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Revalidation Update


Revalidation Update Ros Crowder & Maggie Woods Primary Care CPD Tutors, Oxford Deanery/NHS Berkshire West Objectives for session By the end of this session you should ... – PowerPoint PPT presentation

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Title: Revalidation Update

Revalidation Update
  • Ros Crowder Maggie Woods
  • Primary Care CPD Tutors, Oxford Deanery/NHS
    Berkshire West

Objectives for session
  • By the end of this session you should be
    confident about
  • The structure of strengthened medical appraisal
  • Whats new for revalidation
  • What you need to do now
  • Collecting supporting information
  • Recording CPD
  • Anything else?

What is Revalidation for?
  • Ensuring that doctors are
  • Up to date
  • Fit to practise
  • Setting an absolute minimum standard that every
    doctor who wishes to keep their license to
    practise must meet.
  • Most doctors will easily meet and exceed this

Revalidation the current position
  • Good Medical practice new framework
  • GMC consultation on Revalidation The Way Ahead
    closed in June. Report due in the autumn
  • Royal Colleges have developed specialty standards
  • Revalidation proposals are currently being
    piloted in 10 sites (including NHS South Central
    Berkshire West)
  • Health Secretarys letter to GMC supports
    revalidation extends piloting for second year
  • Indications are that revalidation will be
    streamlined pilots will help to determine how
  • Responsible Officer regulations laid before
    Parliament in July 2010, will come into force 1
    January 2011

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Revalidation current thinking
  • Licence to Practice issued to every doctor who
    requested one, October 2009
  • The GP and Specialist Registers are a record of
    historical achievement once on it the doctor
    will stay on it
  • The Licence will reflect what a doctor is
    revalidated for and relicensing will be the main
    output from revalidation

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Strengthened medical appraisal is a key part of
  • Common quality framework for appraisal
  • Trained appraisers
  • Supporting information
  • Speciality standards
  • Mapping of supporting information to Good Medical
  • Effective local clinical governance systems

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Balancing support and challenge
Feeling Exposed
Too Comfortable
Portfolio of supporting information
  • Reflection on achievements since last years
  • Reflection on last years Personal Development
  • Mapping of supporting information to the
    attributes of Good Medical Practice
  • Self assessment of performance against each GMP
  • Identification of items for next years PDP

