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

2. The Odd One Out ?

3. 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:

4. 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 ?

5. 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

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

7. 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!

8. 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.

9. 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.

10. 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

11. 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)

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. Quality improvement activity
College/Faculty
Guidance on Supporting Information for Appraisal and Revalidation: Guidance for Public Health.
Guidance on Supporting Information for Appraisal and Revalidation: Guidance for Pathologists.
Other
Quality Indicators for appraisal documentation to support revalidation in Wales
Further guidance

19. 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

20. 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

21. References / further information
GMC December 2012 Making revalidation recommendations: the GMC responsible officer Protocol: Guide for responsible officers
GMC March 2012 Supporting information for appraisal and revalidation.
GMC April 2012 How doctors can meet the GMC’s requirements for revalidation in the first cycle.

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