What do all GPs need to What do all GPs need to knowknow

About revalidation and About revalidation and commissioningcommissioning

Autumn 2012Autumn 2012

Background Background

Years of delay may have led to Years of delay may have led to complacencycomplacency

““maybe I’ll retire first”maybe I’ll retire first” We are now assured it will happen from We are now assured it will happen from

December 2012 , subject to government December 2012 , subject to government approvalapproval

Ground rules and advice changed under Ground rules and advice changed under GMC directionGMC direction

Essential to be up to date!Essential to be up to date!

Revalidation Revalidation

Responsible officers will be revalidated in Responsible officers will be revalidated in first four monthsfirst four months

April 2013 roll out to all doctors- expected April 2013 roll out to all doctors- expected all revalidated by march 2016all revalidated by march 2016

If you are on the performers list the RO is If you are on the performers list the RO is responsible for recommending you to the responsible for recommending you to the GMC for revalidationGMC for revalidation

From December 2012 you will know the From December 2012 you will know the year you will be revalidatedyear you will be revalidated

Revalidation Revalidation

The RO needs to be satisfied that you have The RO needs to be satisfied that you have participated in an annual appraisal that covers participated in an annual appraisal that covers all of your medical practice, and that your all of your medical practice, and that your appraiser has signed off at least one appraisal appraiser has signed off at least one appraisal that has good medical practice as its focusthat has good medical practice as its focus

You have brought to your appraisals appropriate You have brought to your appraisals appropriate supporting informationsupporting information

There are no unresolved concerns about your There are no unresolved concerns about your performance as a doctorperformance as a doctor

Revalidation Revalidation

““Minimum supporting information” applies to the Minimum supporting information” applies to the 12 month period prior to your last appraisal 12 month period prior to your last appraisal before your revalidation datebefore your revalidation date

Ie for some of us that means information Ie for some of us that means information gathered this year: 2012-13gathered this year: 2012-13

Revalidation is a continuous process , not a high Revalidation is a continuous process , not a high stakes exam at a fixed point in time- the RO stakes exam at a fixed point in time- the RO should give you time to put things right should give you time to put things right

Part timers , retainers ,and locums all expected Part timers , retainers ,and locums all expected to submit a full standard portfolio to submit a full standard portfolio

Minimum supporting informationMinimum supporting information

Personal details, scope of your work, Personal details, scope of your work, record of annual appraisals, PDPs, probity record of annual appraisals, PDPs, probity and health declarationsand health declarations

At least 50 CPD credits in the 12 months At least 50 CPD credits in the 12 months prior to your last appraisal before your prior to your last appraisal before your revalidation daterevalidation date

At least 2 significant event reviews in 12 At least 2 significant event reviews in 12 months – must include any serious months – must include any serious incidentincident

Minimum supporting informationMinimum supporting information

Audit –evidence of regular participation in Audit –evidence of regular participation in in quality improvement activity relevant to in quality improvement activity relevant to your scope of work, and discussed at your scope of work, and discussed at appraisalappraisal

Colleague feedback and patient feedback- Colleague feedback and patient feedback- one of each in 5 years before your one of each in 5 years before your revalidation recommendation revalidation recommendation

Description of any formal complaintsDescription of any formal complaints

MSF and PSQMSF and PSQ

Various tools approved by GMC – their Various tools approved by GMC – their own tools are simple; require 40 patients own tools are simple; require 40 patients and 15 colleaguesand 15 colleagues

Can use GP-SPRAT, CFET, 2Q MSF, Can use GP-SPRAT, CFET, 2Q MSF, Edgecumbe 360Edgecumbe 360

Initially other non validated tools will be Initially other non validated tools will be acceptable if they focus on what you do, acceptable if they focus on what you do, but suggest data externally collated but suggest data externally collated

MSF and PSQMSF and PSQ

Feedback and reflection essentialFeedback and reflection essential Can be challengingCan be challenging RCGP faculties will be providing supportRCGP faculties will be providing support Means if you haven’t done a personal Means if you haven’t done a personal

PSQ or MSF in the past 3 years , do one PSQ or MSF in the past 3 years , do one soon soon

Extended rolesExtended roles

Any activity beyond the scope of GP training and Any activity beyond the scope of GP training and the MRCGP, or with a separate contract eg the MRCGP, or with a separate contract eg GPwSI or receiving fees outside of care to GPwSI or receiving fees outside of care to registered practice population eg teaching , registered practice population eg teaching , medico-legal work , occ healthmedico-legal work , occ health

