Revalidation and CPD for GPs: The KSS support system:

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Revalidation and CPD for GPs The KSS support
system

• May 2009
• KSS Post-Certificate GP School.

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The Post-Certificate GP School

• KSS First in UK.
• Recognises life-long learning.
• Supports GPs development beyond CCT
• CPD
• Appraisal and Revalidation
• KSS maintained GP Tutor network
• KSS maintained interest in appraisal

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The Post-Certificate GP School

• Manages GP Tutor network, mentoring, remediation.
• Acts a provider for appraisal training and
  development.

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The Post-Certificate GP School Support for GPs.

• Remediation. Local and national levels
• Mentoring
• Learning sets for sessional doctors.
• Refreshers
• Prolonged study leave

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The Post-Certificate GP School

• Reports to CPD Board which will have
  representatives from PCTs ( Responsible Officers
  and Appraisal Leads),LMCs, RCGP, GP Tutors,
  Mentors, Appraisers.
• Responds to Quality Assurance of Appraisal
  Working Group and helps PCTs meet set criteria
  and standards for Revalidation.

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Revalidation ahead

• The elephants already in the room..

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Resistance is futile
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The CMOs proposals Revalidation

• Needs to support doctors to meet their personal
  professional commitment to continually sustaining
  and developing their skills
• Include strong element of patient participation
  and evaluation of the work of their doctors
• Should be a supportive process to raise standards
  across the board not simply a way to identify a
  few poor performing doctors
• SUMMATIVE v FORMATIVE. ASSESSMENT V DEVELOPMENT
• SUMMATIVE AND FORMATIVE.KSS IDEAL

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The purposes of revalidation of GPs

• Relicensing To demonstrate that licensed doctors
  practise in accordance with the GMCs generic
  standards
• Recertification For GPs on the GP register,
  confirm that they continue to meet the standards
  that apply to the discipline of general practice)
• Also. To identify those doctors who need further
  investigation or remediation (as a backstop where
  local systems are not robust or dont exist)

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What it is notOf course, long before you
mature,most of you will be eaten
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Preparation for Revalidation

• Formation of School and Board
• Formation of Quality Assurance of Appraisal
  Working group
• Developing GP Tutor network
• Establishing links
• Developing Appraiser competencies
• Preparing the workforce
• Modelling best practice

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QAWG

• Representation from all PCTs
• Hosted by Post-Certificate School
• Shares best practice for managing the appraisal
  process
• Common approach emerging for planning,
  preparation, production and perusal of appraisal
  material.

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GP Tutor development

• KSS has maintained its Tutor network
• Supported by Lifelong Learning Advisor
• Now supported by Post-Certificate School. New
  management processes.
• New contracts. Emphasising collaborative working
  with allied organisations.
• Service level agreements with additional funding
  to support activities preparing for Revalidation.

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Establishing Links

• PCTs . QAWG and Board and travelling Head of
  School.
• RCGP Involvement of Dean centrally. Head with
  RCGP Faculties. Concept of Buddying system for
  GPs needing remedial support.
• LMCs Board. Today. Local events.
• PGMECs.Some difficult areas.

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Appraisal Development Centres.

• Developing Appraiser competencies..

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Appraiser Development Centres

• Part of KSS Appraiser Development Programme
• Collaborative work with PCTs
• Providing PCTs with the quality assurance needed
  as the appraiser workforce responds to
  revalidation
• Working to ensure all GPs understand the
  revalidation processand are prepared for it.
• Providing support for those in need.

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Appraiser Development Centres

• Pre-Selection.
• New Appraisers.
• Existing Appraisers.
• Lead Appraisers.
• Appraisal with judgement Enhanced appraisal!
• Also training for lay members of local PAGs
• Also training for involved PCT Staff.

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Pre-Selection Potential new Appraisers.
Awareness.

• Awareness, Background, Definitions
• Emotional intelligence
• Communication skills. Analysis. Feedback.
• Use of evidence. Judgement. Standards.
• Process and paperwork.
• Experiential skills development
• Simulated scenario.observed. Feedback.
• Written exercise. Analysis. Reporting.
• Learning needsPDP development.

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Awareness Day at ADC

• Simulated scenarios.
• Written exercise.
• Preparing PDP as appraiser.
• Feedback from trained observers and from
  simulators.
• Facilitated reflection on log.
• Encouraged to share with PCT.

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Selection

• By PCT
• Supported by material from Pre-Selection day PDP
  and mutually agreed report.
• School, LMC and lay representation on interview
  panel.
• Appraiser Development Centre additional work on
  roles and responsibilities, appraisal tools,
  judgement of evidence ( enhanced appraisal)
• Probationary period under Lead Appraiser.

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After Selection Initial Training.

• Appraisal Development Centre.
• One day. Nuts and bolts.
• Roles and responsibilities.
• Good reflective practice.
• Experiential work.
• Learning log and PDP as appraiser.
• Ongoing support.. Learning Sets. Tutors role.
  Lead Appraiser.

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Established appraisers Leadership.

• Appraisal Development Centre
• Similar format to Awareness day.
• Workshop material to a higher standardmore
  challenging material.
• Learning log and updated PDP.
• Dealing with difficultiesusing understanding of
  emotional intelligence.

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Enhanced Role of the GP appraiser

• GP appraiser judges the quality, quantity and
  balance of CPD folder and information about
  performance supplied by the PCT. They review
• Whether PDP of previous years appraisal has been
  completed, justification for postponement or
  failure to complete past learning needs and
  substitution of additional learning activities.
• Whether and how learning needs have been
  identified / prioritised.
• Justification of credits allocated by GP being
  appraised for CPD.
• Other evidence about performance complaints /
  concerns- discuss cause, effects, action taken,
  learning lessons, comparisons with recommended
  standards or peers with appraisee.
• Guide the appraisee to address future learning
  needs (through the PDP) and suggest upskilling or
  remedial action where required to ensure evolving
  revalidation portfolio meets standards required
  for revalidation

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Evidence for medical revalidation
Personal
Royal College
Appraisals
Roles Personal Contextual
CPD
Specialist Skills Knowledge
Personal Audits
5 Signed Off Appraisals
Routine Clinical Governance
Significant Events
Performance Concerns
Personal
Complaints
MSF
Organisational
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Preparing the workforce

• GP Tutor SLAs
• CPD Credit pilot
• Travelling roadshows
• Via appraisers
• Encouraging PLT
• Informing GPSTRs
• Supporting Learning Sets

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Modelling best practice

• Balancing formative and summative components
• Reflective work through Tutor appraisal system,
  based on evidence.
• Tutor MSF pilot.
• Appraiser Learning Sets alongside ADCs
• Early identification of potential problems MUST
  link to ready support..

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Support Lifting back onto table.

• QA of appraisal process and appraiser
  competencies essential!
• Role of Lead Appraiser and Responsible Officer.
• Feed into enlarged KSS Remedial programme.
• Offer of support through Mentoring Programme.
• Local support through Faculty Buddy.

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How it all fits together
Additional evidence on specialist skills
Revalidation
Erasure or other sanctions
Absence of concern (every 5 years)
National
National regulator
Unresolved concerns (continuous process)
Periodic review by local healthcare organisation
Local management processes
Local
Annual appraisal
Evidence portfolio
Regular 360º feedback
Concerns and adverse incidents
Remediation and reskilling
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Can leopards change their spots?
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If only they would group together.
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Model Hyena behaviour

• Collaborative.
• Exploratory.
• Adaptable.
• Nurturing.
• Patient.
• And look beyond ugly!

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Maintain a healthy balance