1. REVALIDATION FOR GENERAL PRACTITIONERS Paul Roblin March 2009

4. Much of the detail may still change.

5. Why now? Autumn 2009: all GPs need licence to practice All registered doctors will entitled to a licence Licence to practice to be introduced before 5 yearly renewal (Revalidation)

6. Autumn 2009 Some doctors may choose to maintain registration only 240K registered (150K active) Only licensed doctors will be subject to Revalidation

7. The Purpose of Revalidation 1.To ensure that doctors are up to date and fit to practice 2.Improve and demonstrate the quality of care that all GPs provide to patients. 3.Identify GPs for whom there are concerns about their fitness to practice

8. Revalidation is the name for the whole process One set of processes with two outcomes 1.Relicensure 2.Recertification

9. Relicensure To demonstrate that licensed doctors continue to practice in line with the generic standards set out by the General Medical Council.

10. Recertification To confirm that GPs on the GP register continue to meet standards that apply to the discipline.

11. Government and GMC have yet to publish their timescales for relicensure and recertification

12. RCGP is putting steps in place to ensure that GPs have as much information and lead-in time as possible to familiarise themselves and fully prepare for the process.

13. ENHANCED APPRAISAL Annual appraisal will be central But it will be ‘enhanced’ appraisal. The future nature and content of appraisal remains under discussion. RCGP proposes and GMC approves (standards required and the methods used)

14. SUBMISSION OF EVIDENCE Every year: a portfolio of evidence for annual appraisal Every five years: a portfolio of evidence for revalidation. Electronic portfolio hoped for

15. Evidence Standardisation (Consistency) Common requirements for evidence Regardless of PCT and appraiser you will be assessed on a consistent basis.

16. Using “Good Medical Practice” GMP is being modernised to define the qualities required of a good GP New GMP will guide the range of annual and 5 yearly evidence 4 domains (currently 7) become 12 generic standards from which criteria are developed Translation questionable

17. Four Future Domains Knowledge, skills and performance Quality and safety Communication and teamwork Maintaining trust

18. The RCGP are proposing that every 5 years, every GP, in whatever environment, should be able to provide:

19. EvidenceConventional portfolio Description of roles  Exceptional circumstances  Evidence of 5 appraisals  Five PDPs  Four reviews of PDPs  250 Learning Credits  Two MSFs from Colleagues (360 degree)  Two Patient Surveys  Review of Complaints  Five significant event audits  Two conventional audits  Statement of probity and health 

20. RCGP CPD Scheme “ Impact and Challenge Model” Developed by the RCGP

21. Learning Credit System Self-accreditation of learning credits Minimum of 250 over the 5 year revalidation cycle Credit value based on the effort required (challenge) and impact on patient care (not time based) Credits are self-attributed and verified at appraisal.

22. Why Impact and Challenge? Encompass the value of the learning Not simply the time spent in CPD Table combining Impact and Challenge

23. Challenge Impact LowMinorModerateSignificantHigh Low 1-2 Credits 2-4 Credits3-5 Credits4-8 Credits 5-10 + Credits Minor 1-3 Credits 2-4 3-75-10 6-12 + Credits Moderate 2-4 Credits3-6 4-8 6-12 8-15 + Credits Significant 3-5 Credits4-75-117-15 + 10-20 + Credits High 4-6 Credits5-106-14 +10-20 +20 Credits +

24. Impact? Impact on patients Impact on the individual Impact on service Positive weighting of impact compared to challenge

25. Challenge? Challenge is context related Related to effort expended Related to circumstances Related to personal ability

26. Low impactMainly confirming current practice  Little change necessary within the practice  No examination of current practice (e.g. data collection)  Knowledge gained is minimal or of low value  Mainly for personal benefit  Anything that does not reach a higher level Minor impact  Confirming current practice although new knowledge acquired which aids understanding or implementation  Some change in practice required (but not necessarily followed through systematically)  May involve others (e.g. discussion on new NICE guidance at practice meeting) but probably falls short of changing practice protocols  Initial data collection for audit discussed but change not yet evaluated  Minor audit (few patients, minimal change and low level gain) Moderate impact  Demonstrating current practice against accepted best practice (e.g. completed audit cycle)  Change in practice in response to new information (e.g. essential general practice – followed through to examining own practice)  Would usually involve others (e.g. change in practice protocol, presenting audit data and implementing change)  Teaching session that demonstrates a change in the learners through evaluation  Working with organisations to influence change in others (e.g. PCO guideline development)  Becoming a trainer in a well established training practice Significant impact  Major change in practice involving an important condition. This should be in response to a change in the accepted evidence (e.g. the use of atenolol in treating uncomplicated hypertension – re designing the practice protocol and reviewing patients taking atenolol considering a switch)  Influencing others to change in response to new evidence either through (evaluated) teaching or through guideline and protocol development on a regional basis  Introducing a new service for patients (e.g. starting a monitoring system for DMARDS / Warfarin, starting a minor surgery clinic from scratch)  Introducing a new service to your team (e.g. a new palliative care team, an “intermediate care” team etc.)  Becoming a trainer to fill the gap left by the retirement of the only other trainer in the practice High impact  Major change in the practice (e.g. becoming a new training practice, becoming a research practice within a recognised research network etc.)  Major contribution or lead on projects that change or confirm professional practice. This would be at a regional or national level  Personal development to implement a new service in practice (e.g. using a recognised scheme to gain a skill and then set up a service – RCGP certificate in substance misuse – new clinic in practice – possibly recognised as a GPwSI)

27. Un-answered questions about appraisal (pilots) Is this definition of a credit acceptable? Is the system easy to understand and use? Are GPs able to produce evidence easily? Are the examples of credits self-accredited justifiable? Are appraisers easily able to verify an individual’s credits in terms of challenge or impact? What if an appraiser disagrees with the doctor? Are appraisers comfortable with this system? Are GPs comfortable with this system? Are we seeing diversity of subject? Are we seeing diversity of method? Is this an appropriate system for all GPs (sessional, OOH, overseas)? Are there further training issues for GPs or appraisers? What are the local resource issues of the system?

28. Pass or Fail: Who Judges?

29. Role of the GP appraiser Judges Quality of a PDP Adequacy of a CPD folder Whether PDP of previous year’s appraisal has been completed Whether and how learning needs have been identified / prioritised Credits scoring And Guides future learning needs Suggests upskilling or remedial action where required

30. Traffic Lighting of appraisals Green, Amber and Red. This could make the retention of the formative aspect of appraisal even more difficult.

31. THE RESPONSIBLE OFFICER Responsible Officer (RO) in every NHS Trust Final say on the revalidation of doctors. Every doctor will have one RO only

32. Evidence Assessment Four tiers –RO –Local Group (RO, RCGP and Lay assessor) –National RCGP –GMC

34. Uncertainties Possibly 2% (?underestimate) of doctors under raised scrutiny. Need for increased resources for both investigatory work and remedial training. Much of the detail may still change. UK Revalidation Programme Board (first meeting was held on 10.2.09)

35. Possible Curriculum and Optional Exam The RCGP will provide a six monthly Essential Knowledge Update of new and changing knowledge that every UK GP should have assimilated The linked Essential Knowledge Challenge will be a voluntary assessment for the GP to provide evidence of keeping up to date

36. The End http://www.gmc-uk.org/about/reform/Revalidation.asp http://www.rcgp.org.uk/practising_as_a_gp/revalidation.aspx