Appraisal and Revalidation 2012September

Part of NEPCSA/northern deanery revalidation roll out programme

Dr Paula Wright

GP tutor for Newcastle

Deanery lead for sessional GPs

Revalidation –the core principles

Revalidation

1. demonstrates that you are up to date and fit to practise

2. should not be overly onerous on GPs but be sufficient to provide confidence to the public

3. must take account of the different working lives of GPs, the process must be objective, fair and equitable

Don’t Panic !

You will be recommended for revalidation if you:

• Are are having an annual appraisal• Providing the required Supporting Information• Have no unresolved performance concerns

There is nothing more that you need to do beyond continuing to engage in the appraisal process

What will the revalidation process involve?

Revalidation • is done by the GMC based on a recommendation by

your local Responsible Officer (every NHS organisation will have one)

• recommendation based on appraisal record [from 1/4/12 unless unusual circumstances eg Maternity leave , Sick leave etc]

• RO for North of Tyne is Mike Guy

When will revalidation be introduced?

• ROs and appraisal leads will be revalidated before April 2013

• all other doctors from April 2013• GMC must give doctors at least 120 days notice

of their revalidation date• Aim is for all doctors to get through the first cycle

of revalidation by 2016• NE GPs will be revalidated in relation to their

birthday months

Revalidation schedule for NE GPs

Appraisal year GP month of Birth Revalidation

2013-2014 May 1/7/13-30/9/13

August 1/10/13-/12/13

November 1/1/14-31/3/14

2014-2015 February 1/4/14-30/6/14

June 1/7/14-30/9/14

September 1/10/14-/12/14

December 1/1/15-31/3/15

2015-2016 March 1/4/15-30/6/15

April 1/7/15-30/9/15

July 1/10/15-1/12/15

October/January 1/1/16-31/3/16

The Revalidation Process- Options for RO

1. recommendation for revalidation to the GMC2. Defer if insufficient information [eg maty leave]

or performance concerns under active review3. Administrative removal for non-engagement if

no documentation and no good reason for this

NB. Revalidation will be done electronically for all doctors. You must register at GMC on-line- http://www.gmc-uk.org/doctors/information_for_doctors/gmc_online.asp

What will happen to doctors who do not revalidate?

• Aims is for early detection and support of “at risk” drs

• A few doctors [??1-2 %] will not be revalidated/ lose their licence to practise if remediation fails-most are already known to performance structures

• Remediation- recent agreement to provide funding via NHSCB

What is appraisal for revalidation ?

1. a supportive discussion between two peers.

2. based on “Good Medical Practice” by the GMC (new domains 4)

3. PDP is key (old and new one)

4. 5 “sign off” statements for appraiser to agree or disagree

Good Medical Practice Framework- new domains

1.Knowledge, Skills and Performance

2.Safety and Quality

3.Communication,

Teamwork and Partnership

4.Maintaining Trust

The domains and attributes of the GMC framework for Good Medical Practice

Domain 1Knowledge, skills and performance

Domain 3Communication, Partnership and Teamwork

Attribute 1Maintain your professional performanceAttribute 2Apply knowledge and experience to practiceAttribute 3Keep clear, accurate and legible records

Attribute 1Communicate effectivelyAttribute 2Work constructively with colleagues and delegate effectivelyAttribute 3Establish and maintain partnerships with patients

Domain 2Safety and Quality

Domain 4Maintaining Trust

Attribute 1•Put into effect systems to protect patients and improve care•Attribute 2Respond to risks to safetyAttribute 3Protect patients from any risk posed by your health

Attribute 1Show respect for patientsAttribute 2Treat patients and colleagues fairly and without discriminationAttribute 3Act with honesty and integrity

Information required for appraisal

GENERAL INFORMATION

+

“SUPPORTING INFORMATION”

General information

• Personal details• Scope of work –list of all the roles

undertaken (documents showing review of these roles should be submitted to your appraiser )

• Record of previous annual appraisals

• Personal Development Plan and its review

• Probity and health declarations

Supporting Information

Is based on:

GMC “Supporting information for appraisal and revalidation” (mandatory)

&

RCGP Guide To revalidation for GPs (version7) (Advisory)

Supporting Information -GMC guidance

General information, plus–Evidence of Continuing Professional Development–Quality improvement activity (e.g. Audit, case reviews, review of teaching, QIP)–Significant Event Audits (SUIs)–Patient feedback–Colleague feedback–Complaints/compliments

