Andy TomlinsonMember Revalidation Delivery Committee

Royal College of Anaesthetists

Update on revalidation and remediation

CDs meetingApril 2012

Revalidation and remediation Anticipated timetable RST, GMC and Academy updates

RCoA update: Supporting Information Remediation

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

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

Updates

Updates: RST

www.revalidationsupport.nhs.uk

www.revalidationsupport.nhs.uk/CubeCore/.uploads/RSTMAGforReval0312.pdf

Updates: RST

www.revalidationsupport.nhs.uk

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 www.gmc-uk.org/

Instructions_for_questionnairesfinal.pdf_48334410.pdf

Updates: Academy Specialty Guidance

Helpful in pilots Greater awareness needed To be finalised end of May 2012

www.aomrc.org.uk/revalidation/item/speciality-frameworks-and-speciality-guidance.html

Specialty advice for ROs, doctors and appraisers by Royal Colleges and Faculties Formal generic training agreed

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

RCoA Update: Specialty specific supporting information

www.rcoa.ac.uk/docs/Revalidation_doh_pilots.pdf

RCoA update: Specialty specific supporting information

More guidance required for:

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

Specialty feedback on professional practice

www.rcoa.ac.uk/docs/peer_patFeedback2011.pdf

Update: Specialty feedback on professional practice

www.rcoa.ac.uk/docs/REV-Statement-03.02.12.pdf

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

Remediation

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

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.

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

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 

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  

Remediation: CDs view

Survey Monkey survey: 240 individuals emailed (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

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

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

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

Comments or questions to:

revalidation@rcoa.ac.uk