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Preparing for revalidation: evidence is the key

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Title: Preparing for revalidation: evidence is the key


1
Preparing for revalidationevidence is the key
  • Dr Cliona Ni Bhrolchain

2
What is the GMC?
  • 13. The GMC is the independent regulator for
    doctors in the UK. Our purpose is to protect,
    promote and maintain the health and safety of the
    public by ensuring proper standards in the
    practice of medicine
  • a. By controlling entry to and maintaining the
    list of registered and licensed medical
    Practitioners
  • b. By setting the educational standards for
    medical school
  • c. By determining the principles and values that
    underpin Good Medical Practice
  • d. By taking firm but fair action against
    doctors registration where the standards of Good
    Medical Practice have not been met

3
What is revalidation?
  • 14. The purpose of revalidation is to assure
    patients and the public, employers and other
    healthcare professionals that licensed doctors
    are up to date and are practising to the
    appropriate professional standards.
  • Although it is widely understood that the
    delivery of medical care to patients will always
    involve an element of risk, revalidation will
    help doctors, employers and the GMC to provide
    further assurance to patients and the public that
    doctors working in the UK are fit to practise.

4
What standard is required?
5
What will happen?
  • 5-year cycle
  • Based on annual appraisal
  • Performance against
  • professional standards from GMC and Royal College
  • Clinical governance information
  • Paper based exercise for majority
  • Decision by Trusts Responsible Officer

6
Producing the evidence
  • Too many standards for individual evidence!
  • Reduced to 4 domains
  • Knowledge, skills and performance
  • Safety and quality
  • Communication, partnership and teamwork
  • Maintaining trust
  • Each domain has attributes

7
Collating the evidence
  • Portfolio for appraisal
  • Electronic appraisal/revalidation pilots
  • MUST START NOW!!

8
What do I collect?
9
To what standard?
  • Independent evidence where possible
  • Triangulation important, avoid multiple use
  • Enough evidence to make a judgement
  • Much more reflective practice

10
Standard of evidence
  • Mapped to domains and attributes
  • Self assessment of evidence and practice
  • Appraiser assessment of evidence and practice
  • All domains/attributes covered over 5 years

11
What tools do I have? (Very similar to trainee
requirements)
  • Patient feedback) 1 per 5 yrs
  • Colleague feedback (MSF/360)) before Y3
  • Personal Development Plan every yr
  • CPD record incl reflective notes every yr
  • Significant events) 2 per yr
  • Case reviews)
  • Audit data 1 per yr
  • Now includes electronic recording and GMP
    domains

12
And
  • Complaints (all) every yr
  • Teamwork e.g. peer review meetings, audit
    meetings
  • Performance data every yr
  • Job plan every yr
  • Probity (self declaration) every yr
  • Health (self declaration) every yr
  • Teaching

13
What do I need to do?
  • Continue with usual appraisal, but make sure
    evidence is more robust
  • Are you registered somewhere for CPD?
  • If not, are you collecting evidence?

14
Worked examplecase review
  • Learning point from clinical practice
  • Identified learning need (DEN)
  • How I will meet that learning need

15
Aide memoire
  • Knowledge, skills and performance
  • Maintain your professional performance
  • Apply knowledge and experience to practice
  • Keep clear, accurate and legible records
  • Safety and quality
  • Put into effect systems to protect patients and
    improve care
  • Respond to risks to safety
  • Protect patients and colleagues from any risk
    posed by your health
  • Communication, partnership and teamwork
  • Communicate effectively
  • Work constructively with colleagues and delegate
    effectively
  • Establish and maintain partnerships with patients
  • Maintaining trust
  • Show respect for patients
  • Treat patients and colleagues fairly and without
    discrimination
  • Act with honesty and integrity

