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February 28 th 2012 The Changing Face of Revalidation Ian Starke, Medical Director, Revalidation, Royal College of Physicians, London

The Changing Face of Revalidation

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The Changing Face of Revalidation. Ian Starke, Medical Director, Revalidation, Royal College of Physicians, London. February 28 th 2012. Overview. Revalidation – definition and process Supporting Information How medical appraisal will work The Medical Appraisal Guide Current issues - PowerPoint PPT Presentation

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Page 1: The Changing Face of Revalidation

February 28th 2012

The Changing Face of Revalidation

Ian Starke,Medical Director, Revalidation,Royal College of Physicians, London

Page 2: The Changing Face of Revalidation

Overview

• Revalidation – definition and process• Supporting Information• How medical appraisal will work• The Medical Appraisal Guide• Current issues• Timetable for revalidation.

Page 3: The Changing Face of Revalidation

What is Revalidation?

• Revalidation is the means by which, every five years, licensed doctors will demonstrate that they remain up to date and fit to practice.

• The purpose of revalidation is to assure patients and the public, employers and other healthcare professionals that this is so.

Page 4: The Changing Face of Revalidation

The Revalidation Process

Page 5: The Changing Face of Revalidation

The Revalidation Process

Annual appraisal

Supporting information

ResponsibleOfficer

X 5

PersonalDevelopment

PlanCPD

Recommendationto GMC

Page 6: The Changing Face of Revalidation

The Revalidation Process

Annual appraisal

Supporting information

ResponsibleOfficer

X 5

PersonalDevelopment

PlanCPD

Recommendationto GMC

ClinicalGovernanceinformation

Page 7: The Changing Face of Revalidation

The Revalidation Process

Annual appraisal

Supporting information

ResponsibleOfficer

X 5

PersonalDevelopment

PlanCPD

Recommendationto GMC

ClinicalGovernanceinformation

Professional excellence.

Page 8: The Changing Face of Revalidation

Supporting Information.

Page 9: The Changing Face of Revalidation

General Information• A description of your whole practice

since your last appraisal • Record of previous appraisals• Previous PDPs and their review• Current job plan (for reference)• Probity and Health

– Self-declaration that you comply with the obligations of Good Medical Practice

Page 10: The Changing Face of Revalidation

Keeping up to date

• Continuing Professional Development– Minimum average of 50 hours per year– Systems and credit categories vary – Cover all areas of your professional work. – Address the agreed PDP objectives

Page 11: The Changing Face of Revalidation

Review of your practice – 1

Quality Improvement Activity• Clinical Audit

– One full cycle per five years• Clinical Outcomes

– Robust, attributable and validated• Case review or discussion

– Two per year if used instead of audit

Page 12: The Changing Face of Revalidation

Review of your practice – 2

Significant Events• Your involvement in SUIs • Summary of clinical incidents in which you

have been involved• Emphasis on learning and practice change• Self-declaration if no such involvement

Page 13: The Changing Face of Revalidation

Feedback on your practice• Colleague Feedback

– Validated multi-source feedback tool• Patient Feedback

– Validated patient questionnaire• Feedback on Teaching and Training• Complaints and Compliments

– Summary of all formal complaints since last appraisal,

– How managed, what was learned– Self-declaration if no complaints.

Page 15: The Changing Face of Revalidation

How appraisal will work

The Medical Appraisal Guide (under development)

Page 16: The Changing Face of Revalidation

Appraisal for Revalidation• Effective appraisal and revalidation will:

– satisfy the requirements of GMP– support the doctor’s professional

development• The Responsible Officer will inform the

GMC of any concerns• Concerns should be addressed as they

arise.

Page 17: The Changing Face of Revalidation

Appraisal for Revalidation

Predominantly formative– Striving for professional excellence

Summative element for revalidation– Up to date and fit to practice

Different systems in UK nations– Medical Appraisal Guide – England– Scottish Online Appraisal Resource– On-line system in Wales

Page 18: The Changing Face of Revalidation

Purposes of Medical Appraisal

To enable doctors: • to demonstrate that they meet the principles

and values of GMP• to enhance their quality of care by planning

their professional development• to consider their own professional development

needs• to ensure that they are working productively

and in line with organisational requirements

Page 19: The Changing Face of Revalidation

The stages of medical appraisal

Page 20: The Changing Face of Revalidation

Confidentialappraisal

discussion

Review by appraiser

ofappraisalPortfolio

Other information from doctor

including; achievements, challenges and

aspirations

Review of last year’s PDP and

summary ofappraisal

Supporting Information (SI) with additional comments from

doctor

Inputs Outputs

Doctor’s PDP

Summary of appraisal discussion

Appraiser’s statements

Post appraisal

sign off bydoctor andappraiser

Description of the doctor’s

scope of work

The stages of medical appraisal

Page 21: The Changing Face of Revalidation

Appraiser’s Statements - 1These should confirm that:• Appraisal has taken place, reflects the scope of work,

and addresses the principles and values of GMP• Appropriate SI has been presented according to the

GMP Framework, and this reflects the nature and scope of the doctor’s work

• Appropriate progress against last year’s PDP has taken place

• Agreement has been reached about a new PDP and any associated actions for the coming year.

