LMC Meeting: Update and Discussion

1. LMC Meeting: Update and Discussion The current situation, national and local. Revalidation and appraisal, fantasy and reality. The construction of GP revalidation and appraisal in Buckinghamshire. Marion Lynch Associate Dean for Revalidation Oxford Deanery and Appraisal Lead Buckinghamshire PCT

2. GP Revalidation: Choose a Lane

3. Hitchhikers' Guide to GP Revalidation Revalidation PRACTISE

4. Vote. Fantasy or Reality? Revalidation can strengthen the medical profession. It will support doctors, improve the service delivered by healthcare organisations, and reassure patients that doctors are up to date and fit to practise. Maurice Conlan. National Director of Revalidation Support Team (May 2009)

5. Fantasy and Reality • Hyperspace highway of governance and regulation. GP is one profession to be regulated. “There is no point acting all surprised about it. The plans and demolition orders have been on display at you local planning office in Alpha Centauri for 50 of your earth years, so you’ve had plenty of time to lodge formal complaints.”

6. The Reality: Professional Regulation for all is here.

7. Reality: Where are we now? Positives • PCT provides appraisal and Bucks appraisers are local GPs. • GMC research – well received. Contributing to national debate. • Interview with GMC publication people at 3.15 today! • Appraiser competences. Useful activity, RCGP conference poster. • Appraisee complaints are few and followed up. • Appraisers are interviewed, trained and assessed. • 5 new appraisers making 43. Challenges • 436 GPs on Performers List of which 103 are non principals. • Appraisal uptake is 81% (including 20 in following year). • Locum appraisal uptake 45% • This area does not collect Form Fours. • PDP quality is patchy. 85% submit PDP

8. Bucks GPs want to know about revalidation.

9. Reality or Fantasy?Will the role of appraisal change? “Revalidation will depend on the quality, consistency and nature of appraisal to ensure the confidence of patients and doctors” Professor Sir Graeme Catto Professor Sir Liam Donaldson Dame Carol Black Medical Revalidation Principles and Next Steps

10. The Big Picture What should be in place for Bucks PCT?

11. Improving Quality and Consistency 3 Components required: • Quality Assurance of Appraisal • Clinical Governance Systems (in SHA now) Information management, risk management (SEA), clinical audit, performance concerns, complains management , CPD service and workforce development • GMP module • Knowledge, skills and performance • Quality and safety • Communication and teamwork • Maintaining trust

12. Quality Assurance of Appraisal 2009

13. QA of Appraisal High Level Indicators 1 Organisational Ethos: Commitment 2 Appraiser Selection, Skills and Training: Skills are reviewed and developed. 3 Appraisal Discussion The appraisal is informed by a portfolio of verifiable supporting information that reflects the whole breadth of the doctor’s practice and informs objective evaluation of its quality. The discussion includes challenge, encourages reflection and generates a Personal Development Plan [PDP] for the year ahead. 4 Systems and Infrastructure The management of the appraisal system is effective and ensures that all doctors linked to the responsible organisation are appraised annually.

14. Appraisal. What is it For? Annual “Enhanced” appraisal will be central (appraisal content under discussion). Professional Development Maintenance needs Development needs Challenge and reflection Organisational & Service Development Revalidation GMP Module Portfolio of evidence PDP New skills, Competencies, technologies

15. GMP Module – How will it work? For this to function we need: • Good Portfolios (what is good?) • New Forms (electronic with evidence of learning and easy to use) • Judgements (from appraisers but on what?) • Effective Appraisers and systems.

16. Good Medical Practice

17. Your Thoughts.Portfolio of evidence for annual appraisal and a portfolio of evidence for revalidation. Strands of the revalidation process that may be handled in appraisal. Decisions not yet made> For Discussion inappraisal? A) MSF (from colleagues and pts) results or reflection? B) Checking CPD (COLLEGE CREDITS) Decide or debate? C) Verifying that evidence is sufficient. Yes/no/ consequences of both. D) Reviewing Drs progress towards revalidation. Is there room? If not where and when and by whom?