16
Aide memoire
  • Knowledge, skills and performance
  • Maintain your professional performance
  • Apply knowledge and experience to practice v
  • Keep clear, accurate and legible records
  • Safety and quality
  • Put into effect systems to protect patients and
    improve care
  • Respond to risks to safety
  • Protect patients and colleagues from any risk
    posed by your health
  • Communication, partnership and teamwork
  • Communicate effectively
  • Work constructively with colleagues and delegate
    effectively
  • Establish and maintain partnerships with patients
  • Maintaining trust
  • Show respect for patients
  • Treat patients and colleagues fairly and without
    discrimination
  • Act with honesty and integrity

17
Aide memoire
  • Knowledge, skills and performance
  • Maintain your professional performance
  • Apply knowledge and experience to practice v
  • Keep clear, accurate and legible records
  • Safety and quality
  • Put into effect systems to protect patients and
    improve care
  • Respond to risks to safety
  • Protect patients and colleagues from any risk
    posed by your health
  • Communication, partnership and teamwork
  • Communicate effectively
  • Work constructively with colleagues and delegate
    effectively v
  • Establish and maintain partnerships with patients
  • Maintaining trust
  • Show respect for patients
  • Treat patients and colleagues fairly and without
    discrimination
  • Act with honesty and integrity

18
Colleague and patient feedback
  • Trusts will have to set up systems
  • GMC will define standards but not stipulate
    providers
  • RCPCH piloted tool with peer comparison
  • WUTH using commercial company
  • Patients
  • Usually recommend minimum of 20 or so for
    analysis
  • Will child feedback be addressed?

19
Worked examplepatient feedback
  • Participated in RCPCH pilot
  • 1st patient feedback since 2003
  • Different attributes
  • Peer comparison
  • Reflection on results

20
Aide memoire
  • Knowledge, skills and performance
  • Maintain your professional performance
  • Apply knowledge and experience to practice
  • Keep clear, accurate and legible records
  • Safety and quality
  • Put into effect systems to protect patients and
    improve care
  • Respond to risks to safety
  • Protect patients and colleagues from any risk
    posed by your health
  • Communication, partnership and teamwork
  • Communicate effectively
  • Work constructively with colleagues and delegate
    effectively
  • Establish and maintain partnerships with patients
  • Maintaining trust
  • Show respect for patients
  • Treat patients and colleagues fairly and without
    discrimination
  • Act with honesty and integrity

21
Aide memoire
  • Knowledge, skills and performance
  • Maintain your professional performance
  • Apply knowledge and experience to practice
  • Keep clear, accurate and legible records
  • Safety and quality
  • Put into effect systems to protect patients and
    improve care
  • Respond to risks to safety
  • Protect patients and colleagues from any risk
    posed by your health
  • Communication, partnership and teamwork
  • Communicate effectively
  • Work constructively with colleagues and delegate
    effectively
  • Establish and maintain partnerships with patients
    v
  • Maintaining trust
  • Show respect for patients
  • Treat patients and colleagues fairly and without
    discrimination
  • Act with honesty and integrity

22
Aide memoire
  • Knowledge, skills and performance
  • Maintain your professional performance
  • Apply knowledge and experience to practice
  • Keep clear, accurate and legible records
  • Safety and quality
  • Put into effect systems to protect patients and
    improve care
  • Respond to risks to safety
  • Protect patients and colleagues from any risk
    posed by your health
  • Communication, partnership and teamwork
  • Communicate effectively
  • Work constructively with colleagues and delegate
    effectively
  • Establish and maintain partnerships with patients
    v
  • Maintaining trust
  • Show respect for patients v
  • Treat patients and colleagues fairly and without
    discrimination
  • Act with honesty and integrity

23
Aide memoire
  • Knowledge, skills and performance
  • Maintain your professional performance v
  • Apply knowledge and experience to practice
  • Keep clear, accurate and legible records
  • Safety and quality
  • Put into effect systems to protect patients and
    improve care
  • Respond to risks to safety
  • Protect patients and colleagues from any risk
    posed by your health
  • Communication, partnership and teamwork
  • Communicate effectively
  • Work constructively with colleagues and delegate
    effectively
  • Establish and maintain partnerships with patients
    v
  • Maintaining trust
  • Show respect for patients v
  • Treat patients and colleagues fairly and without
    discrimination
  • Act with honesty and integrity

