1. Update on revalidation and remediation
Andy Tomlinson
Member Revalidation Delivery Committee
Royal College of Anaesthetists
CDs meeting
April 2012

2. Revalidation and remediation
Anticipated timetable
RST, GMC and Academy updates
RCoA update: Supporting Information
Remediation

3. Revalidation: anticipated timetable
May/June 2012
Final organisational state of readiness assessment (ORSA)
Summer 2012
Assessment of readiness and business case prepared for Ministers
Sept/Oct 2012
Ministerial decision
By end of 2012
Enablement of necessary legislation
By 31 March 2013
All ROs to have been revalidated
By 31 March 2014
At least 20% 0f doctors revalidated with all designated bodies
By 31 March 2016
All remaining doctors revalidated – i.e. approximately 40% each year

4. Revalidation: anticipated timetable
“In the light of the importance of this process to the quality of services delivered to patients, and of the status of the GMC as an independent regulator, the Committee looks to the GMC to give early and public notice if it concludes that delivery of this timetable is at risk.”
Health Select Committee , March 2012

5. Updates

6. Updates: RST www.revalidationsupport.nhs.uk
…..there are some other useful resources to be obtained from this link too.

7. Updates: RST www.revalidationsupport.nhs.uk
…..there are some other useful resources to be obtained from this link too.

8. Updates: GMC All doctors: confirmation of designated body
Make your connection campaign
4,000 – 40,000; estimate of possible problems!
All locum agencies should be designated bodies
Colleague and patient feedback
Instructions for administering GMC colleague and patient questionnaires

9. Updates: Academy Specialty Guidance
Helpful in pilots
Greater awareness needed
To be finalised end of May 2012
Specialty advice for ROs, doctors and appraisers by Royal Colleges and Faculties
Formal generic training agreed
Generic training has agreed that consistency, commonality, legality, generality and impartiality are key

10. Updates: Academy RCoA, FPM and FICM Specialty Advice Demand uncertain
Uncomplicated queries dealt with by College staff
Commence with a small (15-20) team of advisors
Membership to include representation from:
FPM & FICM
All home nations
All major sub-specialties
SAS grade
Retired/ independent practice
Training packages currently being developed
Generic training has agreed that consistency, commonality, legality, generality and impartiality are key

11. RCoA Update: Specialty specific supporting information
…all Colleges and Faculties have had to produce draft ‘specialty specific’ guidance, but this time around it has had to be simplified following the GMC consultation between March and June 2010.
This is the RCoA guidance that has been written for anaesthetists, intensive care medicine and pain specialists and can be downloaded from the College website as indicated. A Working Party within the Academy of Medical Royal Colleges has ensured that there is consistency across all Colleges/Faculties in the content and breadth of supporting information required – it is my view that this is indeed the case and for those interested, all the current draft guidance can be accessed on the Academy website [aomrc.org.uk].
It is important to understand that these are draft only and are to be used by those in the next round of pilots between October 2011 and January Following feedback, the final documents will be produced in the spring of The RCoA would encourage all its membership to look at this document and provide feedback at

12. RCoA update: Specialty specific supporting information
More guidance required for:

13. RCoA update: Specialty specific supporting information
More guidance required for:
Outcomes
Target departments
Appoint LARCs
Survey all departments re outcome measurements
RCoA audit recipe book may be key
Join laparotomy and ♯NOF networks
Patient and Colleague feedback

14. Specialty feedback on professional practice
….for anaesthetists, it is a particular challenge and a Working Party was covened to look at the issues for our specialty. I would encourage you all to read this report and work on ways in which you can try and obtain valid patient feedback, which the RCoA considers should be beneficial for our specialty.

15. Update: Specialty feedback on professional practice
Updated statement from the RCoA.

16. Specialty feedback on professional practice
GMC commissioned survey for feedback showed
Colleague feedback straightforward
75% >14 questionnaires
Patient feedback much more difficult
51% >21 questionnaires
Further work by RCoA with PLG to consider
Communication skills
Quality of care

17. Remediation

18. Remediation
Revalidation likely to identify increased numbers of doctors with fitness to practice issues
~ 1000 remediation cases in progress in England
2,800 (~2%) of all doctors in England subjected to investigation annually
Remediation provision will need to be enhanced & increased
DH report on remediation published Dec 2011

19. Remediation: what is meant?
The overall process agreed with the practitioner to redress identified aspects of underperformance. Remediation is a broad concept varying from informal agreements to carrying out some reskilling, to more formal programmes including supervised remediation and/or rehabilitation.

20. Remediation: DH report
Highlights lack of:
consistency in how organisations tackle doctors with performance issues
clarity about where a PDP stops and remediation starts
clarity as to who has responsibility for the remediation process
clarity on what constitutes acceptable clinical competence and capability
clarity about when the remediation process is complete and successful
clarity about when the doctor’s clinical capability is not remediable
capacity to deal with the remediation process

21. Remediation: DH report
Key recommendations:
Wherever possible, performance problems including clinical competence and capability issues, should be managed locally
Local processes need to be strengthened to try and avoid performance problems occurring and reduce their severity at the point of identification
The capacity of staff within organisations to deal with performance concerns needs to be increased with access to external expertise as required
A single organisation is required to advise and, when necessary, to co- ordinate the remediation process and case management so as to improve consistency across the service 

22. Remediation: DH report
Key recommendations (cont’d):
The medical royal colleges should produce guidance and also provide assessment and specialist input into remediation programmes
Postgraduate deaneries and all those involved in training and assessment need to assure their assessment processes so that any problems arising during training are fully addressed  

23. Remediation: CDs view Survey Monkey survey: General consensus that:
240 individuals ed (all four nations)
54 responses (22.5%)
General consensus that:
Much should be managed locally
College should be involved
‘A supportive rather than driving role’
Setting standards - consistency
Providing advice on assessment and processes
Help make it happen
Concerns about funding

24. Remediation: RAs view From breakout session March 2012:
General consensus that:
College should be involved in
Setting standards and establishing framework
Assessment: both advice and doing
Helping make it happen – organise external placements
Training for specialty needs

25. Remediation: NCAS view
Response to Remediation report
With 10 yrs of experience the organisation best placed to manage process locally
Has an “industry standard” in supporting the management of performance concerns and can provide external expertise to local organisations
Expertise in working in conjunction with many other bodies during case management, including trainees
Understands funding problems

26. Remediation: General consensus
Preferable to identify early
Ensure robust local appraisal and clinical governance processes are in place
Act on information obtained
Majority should be manageable locally

27. Comments or questions to: