1. Dr Paula Wright GP tutor for Newcastle Deanery lead for sessional GPs
Appraisal and Revalidation 2012 September Part of NEPCSA/northern deanery revalidation roll out programme
Dr Paula Wright
GP tutor for Newcastle
Deanery lead for sessional GPs

2. Revalidation –the core principles
demonstrates that you are up to date and fit to practise
should not be overly onerous on GPs but be sufficient to provide confidence to the public
must take account of the different working lives of GPs, the process must be objective, fair and equitable

3. Don’t Panic ! You will be recommended for revalidation if you:
Are are having an annual appraisal
Providing the required Supporting Information
Have no unresolved performance concerns
There is nothing more that you need to do beyond continuing to engage in the appraisal process

4. What will the revalidation process involve?
is done by the GMC based on a recommendation by your local Responsible Officer (every NHS organisation will have one)
recommendation based on appraisal record [from 1/4/12 unless unusual circumstances eg Maternity leave , Sick leave etc]
RO for North of Tyne is Mike Guy

5. When will revalidation be introduced?
ROs and appraisal leads will be revalidated before April 2013
all other doctors from April 2013
GMC must give doctors at least 120 days notice of their revalidation date
Aim is for all doctors to get through the first cycle of revalidation by 2016
NE GPs will be revalidated in relation to their birthday months

6. Revalidation schedule for NE GPs
Appraisal year
GP month of Birth
Revalidation
May
1/7/13-30/9/13
August
1/10/13-/12/13
November
1/1/14-31/3/14
February
1/4/14-30/6/14
June
1/7/14-30/9/14
September
1/10/14-/12/14
December
1/1/15-31/3/15
March
1/4/15-30/6/15
April
1/7/15-30/9/15
July
1/10/15-1/12/15
October/January
1/1/16-31/3/16

7. The Revalidation Process- Options for RO
recommendation for revalidation to the GMC
Defer if insufficient information [eg maty leave] or performance concerns under active review
Administrative removal for non-engagement if no documentation and no good reason for this
NB. Revalidation will be done electronically for all doctors. You must register at GMC on-line-

8. What will happen to doctors who do not revalidate?
Aims is for early detection and support of “at risk” drs
A few doctors [??1-2 %] will not be revalidated/ lose their licence to practise if remediation fails-most are already known to performance structures
Remediation- recent agreement to provide funding via NHSCB

9. What is appraisal for revalidation ?
a supportive discussion between two peers.
based on “Good Medical Practice” by the GMC (new domains 4)
PDP is key (old and new one)
5 “sign off” statements for appraiser to agree or disagree

10. Good Medical Practice Framework- new domains
1.Knowledge, Skills and Performance
2.Safety and Quality
3.Communication,
Teamwork and Partnership
4.Maintaining Trust

11. The domains and attributes of the GMC framework for Good Medical Practice
Knowledge, skills and performance
Domain 3
Communication, Partnership and Teamwork
Attribute 1
Maintain your professional performance
Attribute 2
Apply knowledge and experience to practice
Attribute 3
Keep clear, accurate and legible records
Communicate effectively
Work constructively with colleagues and delegate
effectively
Establish and maintain partnerships with patients
Domain 2
Safety and Quality
Domain 4
Maintaining Trust
Put into effect systems to protect patients and improve care
Respond to risks to safety
Protect patients from any risk posed by your health
Show respect for patients
Treat patients and colleagues fairly and without
discrimination
Act with honesty and integrity

12. Information required for appraisal
GENERAL INFORMATION + “SUPPORTING INFORMATION”

13. General information
Personal details
Scope of work –list of all the roles undertaken (documents showing review of these roles should be submitted to your appraiser )
Record of previous annual appraisals
Personal Development Plan and its review
Probity and health declarations

14. Supporting Information
Is based on:
GMC “Supporting information for appraisal and revalidation” (mandatory)
&
RCGP Guide To revalidation for GPs (version7) (Advisory)

15. Supporting Information -GMC guidance
General information, plus
Evidence of Continuing Professional Development
Quality improvement activity (e.g. Audit, case reviews, review of teaching, QIP)
Significant Event Audits (SUIs)
Patient feedback
Colleague feedback
Complaints/compliments
These must cover your “scope of practice”- ie all your roles

16. Summary of supporting information RCGP version 6 October 2011
Evidence
Frequency
Significant Events
2 per year
Clinical audit
1 in 5 years [others options for some Sessional GPs]
Colleague and patient feedback
1 in 5 years
Complaints
All reviewed every year
PDP
Reviewed every year and new one produced each year
CPD credits
50 per year- 250 over five years

17. Continuing Professional Development
CPD log must demonstrate at least 50 CREDITS
1 hour=1 credit
CPD should cover whole scope of practice-ie all clinical and other roles
Impact multiples hours by 2
Record of educational activities [meetings, conferences, reading etc] and core learning points

18. Supporting information: non standard GPs
peripatetic locums, OOHs doctors, rural remote GPs, etc may have difficulty with some of these evidence requirements , especially audit /SEA and MSF
All GPs need to demonstrate that they regularly review and evaluate the quality of their work .
See guidance from NEPCSA: on supporting information for ‘non standard’ GPs.

19. Audit and sessional GPs
No Access to records outside of consulting time
Lack of Skills and help with in searches
No “specific clinical role” to audit;
No organisational influence
Mobility between practices if locum
Numbers with a single conditions seen by locum or part-time GP is very small
personally delivered care means “process” based for which there is no evidence base (e.g. Record keeping)
“Key is to demonstrate reflection, learning and improvement”-RCGP

20. Quality improvement activities (GMC)
Clinical audit (1/5yr, or alternative)
Case review, (GMC)
Quality Improvement Plan [QUIP], (GMC)
Review of referrals, review of record keeping *
Review of 20 consultations in random surgery with feedback from colleague *
Prospective condition based review *
Audit effectiveness of teaching or health policy change (GMC)
Key is to demonstrate reflection, learning and improvement
*NEPCSA interpretation of RCGP statement above

21. Detailed guidance for sessional Gps
Deanery Sessional GP page: NEPCSA Guidance on Supporting Information for Non-Standard GPs Also Career Break Advice December 2011

22. Significant events – ‘unexpected event which could or did harm patient [s]’
two SEAs each year [RCGP guidance]
Personal to you (involvement in the care not just the discussion meeting)
Lessons learnt , areas for future learning and actions taken as a result of SEA should also be discussed-
SEAs can be discussed in a learning/study group if practice meeting not accessible

23. Significant events – ‘unexpected event which could or did harm patient [s]’
SEAs are defined a bit differently in primary and secondary care –SEA = SUI [serious untoward incident ] in hospital context
Unless your SEA has led to loss of life or serious injury , include it under ‘Quality Improvement Activity ‘ section of the appraisal form

24. Patient and Colleague Feedback
Formative and developmental –not pass fail
Feedback should come from whole scope of practice [all the roles eg clinical, academic etc]
Will be needed for your first revalidation cycle however short.
Try and do this as close as possible to the date of your annual appraisal [birthday month] so that you can discuss the feedback with your appraiser soon after it is received.
Your local GP tutor can also provide support
Certain groups have different benchmarks (locums/ sessionals)

25. Patient and Colleague Feedback-how to collect it
The surveys must be independently collected/analysed
You need to choose a commercial provider of feedback tools approved by the RCGP include- NE discount prices here
CFEP –approx £105 –give code DJ8482 when you apply
Edgecumbe –approx £75 – code is nucapf
Please read the FAQs recently circulated to help guide you in the collection and interpretation of this feedback

26. Complaints
All patient complaints must be discussed each year at appraisal, reflection using NEPCSA template
Learning points and actions must be recorded
Compliments can be listed in this section

27. Scope of work –an example
Area of work
Detail
Qualifications/experience
Length of time
Organisation
Clinical
Regular GP
MRCGP
20 yrs
Surgery
Ad hoc
OOH
10 years
NDUC
Education Regular
Trainer
Dip MEduc
5 years
VTS
Managerial
CCG lead
1 year
CCG
Appraiser
7 years
PCSA
Other roles
Team GP
Falcons

28. Mandatory training- NEPCSA
CPR certification up date every 18 months
Safeguarding children =GPs must achieve competence at LEVEL 3 which means over 3 year period
One approved IT module
One session of single agency training –[ health care staff only]-approx 2 hours
One session of multi-agency training -usually one day (organised by LSCB)

