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Impact of
CPD/Appraisal/Revalidation
on healthcare
Dr Andrew Long
Vice President, Education, RCPCH
Consultant Paediatrician, Great Ormond Street Hospital
Cost benefit
The Department of Health has published a long awaited
impact assessment for revalidation, revealing that the
scheme will cost doctors over £450 in ‘opportunity costs’ per
revalidation cycle and will only prevent 0.75% of cases of
death, severe harm and moderate harm per year.
The impact assessment reveals the scheme will cost a total
of £97m a year, the majority of which accounts for the added
pressures on doctors’ time.
The impact assessment said that there will be two main
costs for revalidation: those associated with undertaking
appraisals and making revalidation decisions.
Evidence that revalidation is delivering value include:
• a continued increase in appraisal rates (which increased from 63% to 91%
between March 2011 and March 2016)
• an increased focus on the quality of appraisers and the appraisal process
• indicative signs that concerns about a doctor’s practice are being identified at an
earlier stage
• strong support for the system among responsible officers and appraisers
• strong support from doctors, appraisers and responsible officers for medical
appraisal, a key element of revalidation.
However, the report also highlights a few areas where further work is needed:
• While doctors continue to value appraisals and continuing professional
development, some feel that revalidation is not yet relevant to their needs..
• Patients and the public need clearer and more powerful roles in revalidation in the
future.
The outcomes/effectiveness of revalidation in the United Kingdom:evaluating the regulatory impact of medical revalidation
Julian Archer, Niall Cameron, Katie Laugharne, Martin Marshall, Sam Regan de Bere, Kieran Walshe, Richard Wright
Purpose of the evaluation
• 30 research questions, addressing 6 core regulatory aims for medical revalidation:
– Is the GMC’s objective of bringing all doctors into a governed systemthat evaluates their fitness to practise on a regular basis being consistently achieved?
– How is the requirement for all doctors to collect and reflect upon supporting information (SI) about their whole practice through appraisal being experienced by revalidation stakeholders?
– Is engagement in revalidation promoting medical professionalism by increasing doctors’ awareness and adoption of the principles and values set out in Good Medical Practice?
– Are revalidation mechanisms facilitating the identification and remedy of potential concerns before they become safety issues or FTP referrals?
– How do ROs fulfil their statutory function of advising the GMC about doctors’ fitness to practise and what support do they have in this role?
– Are patients being effectively and meaningfully engaged in revalidation processes?
Patient involvementInstruments
Patient feedback questionnaires
Patient survey
Patient information from GMC and
patient groups
Patients, Public
Lay
representatives
Rules
Revalidation
processes/regulations
Fitness to Practice
Organisational Protocols
Organisational structures
Rules
Revalidation
processes/regulations
Fitness to Practice
Organisational Protocols
Organisational structures
Community
Medical Community
Patients/carers
Patient groups
Medical Institutions
DoH
NHS
Healthwatch
CCG’s
Non-medical communities
Division of Labour
Patients
Lay representatives
Doctors
Revalidation Representation
Outcome
“Up to date and fit to
practice”
Increased patient
safety and public
confidence
Current system inadequate
- further work in progress
Benefits to profession
Summary
• Revalidation has been implemented in the UK with numerical success
• CPD is an essential component of revalidation
– demonstrate knowledge and skills necessary
– show relationship to Good Medical Practice
• Revalidation portfolio should demonstrate professional attitude to working life
• Best outcome for patients is likely to relate to how seriously clinicians engage with the process
• Highlights the need for reflective practice
Questions….?
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