–These must cover your “scope of practice”- ie all your roles

Summary of supporting information RCGP version 6 October 2011

Evidence FrequencySignificant Events 2 per year

Clinical audit 1 in 5 years [others options for some Sessional GPs]

Colleague and patient feedback

1 in 5 years

Complaints All reviewed every year

PDP Reviewed every year and new one produced each year

CPD credits 50 per year- 250 over five years

Continuing Professional Development

•CPD log must demonstrate at least 50 CREDITS•1 hour=1 credit•CPD should cover whole scope of practice-ie all clinical and other roles•Impact multiples hours by 2•Record of educational activities [meetings, conferences, reading etc] and core learning points

Supporting information: non standard GPs

• peripatetic locums, OOHs doctors, rural remote GPs, etc may have difficulty with some of these evidence requirements , especially audit /SEA and MSF

• All GPs need to demonstrate that they regularly review and evaluate the quality of their work .

See guidance from NEPCSA: on supporting information for ‘non standard’ GPs.

Audit and sessional GPs

No Access to records outside of consulting time

Lack of Skills and help with in searches

No “specific clinical role” to audit;

No organisational influence

Mobility between practices if locum

Numbers with a single conditions seen by locum or part-time GP is very small

personally delivered care means “process” based for which there is no evidence base (e.g. Record keeping)

“Key is to demonstrate reflection, learning and improvement”-RCGP

Quality improvement activities (GMC)

• Clinical audit (1/5yr, or alternative)• Case review, (GMC)• Quality Improvement Plan [QUIP], (GMC)• Review of referrals, review of record keeping *• Review of 20 consultations in random surgery with

feedback from colleague *• Prospective condition based review *• Audit effectiveness of teaching or health policy change

(GMC)Key is to demonstrate reflection, learning and improvement*NEPCSA interpretation of RCGP statement above

Detailed guidance for sessional Gps

Deanery Sessional GP page:

NEPCSA Guidance on Supporting Information for Non-Standard GPs

http://northerndeanery.ncl.ac.uk/NorthernDeanery/primary-care/continuing-practice/retainer-scheme/information-for-sessional-gps

Also

Career Break Advice December 2011

Significant events – ‘unexpected event which could or did harm patient [s]’

• two SEAs each year [RCGP guidance]• Personal to you (involvement in the care not just the

discussion meeting)• Lessons learnt , areas for future learning and actions

taken as a result of SEA should also be discussed- • SEAs can be discussed in a learning/study group if

practice meeting not accessible

Significant events – ‘unexpected event which could or did harm patient [s]’

• SEAs are defined a bit differently in primary and secondary care –SEA = SUI [serious untoward incident ] in hospital context

• Unless your SEA has led to loss of life or serious injury , include it under ‘Quality Improvement Activity ‘ section of the appraisal form

Patient and Colleague Feedback

• Formative and developmental –not pass fail• Feedback should come from whole scope of practice [all the roles

eg clinical, academic etc]

• Will be needed for your first revalidation cycle however short.

• Try and do this as close as possible to the date of your annual appraisal [birthday month] so that you can discuss the feedback with your appraiser soon after it is received.

• Your local GP tutor can also provide support

• Certain groups have different benchmarks (locums/ sessionals)

Patient and Colleague Feedback-how to collect it

• The surveys must be independently collected/analysed • You need to choose a commercial provider of feedback tools

approved by the RCGP include- NE discount prices here

• CFEP –approx £105 –give code DJ8482 when you apply• http://www.cfepsurveys.co.uk/products/general-practice/360.aspx • Edgecumbe –approx £75 – code is nucapf

http://www.edgecumbehealth.co.uk/edgecumbe-doctor-360.php

• Please read the FAQs recently circulated to help guide you in the collection and interpretation of this feedback

Complaints

•All patient complaints must be discussed each year at appraisal, reflection using NEPCSA template

•Learning points and actions must be recorded

•Compliments can be listed in this section

Scope of work –an example

Area of work Detail Qualifications/experience

Length of time

Organisation

Clinical

RegularGP MRCGP 20 yrs Surgery

Ad hoc OOH MRCGP 10 years NDUCEducation Regular

Trainer Dip MEduc 5 years VTS

Ad hoc

Managerial

RegularCCG lead 1 year CCG

Ad hoc Appraiser 7 years PCSAOther roles Team GP 5 years FalconsAd hoc

Mandatory training- NEPCSA

CPR certification up date every 18 months

Safeguarding children =GPs must achieve competence at LEVEL 3 which means over 3 year period

One approved IT module

One session of single agency training –[ health care staff only]-approx 2 hours

One session of multi-agency training -usually one day (organised by LSCB)

Sign Off statements for the appraiser

1. An appraisal has taken place that reflects the doctor’s scope of work and addresses the principles and values set out in Good Medical Practice. 