RCGP Proposed Essential Information June 10
Type of Information Min. Required in 5 Years Comments
1 Significant Event Review/Case Review 5 Minimum 1 per year
2 Review of Complaints All
3 Audit (of which some may be less formal data review) 2 completed cycles (or one satisfactory one plus a quality improvement project) Minimum 2 in 5 years
4 Patient Feedback Survey and Review 2 (or one satisfactory one plus a consultation skills review) To be presented no later than years 2 and 5
5 Colleague Feedback Survey and Review 2 To be presented no later than years 2 and 5
6 New PDP and Review of Previous Years PDP 5 Annually
7 CPD Completion 5 Annually
8 Health Self Declaration and Review 5 Annually
9 Probity Self-Declaration and Review 5 Annually
Good Medical Practice Domains Attributes GMC,
4 Domains 12 Attributes 70 standards
Domain 1
Knowledge, Skills Performance
Keep clear, accurate and legible records
Maintain your professional performance
Apply knowledge and experience to practice
Domain 1 - Knowledge, Skills and
Performance Numbers following generic standards
in this framework refer to paragraph numbers in
Good Medical Practice, except where preceded by
MfD which refers to our booklet Management for
Doctors or Research which refers to Research
the role and responsibilities of doctors.
Attributes Generic Standards
Maintain your professional performance All doctors Maintain knowledge of the law and other regulation relevant to practice (13) Keep knowledge and skills up to date (13) Participate in professional development and educational activities (12) Take part in regular and systematic audit (14)
Apply knowledge and experience to practice All doctors Recognise and work within the limits of your competence (3a) Doctors with management, teaching or research roles Follow appropriate national research governance guidelines (71) Apply the skills, attitudes and practice of a competent teacher/trainer (16) Work effectively as a manager (MfD 12, 17) Doctors with clinical roles Adequately assess the patients conditions (2a) Provide or arrange advice, investigations or treatment where necessary (2b) Prescribe drugs or treatment, including repeat prescriptions, safely and appropriately (3b) Provide effective treatments based on the best available evidence (3c) Take steps to alleviate pain and distress whether or not a cure may be possible (3d) Consult colleagues, or refer patients to colleagues, when this is in the patients best interests (2c, 3a, 3i, 54,55) Support patients in caring for themselves (21e)
Keep clear, accurate and legible records All doctors Keep clear, accurate and legible records (3f) Make records at the same time as the events you are recording or as soon as possible afterwards (3f) Doctors with clinical roles Record clinical findings, decisions, information given to patients, drugs prescribed and other information or treatment (3f)
Domain 2
Safety and Quality
Protect Patients and Colleagues from any Risk
Posed by Your Health
Put into Effect systems to protect patients and
improve care
Respond to Risks to Safety
Domain 2 - Safety and Quality
Attributes Generic Standards
Put into effect systems to protect patients and improve care All doctors Respond constructively to the outcome of audit, appraisals and performance reviews (14e) Take part in systems of quality assurance and quality improvement (14) Comply with risk management and clinical governance procedures Co-operate with legitimate requests for information from organisations monitoring public health (14i) Provide information for confidential inquiries, significant event reporting (14g) Doctors with management roles Make sure that all staff for whose performance you are responsible, including locums and students, are properly supervised (17) Ensure systems are in place for colleagues to raise concerns about risks to patients (45) Doctors with clinical roles Report suspected adverse drug reactions (14h) Ensure arrangements are made for the continuing care of the patient where necessary (40, 48)
Respond to risks to safety All doctors Report risks in the health care environment to your employing or contracting bodies (6) Safeguard and protect the health and well-being of vulnerable people, including children and the elderly and those with learning disabilities (26, 28) Take action where there is evidence that a colleagues conduct, performance or health may be putting patients at risk (43, 44) Doctors with clinical roles Respond promptly to risks posed by patients Follow infection control procedures and regulations
Protect patients and colleagues from any risk posed by your health All doctors Make arrangements for accessing independent medical advice when necessary (77) Be immunised against common serious communicable diseases where vaccines are available (78)
Domain 3
Communication, Partnership Teamwork
Establish and Maintain Partnerships with Patients
Communicate Effectively
Work Constructively with Colleagues and Delegate
Domain 3 - Communication, Partnership and
Attributes Generic Standards
Communicate effectively All doctors Communicate effectively with colleagues within and outside the team (41b) Explain to patients when something has gone wrong (30) Doctors with management roles Encourage colleagues to contribute to discussions and to communicate effectively with each other (MfD 50) Doctors with clinical roles Listen to patients and respect their views about their health (22a, 27a) Give patients the information they need in order to make decisions about their care in a way they can understand (22b, 27) Respond to patients questions (22c, 27b) Keep patients informed about the progress of their care (22c) Treat those close to the patient considerately (29) Pass on information to colleagues involved in, or taking over, your patients care (40, 51-53)
Work constructively with colleagues and delegate effectively All doctors Treat colleagues fairly and with respect (46) Support colleagues who have problems with their performance, conduct or health (41d) Act as a positive role model for colleagues (41) Ensure colleagues to whom you delegate have appropriate qualifications, experience (54) Doctors with management roles Provide effective leadership (MfD 50)
Establish and maintain partnerships with patients Doctors with clinical roles Encourage patients to take an interest in their health and take action to improve and maintain it (4, 21f) Be satisfied that you have consent or other valid authority before you undertake any examination or investigation, provide treatment or involve patients in teaching or research (36)
Domain 4
Maintaining Trust
Act with Honesty and Integrity
Show Respect for Patients
Treat Patients and Colleagues Fairly and Without
Domain 4 - Maintaining Trust
Attributes Generic Standards
Show respect for patients All doctors Implement and comply with systems to protect patient confidentiality (37) Doctors with research roles Respect the rights of patients participating in research (Research 2, 5) Doctors with clinical roles Be polite, considerate and honest and respect patients dignity and privacy (21a, b, d) Treat each patient fairly and as an individual (38-39, 21c)
Treat patients and colleagues fairly and without discrimination All doctors Be honest and objective when appraising or assessing colleagues and when writing references (18-19) Respond promptly and fully to complaints (31) Doctors with clinical roles Provide care on the basis of the patients needs and the likely effect of treatment (7-10)
Act with honesty and integrity All doctors Ensure you have adequate indemnity or insurance cover for your practice (34) Be honest in financial and commercial dealings (73) Ensure any published information about your services is factual and verifiable (60, 61) Be honest in any formal statement or report, whether written or oral, making clear the limits of you knowledge or competence (63-65, 67-68) Doctors with research roles Obtain appropriate ethical approval for research projects (Research 5) Be honest in undertaking research and reporting research results (71b) Ensure that your research is audited regularly (Research 43) Doctors with clinical roles Inform patients about any fees and charges before starting treatment (72a)
Appraisers role - Assessing Supporting
  • Does it suggest cause for immediate concern?
  • Which attribute(s) of GMP does it inform?
  • (NB Many items will inform more than one
  • Does it show evidence of personal reflection?

