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

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

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

10. 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?

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

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

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

14. 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

15. 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

16. Revalidation for doctors in training
EOE Deanery Revalidation Team

17. 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.

18. 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

19. 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

20. 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)

21. 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

22. 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

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

24. 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.

25. 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

26. 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

27. 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.

28. 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

30. 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

31. 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)

32. 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

33. Scenarios

34. 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.

35. 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.

36. 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.

37. 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.

38. 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.

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

40. Questions