18. Revalidation Portfolio Personal Appraisals Royal College Specialist Skills & Knowledge Activity Audits & Reflection My Roles My CPD 5 annual Appraisals Complaints Performance Concerns Significant Events Clinical Audit/Data MSF Organisational

19. TOTAL

20. How Much Evidence is Enough? 42 pieces(plus a few alls). It would have been easier to know the ultimate question. A computer knows the question and it shall be called…...

21. NHS REVALIDATION TOOLKIT

22. https://demo.nhsrevalidationtoolkit.org/

23. Electronic Age: Will IT capture what it is to be a good GP? • The Ten Commandments God: Im No. 1. No pix, plz. Uzmy name nicely. Day7=holy. Take care of mum’n’dad. Don’t kill, scrUround, steal or lie. Keep yr hands (&eyz) off wotisntyrs. http://www.ship-of-fools.com/Features/frameit.htm?0802/txt_comp3.html

24. Does that Cover Being a GP? • What about…………………… To cure sometimes, to relieve often to comfort always? It is more important to know what patient has the disease than what disease the patient has. (Peabody 1927) Total (Professional) Perspective Vortex

25. Answers: Judgements by the Appraiser • Portfolio is complete • Allocation against attributes of GMP and coverage is reasonable • Information demonstrates the doctor meets the standards defined by the GMC and Royal College • PDP addresses development needs of the doctor • PDP covers weaknesses and gaps in the accumulating revalidation portfolio • No new serious performance or conduct concerns have arisen

26. PCT and Responsible Officer(Draft Answer) May 09 Publication of consultation response Jun 09 Publish draft Regulations, Guidance and agreed timetable Oct 09 Revision of Regulations and Guidance Feb 10 Regulations to Parliament Apr 10 Regulations come into force, begin recruitment Oct 10 RO’s in place

27. Answer: CPD Learning Credits • Challenge and impact • New type of learning that emphasizes: • 􀂄creating • 􀂄applying • 􀂄analyzing • 􀂄synthesizing knowledge • 􀂄engaging in collaborative learning throughout the lifespan 50 each 5 years. Method TBC • Bucks and Berks work together. Maybe trail this with the refresher course by developing resources to move from attendance records to patient impact measures.

28. Questions from you • Are GPs able to produce evidence easily? NO. What else is needed to make it easy? E.g. GP Refresher Course, patient impact statements on attendance certificates • Are the examples of credits self-accredited justifiable? Evidence is pointing to yes, we can try it too. • Are appraisers easily able to verify an individual’s credits in terms of challenge or impact? RST suggest that this should be outside of appraisal? • What if an appraiser disagrees with the doctor? Appraiser opinion counts • Are appraisers comfortable with this system? NOT REALLY • Are GPs comfortable with this system? Yes No NOT REALLY • Are we seeing diversity of subject? QA • Are we seeing diversity of method? QA • Is this an appropriate system for all GPs (sessional, OOH, overseas)? QA and local support. Resource for locums being developed. • Are there further training issues for GPs or appraisers? Yes • What are the local resource issues of the system? Huge and requested

29. Questions from me. Next Steps. • All GPs will need to undertake appraisal in order to revalidate. How do we reach the 18% significant minority who are not engaged? • What about those who are not taking part? • What information / support needs to be made available to the majority? • Appraisal: In house or out sourced? • Choice of appraiser or allocation of appraiser? • Volunteer for revalidation as an area or wait to be pushed? • What about the stuff of General Practice that cannot be measured this way?

30. More answers than questions on local website Coming soon locum site

31. More questions than answers on national one https://demo.nhsrevalidationtoolkit.org/ (You need to register) http://www.bucksmec.co.uk/documents/Revalidation_Report_472.pdf http://www.bucksmec.co.uk/documents/Principals_of_GP_Appraisal_415.pdf • BUCKS NEWS • PLT End of Life strategy, improving care in primary care14th July • Refresher Course to potentially include IT FAYRE. Tbc. • Programme of education. Pilot with Pain Management and AF • GP Refresher Course: to continue with support for CPD credits, e.g. audit support. • Appraisers review: New contract for new role and more training. • Form Fours to be submitted, typed only, locums are paid £150, more people to use IT! • Allocation of appraisals in quarter of year to prevent spill into next financial year.