Assessing Supporting Information
  • Does it contribute to revalidation
  • Yes, on its own (e.g. colleague and patient
  • Yes, if produced regularly (e.g. outcome data)
  • Not as it stands, because (e.g. incomplete)
  • No, it doesnt reflect what the doctor does
  • Has the doctor met the CPD recommendations of
    their College/Association?
  • What learning needs (if any) does it identify

Conclusion by Appraiser
  • A) Potential risk
  • Are there genuine immediate concerns about this
    doctors practice?
  • If yes, are measures in place to protect
    patients, colleagues, the doctor and the public?
  • B) Areas for development
  • Are there areas where the doctors performance
    has not been clearly demonstrated to be of a
    satisfactory standard with regard to the guidance
    expressed in GMP?
  • Does the PDP cover all areas that the doctor
    needs to address, with timeframes?
  • C) Revalidation
  • Are there areas where the doctors progress
    towards satisfactory Revalidation may be in
  • Have these been identified and understood, with
    an appropriate plan in place?

  • The appraisers judgement and evidence from the
    organisations clinical governance systems will
    inform the Responsible Officers recommendation
    to the GMC

  • Any questions?

Preparing for revalidation
  • Prepare your portfolio of supporting information
  • Become familiar with the RCGP standards
  • Become familiar with the GMP domains, attributes
    standards start to map supporting information
  • Document reflection on supporting information
  • Develop IT skills if necessary (electronic
  • Keep up to date with revalidation plans GMC,
    RCGP, RST, Healthcare Republic
  • Participate in the South Central pilot (optional)

Revalidation Support Team Pathfinder pilotsApril
2010 March 2011
  • 3000 appraisals across England
  • Whole system testing
  • Testing Information flows
  • Nominated Responsible officer role
  • Preparation for live testing
  • Evaluation to inform Treasury impact assessment
  • Single Multi organisational
  • Advanced and early stage sites
  • Range of doctor specialties and roles

High level aims
  • To identify the impact on individuals and
  • organisations in terms of cost, time and
  • resources
  • To identify problems arising at
  • organisation and individual level in
  • implementing the proposed arrangements
  • To identify any benefits related to the
  • appraisal and revalidation process eg
  • patient care and clinical outcomes

  • All NHS South Central organisations
  • Whole systems pilot sites
  • Isle of Wight
  • Milton Keynes
  • Royal Berkshire NHS Foundation Trust
  • Voluntary pilot sites
  • All other NHS South Central organisations

  • Participation in the revalidation pilot
  • Identification of Responsible Officer
  • Strengthened Training of Appraisers for
    Revalidation (STAR)
  • Revalidation Pilot Toolkit (new electronic
  • Consent to take part
  • Collect supporting information for appraisal on
  • Appraisal discussion
  • Participate in evaluation

Appraisee Personal Profile
Supporting information
Post Appraisal Sign off
Post Appraisal Review and Signoff
Appraisal cycle using RPT
GMP Review
Post Appraisal Commentary Actions Agreed
Pre Appraisal Toolkit portfolio Sign off
Pre Appraisal Toolkit Portfolio Review and Sign
Key Appraisee Appraiser Offline Activity
Revalidation Pilot Toolkit sandpit site
  • https//

Activity 1
  • In pairs
  • Identify a piece of supporting information
    (audit, significant event, complaint,
    patient/colleague feedback etc)
  • Use the forms provided to reflect on this (using
    the examples of questions for reflection form)
  • Identify the GMP attributes and map to the
    appropriate ones
  • Feedback to the rest of the group
  • are the templates helpful for reflection?
  • how easy is it to map to GMP attributes?

RCGP Proposals for Continuing Professional
Education (CPD)
  • Continuing education recorded in the form of
    learning credits
  • At least 50 learning credits a year
  • More than 250 over 5-year revalidation cycle
  • Minimum of 1 credit for each hour of education
  • Each hour of education leading to improvements in
    care or practice will qualify for 2 credits.

  • Attendance at conferences, meetings, seminars,
    workshops etc
  • Reading journals recording learning
  • Shadowing a colleague
  • E- learning
  • etc

Identifying items for a PDP
  • From previous appraisal
  • From a service/practice review
  • From an audit
  • From a significant event
  • From a complaint
  • From a patient satisfaction survey
  • From multi-source feedback
  • From PUNs DENs

Identifying items for a PDP
  • Identify the source e.g. audit, complaint
  • Think about what is required e.g. better outcomes
    for patients with diabetes
  • Identify your individual learning needs
  • What is your preferred learning style?
  • Work out how best to meet your learning needs
  • Identify the desired outcome - how will you know
    when you have met the outcome?
  • Plan a realistic timescale