Page 22: The Changing Face of Revalidation

Appraiser’s Statements - 2• “I understand that I must protect patients from risk of

harm posed by another colleague’s conduct, performance or health. If I have concerns that a colleague may not be fit to practice, I am aware that I must take appropriate steps without delay, so that concerns are investigated and patients protected where necessary”.

• No information has been presented or discussed in the appraisal that raises a concern about the doctor’s fitness to practice.

Page 23: The Changing Face of Revalidation

Tools for Revalidation

Page 24: The Changing Face of Revalidation

Tools for revalidation• MSF colleague and patient questionnaires

– http://www.rcplondon.ac.uk/resources/clinical-resources/revalidation-practice/multi-source-feedback-msf-colleague-and-patient-q

• Personal Clinical Audit Tool (pCAT)– www.p-cat.org.uk

• Supporting Information, guidance and FAQs on AoMRC and College websites

– http://aomrc.org.uk/revalidation.html

• Revalidation e-system – June 2012

Page 25: The Changing Face of Revalidation

Outstanding issues• Training, advice and support• Quality assurance• Remediation

Page 26: The Changing Face of Revalidation

Training• Responsible Officers

– Training provided by RST• Appraisers

– “Top-up” training by RST• Specialty advisers

– Training by Academy and Colleges– Consistency essential

• between individuals • between specialties

Page 27: The Changing Face of Revalidation

Advice and support

• Legal responsibility on the RO to make a recommendation

• Local advice based on written guidance and FAQs

• Otherwise routed through Colleges• NCAS and ELAs

Page 28: The Changing Face of Revalidation

Quality Assurance• GMC guidance [CQC, SHAs, RO networks]

http://www.gmc-uk.org/doctors/revalidation/9613.asp

• QA of RO recommendations?• RST on QA of medical appraisal

http://www.rcpsg.ac.uk/Education/Revalidation_CPD/Documents/Revalidation%20Papers%2009/NHS%20AQMAR.pdf

• RO responsible for QA of appraisal process in the organisation

Page 29: The Changing Face of Revalidation

Remediation and re-skilling

Academy report – Dec 2009 http://www.gmc-uk.org/Item_6e___Annex_E_AoMRC_Remediation_Report.pdf_28987523.pdf

DH (England) report – 2011 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131814.pdf

Academy working party now set up.

Page 30: The Changing Face of Revalidation

Remediation: DH report• Performance problems should be managed locally

wherever possible• Local processes need to be strengthened• The capacity of staff to be increased with access

to necessary external expertise• A single organisation is required to co-ordinate• The medical Royal Colleges to provide guidance,

assessment and specialist input• Deaneries to develop their assessment processes

to address any problems arising during training.

Page 31: The Changing Face of Revalidation

Proposed DefinitionsRemediation: The overall process agreed with

the practitionerRe-skilling: Provision of support, training and

education to address identified needsSupervised remediation programme: A formal

programme, usually including both re-skilling and supervised clinical placement,

Rehabilitation: The process for restoring a practitioner to independent practice by managing physical or mental health problems

Page 32: The Changing Face of Revalidation

Remediation and re-skilling

Need for support / remediation

Personal Development Plan

RO / GMC

Directed remediation activity

Specialty expert advice

Enhanced PDP

Targeted learning

Specialty support available

Developmental PDP

Employer ‘in-house’ support

Specialty advice available

Fitness to Practice

Specialty expert advice

RO / NCASRO / Appraiser Appraiser

Page 33: The Changing Face of Revalidation

Summary

• Supporting information as simple as possible • SI will cover domains / attributes of GMP• CPD increasingly focussed on learning• Appraisal is the key to revalidation• Mechanisms for advice and support• Quality assurance• Remediation and re-skilling

Page 34: The Changing Face of Revalidation

AoMRC, RST and GMC websites

http://aomrc.org.uk/revalidation/revalidation-publications-and-documents/item/academy-reports-and-resources.html

http://www.revalidationsupport.nhs.uk/medical_appraisal_guide/draft_core.asp

http://www.gmc-uk.org/Supporting_information.pdf_42293176.pdf

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

Page 35: The Changing Face of Revalidation