24
Colleague multisource feedback (MSF/360)
  • Provides the opportunity for
  • non-medical co-workers
  • medical colleagues (including trainees and
    juniors)
  • to reflect on the professional skills and
    behaviour of a doctor

25
Colleague multisource feedback (MSF/360)Suggestio
ns for community paediatricians
  • Require 1 per 5 year cycle, 1st before Y3
  • If working in isolated situation might wish to
    consider doing more
  • Usually recommend minimum of 11 or so replies for
    analysis
  • Questionnaires need to comply with guidance
    issued by GMC

26
Who should I ask?Suggestions for community
paediatricians
  • Clinical colleagues
  • Medical
  • Consultant colleagues
  • SAS/trainees
  • CD/lead clinician
  • Nursing
  • Therapists
  • Non-clinical
  • AC staff
  • Secretary
  • Head teachers/SENCOs
  • Ed Psych
  • Social care
  • If statutory role
  • Senior managers in CYPD, HPA, PCT

27
Worked exampleteaching/training
  • Devised a return to work programme for
    UK-trained comm paed returning to UK practice
    after 10-yr break
  • Evidence
  • Anonymised copy of programme
  • Comments from NCAS on programme

28
Aide memoire
  • Knowledge, skills and performance
  • Maintain your professional performance
  • Apply knowledge and experience to practice
  • Keep clear, accurate and legible records
  • Safety and quality
  • Put into effect systems to protect patients and
    improve care v
  • Respond to risks to safety
  • Protect patients and colleagues from any risk
    posed by your health
  • Communication, partnership and teamwork
  • Communicate effectively
  • Work constructively with colleagues and delegate
    effectively v
  • Establish and maintain partnerships with patients
  • Maintaining trust
  • Show respect for patients
  • Treat patients and colleagues fairly and without
    discrimination
  • Act with honesty and integrity

29
Other possibilities for teaching/training
  • GMC/PMETB annual trainee survey
  • Dept results
  • Deanery quality assurance
  • Feedback forms from teaching/training activity
  • Example of a presentation, e-learning material
    prepared

30
Worked exampleperformance
  • Very little official performance data
  • Clinic numbers compared with hospital peers so
    hard to interpret
  • MDTs, CP etc not counted electronically
  • Evidence
  • Use diary to collect information on MDTs

31
Or another strategy
  • Move to Derby where Fawzia Rahman will do it all
    for you!!

32
Aide memoire
  • Knowledge, skills and performance
  • Maintain your professional performance v
  • Apply knowledge and experience to practice v
  • Keep clear, accurate and legible records
  • Safety and quality
  • Put into effect systems to protect patients and
    improve care v
  • Respond to risks to safety
  • Protect patients and colleagues from any risk
    posed by your health
  • Communication, partnership and teamwork
  • Communicate effectively
  • Work constructively with colleagues and delegate
    effectively
  • Establish and maintain partnerships with patients
  • Maintaining trust
  • Show respect for patients
  • Treat patients and colleagues fairly and without
    discrimination
  • Act with honesty and integrity v

33
Worked example record keeping
  • GMC standard
  • 3(f) Keep clear, accurate and legible records,
    reporting the relevant clinical findings, the
    decisions made, the information given to
    patients, and any drugs prescribed or other
    investigation or treatment
  • 3(g) Make records at the same time as the events
    you are recording or as soon as possible
    afterwards
  • 51 When you refer a patient, you should provide
    all relevant information about the patient,
    including their medical history and current
    condition

34
What evidence might be available?
  • Medical record audits
  • CP peer review
  • SEN(M) reports compliance with code of practice
  • Anonymised letters to patients/colleagues
  • Colleague MSF
  • Any comments received from colleagues on quality
    of records/letters
  • SAIL instrument
  • Copying letters to patients (NHS standard)

35
Summary
  • We will need a more structured approach to
    collecting evidence but..
  • Most of it is already there and can be collected
    as we go along
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