What development needs have I? How will I address them? Date by which I plan to achieve the development goal Outcome Completed
Explain the need Explain how you will take action, and what resources you will need The date agreed with your appraiser for achieving the development goal How will your practice change as a result of the development activity Agreement from your appraiser that the development need has been met

Recording CPD
  • Document learning outcomes
  • for you
  • for the team / the practice
  • for the patient
  • Action plan for implementing learning
  • for you
  • for the team / the practice
  • for the patient
  • Work out number of CPD credits
  • Keep an ongoing summary record of CPD activity

CPD credits - RCGP guidance
  • Based on the time spent on the learning but with
    an opportunity to gain further credits by
    demonstrating the outcome (impact) of
  • Impact in this context refers to the impact on
  • ?? patients (e.g. a change in practice,
    implementing a new clinical guideline, initiating
    a new drug for the first time)
  • ?? the individual (personal development, e.g.
    development of a new skill or further development
    of existing skills)
  • ?? service (e.g. developing and implementing a
    new service, becoming a training practice,
    teaching others)
  • ?? others (teaching, training, NHS locally or

CPD credits - RCGP guidance
  • In essence 1 hour of education is 1 learning
    credit. However, if that education leads to
    changes for patients, the doctor or the practice,
    the GP can claim 2 learning credits for each hour
    of such education.
  • Credits are self-assessed and verified at
    appraisal, and account should be taken of the
    need for GPs to use their CPD to ensure that they
    are up to date in all areas of their work.

CPD credits - RCGP guidance
  • A CPD credit is defined as being based on an hour
    of learning activity (including planning and
    reflection) recorded in such a way that it
    demonstrates the learning achieved relevant to
    the working situation of the GP.
  • Credits are self-assessed and, although a
    certificate of completion or attendance may be
    used as evidence of activity, it is the
    demonstration of learning achieved and relevance
    to the work that the GP undertakes that defines
    the credit.

CPD credits - RCGP guidance
  • For instance
  • ?? an individual attends a meeting (1 hour) on
    heart failure, acquires the knowledge that
  • beta-blockers are beneficial to patients with
    this condition, and then records this within his
  • her appraisal documentation
  • Credits claimed 1 this demonstrates the
    acquisition of knowledge and as yet there is no
  • demonstration of personal, practice or patient

CPD credits - RCGP guidance
  • ?? a different individual attends the same
    meeting. He or she records the same acquisition
    of knowledge. However, included are two patient
    case studies demonstrating the introduction of
    beta-blockers in heart failure
  • Credits claimed 1 2 (impact) 2

CPD credits - RCGP guidance
  • A third individual attends the same meeting. The
    acquisition of knowledge is recorded. However, in
    his or her appraisal folder, an audit is planned
    after consideration of current practice (1 hour).
    This individual demonstrates audit of his or her
    patients with heart failure, changes are made
    appropriately following discussion with
    colleagues (1 hour) and a second audit cycle
    demonstrates an improvement in care
  • Credits claimed 1 (initial meeting (1 hour)) 2
    (planning (1 hour) and discussion associated
  • with audit (1 hour)) 2 (impact) 6

CPD credits - RCGP guidance
  • The GP would be expected to include the
    following evidence in his or her appraisal
  • ?? a record of the developmental activity
  • ?? learning points acquired
  • ?? relevance to his or her working situation.
  • In addition, to claim the impact factor (credit
    2) the GP would be expected to include a
    demonstration of application of new learning
  • ?? case study
  • ?? simple data collection
  • ?? audit
  • ?? reflective piece demonstrating change in a

CPD record an example
Date CPD activity No of hours Learning outcomes Impact Credits claimed

Activity 2
  • In pairs
  • Think of an example of CPD
  • Work out how many credits you would claim
  • Feedback to group
  • How you worked out the number of hours
  • How you identified the impact of the CPD

Activity 3
  • In pairs
  • Identify 2 or 3 items for a PDP complete the
  • - make sure that they are personal development
  • document the action you will need to take and the
    resources you will require
  • - be clear what outcome you wish to achieve

What development needs have I? How will I address them? Date by which I plan to achieve the development goal Outcome Completed
Explain the need Explain how you will take action, and what resources you will need The date agreed with your appraiser for achieving the development goal How will your practice change as a result of the development activity Agreement from your appraiser that the development need has been met

Further information
  • GMC
  • http//
  • Revalidation Support Team
  • RCGP
  • http//
  • South Central Revalidation Pilot
  • http//
  • Ros Crowder / Maggie Woods, CPD Tutors

CPD Resources
  • Website
  • http//
  • Leicester Statement, Structured Reflective
  • http//

The end!
  • How do you feel about revalidation now?