Must demonstrate fit for these roles- eg trainer Must demonstrate fit for these roles- eg trainer approval from deanery, review of appraisers approval from deanery, review of appraisers practice, statement from OOH providerpractice, statement from OOH provider

PDPsPDPs

Must be SMART, no max or min number Must be SMART, no max or min number of itemsof items

Must contain statement of development Must contain statement of development need, how this will be addressed, date by need, how this will be addressed, date by which it will be achieved, intended which it will be achieved, intended outcome , and review by appraiseroutcome , and review by appraiser

If not achieved , explanation as to why notIf not achieved , explanation as to why not Need to consider more than just clinical Need to consider more than just clinical

learning, eg leadership and managementlearning, eg leadership and management

CPD creditsCPD credits

250 in 5 year cycle required250 in 5 year cycle required In essence 1 credit = 1 hour if accompanied by In essence 1 credit = 1 hour if accompanied by

reflective record; a certificate alone is no creditreflective record; a certificate alone is no credit Claim 2 credits per hour if can demonstrate Claim 2 credits per hour if can demonstrate

impact eg leading to a change in practiceimpact eg leading to a change in practice Self allocated and approved by appraiserSelf allocated and approved by appraiser Should reflect broad range of activity over 5 yrs- Should reflect broad range of activity over 5 yrs-

ie not just diabetes courses for diabetes GPwSIie not just diabetes courses for diabetes GPwSI

Significant eventsSignificant events

Need to include description of event, who Need to include description of event, who was involved and who it was discussed was involved and who it was discussed withwith

What went well?What went well? What could have been done differently?What could have been done differently? Reflections in terms of knowledge, skills , Reflections in terms of knowledge, skills ,

safety, partnership and communicationsafety, partnership and communication Agreed changes ,and their effectAgreed changes ,and their effect

Significant events Significant events

Ideally discuss in team , but may be Ideally discuss in team , but may be difficult for locumsdifficult for locums

Encourage practitioner groups, locum Encourage practitioner groups, locum chamberschambers

Can do serial case review -10 consecutive Can do serial case review -10 consecutive cases , or 10 cases with a specific cases , or 10 cases with a specific conditioncondition

Audit Audit

At least one full cycle audit that you have At least one full cycle audit that you have taken part in ie not just the medical taken part in ie not just the medical student audit!student audit!

Audit is a systematic analysis of the quality Audit is a systematic analysis of the quality of careof care

Needs to be relevant to your practice, Needs to be relevant to your practice, amenable to change, and appropriately amenable to change, and appropriately actionedactioned

Audit Audit

Criterion – statement of best practice , Criterion – statement of best practice , preferably evidence basedpreferably evidence based

Standards set- how you think you will Standards set- how you think you will measure up to best practice , bearing in measure up to best practice , bearing in mind reality of GPmind reality of GP

Data collection 1Data collection 1 Compare to standards , discuss changes Compare to standards , discuss changes

neededneeded

Audit Audit

Changes put into actionChanges put into action Compare to standards and discuss Compare to standards and discuss

whether quality improvement resulted , whether quality improvement resulted , and if not why not – and repeat as and if not why not – and repeat as requiredrequired

Topics could include antibiotic prescribing, Topics could include antibiotic prescribing, use of investigations, prescribing, use of investigations, prescribing, hypertension management etc hypertension management etc

Audit Audit

Can submit a quality improvement project Can submit a quality improvement project eg reviewing use of care pathways in a eg reviewing use of care pathways in a particular group of patientsparticular group of patients

Action audit – reviewing care of cases of a Action audit – reviewing care of cases of a defined nature with a colleague , matching defined nature with a colleague , matching performance to preset criteria- my be performance to preset criteria- my be suitable for locums / OOH doctorssuitable for locums / OOH doctors

Commissioning Commissioning

New responsibility for GPs to be cost New responsibility for GPs to be cost aware and make efficient use of resourcesaware and make efficient use of resources

We are all involved in commissioning We are all involved in commissioning through referral and prescriptionthrough referral and prescription

Links to QIPP agenda and QOF ongoingLinks to QIPP agenda and QOF ongoing Suggestion that PDPs take local and Suggestion that PDPs take local and

national priorities into account ,as well as national priorities into account ,as well as personal needspersonal needs