Liam BrennanCouncil member & revalidation lead

Royal College of Anaesthetists

Revalidation for anaesthetists

Update - June 2012

Introduction Appraisal for revalidation Timetable for revalidation & transitional arrangements Supporting information

CPD

Review of clinical outcomes

Patient & colleague feedback

Doctors in training Remediation Obtaining advice

Why do we need Revalidation?

Revalidation: is it really going to happen? Andrew Lansley’s letter to GMC, June 2010

• Full support for revalidation• Extend piloting for a further year

House of Commons Health Select Committee, Feb 2011• GMC required to ensure ‘no further delays to late 2012

implementation of revalidation’

House of Commons Health Select Committee, March 2012• ‘’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.”

What is Revalidation?

It’s about providing assurance that all doctors with a GMC license are up to date and fit to practice

What is Revalidation?

It’s about providing assurance that all doctors with a licence are up to date and fit to practice Based on continuing evaluation of current practice in

the context of everyday working environment Based on local systems of annual appraisal that are

based on the GMC core guidance Good Medical Practice* It is not a “point in time” assessment of knowledge &

skills

* http://www.gmc-uk.org/guidance/good_medical_practice.asp

What is Revalidation?

It’s about providing assurance that all doctors with a licence are up to date and fit to practice Based on continuing evaluation of current practice

in the context of everyday working environment Based on local systems of annual appraisal that are

based on the GMC core guidance Good Medical Practice

It is not a “point in time” assessment of knowledge & skills

A five year process NOT a fifth year event !

Appraisal/revalidation…..a continuing cycle

AppraisalAppraisal Appraisal Appraisal Appraisal Appraisal

Appraisal Appraisal Appraisal Appraisal Appraisal

One revalidation cycle

One revalidation cycle

Second revalidatio

n cycle

Appraisal/revalidation…..a continuing cycle

AppraisalAppraisal Appraisal Appraisal Appraisal Appraisal

Appraisal Appraisal Appraisal Appraisal Appraisal

One revalidation cycle

One revalidation cycle

Second revalidatio

n cycle …..for each and all our professional lifetimes!

GMC revalidation model

Portfolio of Supporting Information

Five x yearly appraisals

Responsible Officer

Failure to engageRequestdeferral

Employer liaison serviceSpecialty-specific advice

General Medical Council

Recommend revalidation

What is appraisal?

“A professional process of constructive dialogue, in which the doctor being appraised has a formal structured opportunity to reflect on his/her work and consider how his/her effectiveness might be improved”

“A positive process to give someone feedback on their performance, to chart their continuing progress and to identify developmental needs. It is a forward looking process, essential for the development and educational planning needs of the individual”

DH December 2002

Appraisal: for revalidation

Existing appraisal practice

Clinical and non-clinical aspects mapped to GMP

CPD reviewed against Core topics Job plan

Match job plan to Trust needs

Increased use of MSF

PDP taking account of the above

Appraisal for revalidation Clinical and non-clinical

mapped to four domains of GMP

Judgements on: Adequacy of supporting

information including: CPD Audit MSF

Clinical risks/safety Progress towards

revalidation Match job plan to Trust needs PDP taking account of the

above

Appraisal remains largely a formativeprocess but with summative components

www.revalidationsupport.nhs.uk

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 revalidated

By 31 March 2014 ~20% of doctors to have revalidated

By 31 March 2016 The ‘vast majority’ of doctors to have revalidated

By 31 March 2018 All remaining doctors revalidated• Challenge of non-affiliated doctors• GMC ‘ making your connection’ campaign

Transitional arrangements

Specialty specific supporting information

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

Final version publishedlate summer 2012

Supporting informationGeneral information - providing context about what

you do in all aspects of your professional work Personal details Scope of whole practice (inc NHS, independent, voluntary)

Anaesthetic/ICM/pain medicine caseload data Data on complex procedures e.g. central access, regional blocks

Probity statement Personal declaration of disciplinary, criminal or regulatory sanctions Competing interests e.g. financial or other Any declarations of professional conduct/performance of others

Personal health declaration Self-declaration of health issues that could pose a risk to patients

Supporting information

Supporting information

Continuing Professional Development (CPD)

GMC principles of CPD • Responsibility for personal learning

Personal responsibility for identifying your CPD needs, planning how they should be addressed and undertaking CPD that will support professional development and practice

• ReflectionGood Medical Practice requires you to reflect regularly on your standards of medical practice

• Scope of practiceYou must remain competent and up-to-date in all areas of your practice

• Individual and team learningCPD activities should aim to maintain and improve the standards of your practice and teams in which you work

• Identification of needsCPD activities should be shaped by assessment of your professional needs and the needs of the service and the people who use it

• OutcomesYou must reflect on what you have learnt through your CPD and record any impact or expected impact on your performance and practice GMC Guidance on CPD (June 2012)

www. gmc-uk.org/education/continuing_professional_development.asp

How much CPD is required?