2.       Appropriate supporting information has been presented in accordance with the Good Medical Practice Framework for appraisal and revalidation and this reflects the nature and scope of the doctor’s work. 

3.       A review that demonstrates appropriate progress against last year’s personal development plan has taken place. 

4.       An agreement has been reached with the doctor about a new personal development plan and any associated actions for the coming year. 

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

Sign Off statements for the appraiser

– Not signing one of the statements does NOT mean the doctor wont revalidate –it serves to signpost what additional work needs to be done for the following year

PDP- definition (RCGP)

a formal agreement, between the appraisee and appraiser, on the learning and development needs of the appraisee, identified at the appraisal interview, with an outcome based learning plan for the subsequent year

PDPs - What Goes Into Them

Personal developmentTargeted learning

Practice developmentOK if also involves personal learning

Professional goalsProfessional or career development

Producing supporting information

Capture scope of practice

Personal Development aims - Personal Development aims - best practice best practice

1. Meet SMART criteria2. Reflect appraisee’s approach to learning3. Link to improving patient care4. needs identified through reflection on

practice, SEAs, case reviews , audit etc

5. aspirations identified by the appraisee

6. Gaps in supporting information

Career breaks

RCGP talks about “minimum portfolio” if out of practice for a significant period:

• 3 out of 5 appraisals• 200 clinical sessions (of which 100 should be undertaken

in the 2 years prior to revalidation). • 150 credits

All yet to be tested in real life

Appraisal Checklist- identifying problems early

1. Appraiser complete checklist of supporting information for RO

2. significant gaps – put in next year’s PDP3. Range of actions available to appraiser is they

have concerns:1. Second sign off by GP tutor to check appropriate

actions2. Signposting for support (tutors, occ health, deanery

etc)3. Flag up for close scrutiny by RO

Booking your appraisal

• 200 appraisers covering North east and 2500 Gps.• Appraisals by birthday month• Must book via new website being launched 2012

www.gpappraisalsne.nhs.uk• Booking early means more choice• Select appraiser according to their availability that month• Website has Bio/profile on the appraiser• Maternity leave, Sabbaticals, Sick leave etc –apply for

deferment via website• Admin will no longer allocate if you are delayed. Its all

up to you !

Collecting information for your annual appraisal

FREE Options• The new Medical Appraisal Guide [MAG] Form • GP tools set up by a GP https://www.gptools.org/

SUBSCRIPTION BASED OPTIONS• The RCGP Revalidation e-portfolio• Clarity Appraisal toolkit [previously NHS toolkit]

It’s a matter of appraisee choice, however…

Things to consider when choosing toolkits

Must use new GMC domains (all do except RCGP e-portfolio)

Must :

• comply with NEPCSA checklist • use NEPCSA templates for SEA/Audit/case

review/ complaints etc.No requirements for appraisers to log onto an online

toolkit to see your evidence (discretionary)

Be prepared to extract your information from your chosen website and email to your appraiser

MAG form

1. Writable PDF with facility to store uploaded supporting information (NEPCSA templates)

2. Need latest ADOBE reader

3. Also has place for writing the appraisal summary (form4)

4. after summary agreed appraisers does lock down which cannot be reversed

5. After this “open new year” creates new year and keeps only summary and pdp (all supporting information removed)- this version goes to PCT.

Guidance from your appraisal lead

You should be getting updates and guidance directly from your PCt admin lead.

if you are not it means they dont have your email address and you are not in their system.

Nepcsa.notgpapprausal@nhs.net

Where to get advice

Always refer to PCSA web-based booking site https://gpappraisals.nepcsa.nhs.uk/

Also• Your appraiser • Your tutor (Paula Wright)• GP tutor for Sessional Gps:

• Paula Wright pfwright@doctors.org.uk• Steve Blades stephen.blades@nhs.net

• Appraisal lead- Di Jelley (specially if career breaks, deferments)

Useful websites for further information

• PCSA web-based booking site https://gpappraisals.nepcsa.nhs.uk/

•  UK Revalidation Support Team http://www.revalidationsupport.co.uk/

• Royal College of General Practitioners http://www.rcgp.org.uk/revalidation.aspx

• General Medical Council • http://www.gmc-uk.org/