29. Sign Off statements for the appraiser
An appraisal has taken place that reflects the doctor’s scope of work and addresses the principles and values set out in Good Medical Practice. 
2.       Appropriate supporting information has been presented in accordance with the Good Medical Practice Framework for appraisal and revalidation and this reflects the nature and scope of the doctor’s work. 
3.       A review that demonstrates appropriate progress against last year’s personal development plan has taken place. 
4.       An agreement has been reached with the doctor about a new personal development plan and any associated actions for the coming year. 
5.       No information has been presented or discussed in the appraisal that raises a concern about the doctor’s fitness to practise.
This is the latest thinking about how to ensure that the statement about engagement does not contain too many elements
It is likely to change in the light of testing and piloting
Appraisers can be trained to use their professional judgement about engagement in the appraisal process and how to sign the exact statements agreed for the role out of revalidation and available by 31st March 2012, if they discuss the issues around these three areas: the appraisal taking place, the whole scope of work being covered and the supporting information being sufficient and appropriate. 29

30. Sign Off statements for the appraiser
Not signing one of the statements does NOT mean the doctor wont revalidate –it serves to signpost what additional work needs to be done for the following year
This is the latest thinking about how to ensure that the statement about engagement does not contain too many elements
It is likely to change in the light of testing and piloting
Appraisers can be trained to use their professional judgement about engagement in the appraisal process and how to sign the exact statements agreed for the role out of revalidation and available by 31st March 2012, if they discuss the issues around these three areas: the appraisal taking place, the whole scope of work being covered and the supporting information being sufficient and appropriate. 30

31. PDP- definition (RCGP)
a formal agreement, between the appraisee and appraiser, on the learning and development needs of the appraisee, identified at the appraisal interview, with an outcome based learning plan for the subsequent year

32. PDPs - What Goes Into Them
Personal development
Targeted learning
Practice development
OK if also involves personal learning
Professional goals
Professional or career development
Producing supporting information
Capture scope of practice

33. Personal Development aims - best practice
Meet SMART criteria
Reflect appraisee’s approach to learning
Link to improving patient care
needs identified through reflection on practice, SEAs, case reviews , audit etc
aspirations identified by the appraisee
Gaps in supporting information 33

34. Career breaks
RCGP talks about “minimum portfolio” if out of practice for a significant period:
3 out of 5 appraisals
200 clinical sessions (of which 100 should be undertaken in the 2 years prior to revalidation).
150 credits
All yet to be tested in real life

35. Appraisal Checklist- identifying problems early
Appraiser complete checklist of supporting information for RO
significant gaps – put in next year’s PDP
Range of actions available to appraiser is they have concerns:
Second sign off by GP tutor to check appropriate actions
Signposting for support (tutors, occ health, deanery etc)
Flag up for close scrutiny by RO

36. Booking your appraisal
200 appraisers covering North east and 2500 Gps.
Appraisals by birthday month
Must book via new website being launched
Booking early means more choice
Select appraiser according to their availability that month
Website has Bio/profile on the appraiser
Maternity leave, Sabbaticals, Sick leave etc –apply for deferment via website
Admin will no longer allocate if you are delayed. Its all up to you !

38. Collecting information for your annual appraisal
FREE Options
The new Medical Appraisal Guide [MAG] Form
GP tools set up by a GP
SUBSCRIPTION BASED OPTIONS
The RCGP Revalidation e-portfolio
Clarity Appraisal toolkit [previously NHS toolkit]
It’s a matter of appraisee choice, however…

39. Things to consider when choosing toolkits
Must use new GMC domains (all do except RCGP e-portfolio)
Must :
comply with NEPCSA checklist
use NEPCSA templates for SEA/Audit/case review/ complaints etc.
No requirements for appraisers to log onto an online toolkit to see your evidence (discretionary)
Be prepared to extract your information from your chosen website and to your appraiser

40. MAG form
Writable PDF with facility to store uploaded supporting information (NEPCSA templates)
Need latest ADOBE reader
Also has place for writing the appraisal summary (form4)
after summary agreed appraisers does lock down which cannot be reversed
After this “open new year” creates new year and keeps only summary and pdp (all supporting information removed)- this version goes to PCT.

42. Guidance from your appraisal lead
You should be getting updates and guidance directly from your PCt admin lead. if you are not it means they dont have your address and you are not in their system.

43. Where to get advice
Always refer to PCSA web-based booking site
Also
Your appraiser
Your tutor (Paula Wright)
GP tutor for Sessional Gps:
Paula Wright
Steve Blades
Appraisal lead- Di Jelley (specially if career breaks, deferments)

44. Useful websites for further information
PCSA web-based booking site
 UK Revalidation Support Team
Royal College of General Practitioners
General Medical Council