Minimum of 50 credits per year; 250 credits in 5 year revalidation cycle is recommended

Internal Minimum 20 credits (NB at least 10 from local clinical governance

meetings) External

Minimum 20 credits

RCoA encourages wide range of CPD activities to reflect your whole practice

Full details of RCoA CPD guidance available at: http://www.rcoa.ac.uk/document-store/guidelines-continuing-

professional- development

RCoA CPD matrix Resource to assist in planning CPD needs Regard as a menu rather than a tick box list

Level 1 Core knowledge expected of all who received their base

training as anaesthetists Easily achievable by review of clinical activity, local

meetings, e-learning; some topics included in mandatory training

Level 2 Knowledge & skills relevant to an anaesthetist’s whole

practice (inc on call, independent/voluntary practice) Achievable via local meetings, e-learning & some external

CPD activity Level 3

Knowledge & skills required for a ‘special interest’ area of practice*

Will rely heavily on external CPD activity Suggestions via relevant Faculty/specialist society

website*Special interest areas are as defined in advanced level CCT curriculum although other clinical & non-clinical areas may be suitable for Level 3 CPD

CPD & appraisal

• Achievable amount of CPD from relevant matrix levels agreed at appraisal• Include CPD goals as part of PDP• Review evidence of completion at next appraisal & sign off

RCoA Online CPD system

Users• Searchable database of

approved events• CPD diary & reflective review• Personal development plan• Breakdown of CPD credits• Integration to eLA• Depository for CPD certificates• End of year CPD activity report• Free to Fellows & Members

Providers• Submit applications for CPD

approval• Dedicated help line for

providers• Addition of event to database• Link to event website for more

information & booking• Learning outcomes review by

users

www.cpd.rcoa.ac.uk

Clinical outcomes

Review of clinical outcomes National

NAP projects ♯ NOF network Laparotomy network ICNARC

Local RCoA audit recipe book may be key (new edition published June 2012) One or two audits per year in each anaesthetic department Review areas of core clinical outcome e.g. post op pain relief, PONV,

line related sepsis, ICU readmission Benchmark personal practice against national/local standards whenever possible

New initiative - national ‘sprint’ audits

Patient & colleague feedback

Patient & colleague feedback

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

• Patient & colleague MSF should be collected at least once in each revalidation cycle• Several validated MSF tools • GMC,RCoA & FICM guidance available

wwwgmcuk.org/doctors/revalidation/colleaguepatient_feedback_resources.asp

Patient & colleague feedback

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

Patient & colleague feedback GMC commissioned survey for feedback showed:

Colleague MSF straightforward 75% >14 questionnaires

Patient feedback more difficult for perioperative anaesthetist 51% >21 questionnaires Difficulties with timing, distribution & collection of patient feedback

Further work by RCoA with patient groups to consider:

Logistical difficulties of patient MSF Quality of care

Despite difficulties RCoA recommend engaging with patient MSF

Doctors in training

Doctors in training

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 re-skilling, to more formal programmes including supervised remediation and/or rehabilitation.’

Remediation: DH report 2011

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: Clinical Directors view

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 of remediation programmes

Remediation: Regional advisors view

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: General consensus

Preferable to identify performance concerns early Ensure robust local appraisal and clinical

governance processes are in place Act on information obtained Majority of issues should be manageable locally

Work with national organisations e.g. NCAS Work with Academy of Medical Royal

Colleges to produce consistent approach across the profession

Obtaining information & advice

Sources of information & advice

GMC website

http://www.gmc-uk.org/doctors/revalidation.asp

RCoA & FICM website

http://www.rcoa.ac.uk/revalidation-cpd

http://www.ficm.ac.uk/cpd-and-revalidation

RCoA Bulletin articles

http://www.rcoa.ac.uk/bulletin

Specialty advisors

Revalidation specialty advice

• Common model for delivery of specialty advice agreed by AoMRC• Central contact point for all specialty advice via the College:

revalidation@rcoa.ac.uk

Revalidation specialty advice

Comments or questions to:

revalidation@rcoa.ac.uk