Revalidation

THE ROYAL COLLEGE OF ANAESTHETISTS

What, when and how

What?Responsibility of individual doctors (and

the GMC and Professional bodies)

When?Piloting in 2009, ready and delivered in 2010

How?Locally with RCoA support

Definition

‘Revalidation is a process where doctors will be required to “periodically demonstrate their continued fitness to practise … and for specialist doctors, to demonstrate that they meet the standards that apply to their particular medical specialty (DH 2007: 6). If demonstration fails then an evaluation (GMC guidance relating to Medical Act, 2002) of evidence would be required, progressing to assessment if it is deemed necessary’.

It is important to remember that …..

The purpose of revalidation and medical regulation is not solely to identify doctors whose performance is not of a sufficiently high standard

The vast majority of doctors are practicing medicine to a high standard

Revalidation should be a process that will support continuous quality improvement in standards and practice for both doctors and patients alike

What is it?

A combined process of public assurance about medical fitness to practice

Three elements:Registration LicensingCertification

Registration

Identified as a doctorNo rights

• To practice

• To prescribe

• To certify death

Licensing

Identified on register to practiceGeneral rights (pays Fee)No specialist recognitionRemains open after retirementRenewed every 5 years

• Local process

Certification

Identified as a specialist (or GP)All non-training post holders

• Consultants / SAS + Trust posts

• Independent sector doctors

Renewed every 5 years• Recommendation from RCoA to GMC

• Linked to local process

Summary so far

RegistrationAble to be called a doctor

License to practiceCan practice as a doctor

CertificationCan practice as a specialist (anaesthetist)

When?

2009All on GMC register issued a license to practiceClock starts

2010Recertification startsNot across all specialities20% each year - who will it be?

NB – no evidence older than 5 years is admissible

How?

Demonstration that we meet the standards depends on a cascade Stage 1 provide evidence >95% Stage 2 may need evaluation <>5%Stage 3 GMC assessment <>1%

Demonstrating Practice – 5 years, 5 appraisals, 5 types of evidence

• Evidence required for Revalidation1. Local Evidence – Clinical Governance information including recorded concerns , complaints and incidents.

Evidence of annual review and discussion at appraisal2. MSF and Patient Survey – completion of 1 cycle (e.g. 2 MSFs)3. CPD – 5 year cycle of 250 credits4. Non-Clinical Evidence (if appropriate), e.g.

- Teaching Evaluations- Published Research Papers- Management Appraisals

5. Two Specialist Methods and Evidence which could include:- Clinical Audit (Completion of 1 cycle)- Peer Review- Case Based Discussion- Outcomes Data- Knowledge Assessment- Observation of Consultations / Procedures- Case Notes or Outpatient Letter Audit (1 cycle)- Involvement in Clinical Guideline Development (e.g. Participation on a NICE GDG)

Demonstrating Practice – 5 years, 5 appraisals, 5 types of evidence

• Evidence required for Revalidation1. Local Evidence – Clinical Governance information including recorded concerns , complaints and incidents.

Evidence of annual review and discussion at appraisal2. MSF and Patient Survey – completion of 1 cycle (e.g. 2 MSFs)3. CPD – 5 year cycle of 250 credits4. Non-Clinical Evidence (if appropriate), e.g.

- Teaching Evaluations- Published Research Papers- Management Appraisals

5. Two Specialist Methods and Evidence which could include:- Clinical Audit (Completion of 1 cycle)- Peer Review- Case Based Discussion- Outcomes Data- Knowledge Assessment- Observation of Consultations / Procedures- Case Notes or Outpatient Letter Audit (1 cycle)- Involvement in Clinical Guideline Development (e.g. Participation on a NICE GDG)

Colleges and Faculties: Roles and Responsibilities

1. Set Standards • Specialist Recertification• Specialty Service Provision and potentially Accreditation

2. Develop Specialty Tools and Methods

3. Train Appraisers in Specialty Standards and Methods

4. College/Faculty Role in Revalidation Recommendation • Quality assure local systems and processes leading to the Recommendation• Provide College Representatives to work at the Local level with the LRO to review appraisals and

evidence throughout the 5 year cycle and jointly confirm the Recommendation and send a Statement of Assurance to GMC

• College Regional Advisors?• Larger Colleges may need additional representatives in the larger regions

• Review all evidence portfolios and confirm Recommendation from LRO to GMC • Audit a proportion of evidence portfolios for quality assurance

5. Provide remediation support or advice for doctors identified as in need

Appraisal / assessment

We are well into the 5 year cycleThe evidence has to match the current

GMC Domains of Good Medical Practice (4 not initial 7)

Probity and health are for local use only

Specialist Standards for re-certification

4 Domains adapted from Good Medical Practice

Domain 1 - Knowledge, skills and performance

Domain 2 - Safety and quality Domain 3 - Communication, partnership and

teamwork Domain 4 – Maintaining Trust

Work Streams

These all interlink:CPDE-portfolioNon-clinical activityMSFRemediationDepartmental accreditation

CPD

Core topics are essential for all Primarily a knowledge based processLargely ‘internal’ process

Higher levels of CPD are necessary to demonstrate currency of practiceExternal process is likely to be necessary

CPD Process

Appropriate Recordable Verifiable

The ‘levels’ of CPD will varyThe content of CPD will vary

Definitions of CPD

Core topicsEssential knowledge for all practitionersRedefined from core topics agreed by

UEMS

Level 1Essential for safe practice when on callHospital specific

• May be evidenced by clinical activity or external CPD

Advanced CPD

Job planned clinical activityThe content of this specialised clinical work

has been defined by the relevant specialist societies

• It will be published on the CPD web-site• It will be used for evaluation if necessary• It will be a largely external process

Multi-source feedback

Two systemsThe precise nature will vary across

specialities• There is a minimum number of returns necessary• There is a maximum number of questions

Patient feedbackNot yet clearly defined for anaesthesia

Peer / teamMany commercial systems exist

Anaesthesia

Team systemsThese must inform the GMC Good

Medical Practice domains• They are often part of a Trust-wide

process• Most are poorly validated

Remedial process must be in place

Non-clinical activity

A process for identifying activity for the ‘wider’ NHSTeaching / trainingResearchCollege / AAGBI workAudit Writing / editing

Non-Clinical Activity

This will be considered as part of revalidationEvidence from the appraisal process

related to that activity will be usedNon-clinical activity does not replace the

CPD requirements for full-time practitioners

E-portfolio

This should underpin the entire processProvides the easiest method of completing

appraisal• Expensive• High security demands• Multi-speciality

Not likely to be fully functional on time

E-portfolio

More than a revalidation toolPersonal documentsLinked to e-CPD systemSecure Learning / reflective diaryLogbook dataTeaching / training activity

Departmental Accreditation

Part of healthcare regulationThe context for assessing

performance in revalidation• Evaluation of a doctor’s performance has to

include the environment in which they work• Local CPD activity may be recognised only

from accredited departments in the future

What should you do?

Today!Review your appraisalsIdentify any gaps in CPDCheck with your CD about opportunities

to ‘catch up’Start / continue to record logbook data

or identify systems that can

Planning

Find and organise the box-filesOne folder for each year

• Identify appraisals• Identify ‘themes’ from appraisals• Log praise / complaints• Collate CPD• Pilot / complete MSF

Where is the information

Links :http://aomrc.org.uk/revalidation.aspx

http://www.gmc.uk.org/about/reform/index.asp

http://www.rcoa.ac.uk/index.asp?SectionID=3