Wales: building on success

Wales: building on success Art House 3rd December 2008

Contacts • Malcolm Lewis, GP Director • Katie Laugharne, Organisational Lead • Chris Price, Lead Associate Dean CPD & Appraisal chris@pustule.demon.co.uk

The database is set up to manage the entire appraisal process electronically It is accessed with multiple “level” of log in Administrator functions allow office staff to manipulate data without access to confidential files The data allows the PCO to see who has and who has not had an appraisal Regular reconciliation against the MPL ensures full coverage Multiple statistics are collected easily All doctors with a “primary” MPL in Wales are offered appraisal Doctors that do not undergo appraisal are handled by the PCO and in general are removed from the MPL Mechanisms are in place for temporary suspension (e.g. illness, maternity or performance) How to use the Wales appraisal database

Doctors request registration Administration checks against MPL and GMC IF OK emailed a username and password (changeable) and are allocated a quarter in which their appraisal should take place each year They are now in an annual cycle of appraisal Appraisers are appointed and trained The appraiser is activated (one click) The appraiser chooses the geographical areas they are willing to cover (a choice of 22 areas and they can choose any number) The appraiser also completes a sentence about themselves – e.g. I prefer to appraise on Wednesday afternoon How to use the Wales appraisal database

The doctor is required to complete Forms 1 and 2 (personal and professional details and scope of work) and verify them annually The doctor collects CPD “evidence” this can be presented on line (our preferred method) or in a folder or a combination of the above The doctor chooses 3 appraisers from a list of appraisers that cover the area The request is sent electronically Reply is either by email or by phone call Appraisal occurs Appraiser has declared themselves “open for the area” (they cover the area and they have appraisal time available) Doctor has requested them They can accept or refuse the request (full, know them too well, other reasons) If rejected request goes to next appraiser on doctor’s list If accepted appraisal occurs How to use the Wales appraisal database

Appraisal has occurred Within 2 weeks doctor receives email (from database) saying the form 4 (record of appraisal) and PDP are ready for reviewing Doctor logs in and accesses form 4 Doctor agrees with the form 4 and PDP – one click – accepts appraisal finished and recorded Doctor disagrees – email or telephone dialogue – satisfactory outcome one click finished Unsatisfactory – doctor does not agree – appraisal coordinator mediates Appraisal has occurred Within 2 weeks appraiser writes up form 4 and the PDP One click alerts doctor it is ready for review Doctor agrees form 4 and PDP – appraisal process finished – appraisal is recorded as one performed by this appraiser Doctor disagrees – negotiation and if appropriate only the appraiser can edit Process otherwise as to the left How to use the Wales appraisal database

So you would like to try it out We have two dummy accounts Doctor1 Appraiser1 Password for both is available from chris@pustule.demon.co.uk Obviously doctor1 is a “doctor” appraiser1 is both a “doctor” and an appraiser You can enter data in the accounts without interfering with our system Go to http://gp.cardiff.ac.uk Click login Enter username doctor1 and password and click login You will now have the option of appraisal database or CPD – click the former You will now see form 1with data already in How to use the Wales appraisal database

Click here and here to enter data (this is compulsory each year before the user is allowed to choose an appraiser) Please see next slide before clicking here

The lower area contains data that we would rather you didn't change. You can see the functions of each button and use your back arrow on your browser to avoid changing data. Try LHB (PCO), allocated quarter and appraiser – each takes you to an email page which will send an email to office staff who can change as appropriate The practice button takes you to a change practice field – please see next slide

Currently Mickey is a practice unspecified “freelance” GP. If he joins a practice he can allocate himself to that practice – lets say he joins Cwmbran Village Surgery – we can search on a partial address or postcode – the search on the next slide will be on CWM

“Cwm” is valley in Welsh and so there are a few place names around – we could have narrowed the search by using Cwmbran or the postcode. By not allowing free text entry of practice address we avoid multiple practices e.g. “the high street surgery” and “the surgery high street”. We choose Cwmbran village and the next screen is shown on the next slide

Mickey is now in the practice Please use your back button to get to form 1 again

You get to form 2 from form 1 by clicking the link at the top left of the form 1 box. Once here you see the four divisions of form 2 Each of these divisions needs to be updated or verified annually before the system allows the doctor to choose an appraiser Please click edit on “responsibilities and activities within the practice” (next slide)

Please feel free to explore the hierarchy and add or remove responsibilities from Mickey's record . The free text box allows further clarification as appropriate. Forms 1 and 2 completed annually is the minimum on line information a doctor needs to provide to obtain an appraisal in Wales. This puts the appraisal year in the context of the doctor’s working environment that year. The demographic data collected is extremely specific and represents what a doctor actually considers (s)he does. Please try out the other three areas of form 2

Select form 3 from the button on the top left of the form 2 box. This is a “new” form 3 reflecting the GMC’s domains for appraisal and assessment. Please explore the four domains first – click on domain 1

Ignore the living PDP for now The events in this domain are listed in 2 formats – one is our old form 3 format and the other is the new – feel free to look at them. There are two opportunities to add new information – personal and practice – please try them out – the reason for the practice information section is at the top of the entry page – you may save events here without messing up the system. Try out the other 3 domains – then next slide

From form 3 click on insights and reflections – this page is fairly self explanatory . Try out the constraints – we report constraints to the LHB annually

From form 3 click on living PDP You may notice that the living PDP is also displayed under each domain but only including items from that domain. You may add and change items in the additional and aspirational section – the agreed section is completed by the appraiser and is fixed The next slide explains the living PDP

The living PDP • It is clear that the agreement of a PDP and the delivery on that PDP will be an integral part of revalidation • PDPs need to be SMART (Specific Measurable Achievable Relevant Time-bound link) • A complete system will recognise the learning needs and seek to deliver on them • The Wales system ensures a SMART PDP and furthermore seeks to offer delivery

A & R – in discussion with appraiser M T S

Forcing the “S” in SMART • A learning needs hierarchy has been developed using over 7000 records from the first 4 years of appraisal in Wales – taken from the PDP • Most needs were specific – however there were some records with nebulous comments (10% or so) e.g.:- • Addressing Educational needs • Career development/ progression • Consulting room - redecorating • Continuing Medical Education • Distance learning • Grade 7 guitar exam

Forcing the “S” in SMART • The outcome for the deanery is identifying specific needs • Leading to specific delivery • The benefit for the individual is:- “I do my appraisal – collect all the information and then at the end I am supposed to plan my education for the next 12 months – the next day I am handed the practice’s diabetic clinic and I need to learn how to initiate patients on insulin.” • This is a huge learning need and negates all the other issues in the current PDP • Two choices – don't put into PDP – wait a year to add

Forcing the “S” in SMART • Solution • Living PDP • PDP not fixed at appraisal but fluid • This doctor adds to his “additional PDP” • This doctor also aspires (in the aspirational section) to the diploma in diabetes • The living PDP adapts to planned learning throughout the year (and beyond) • The living PDP creates discussion at appraisal for the “agreed” PDP for the next year

Try adding a row to the additional PDP as if you were that doctor needing to learn about diabetes quite quickly – use the hierarchy to be as specific as you can – you may also wish to add a non clinical learning need

In between appraisals • On the menu to the left of your screen you can obtain your previous appraisals (including your PDP) • This should (but does not for Mickey) display previous form 4s with your learning needs (remember the hierarchy – let’s choose diabetes general update) • So a complete system should deliver on that need – click “home” on the menu on the left then choose “CPD” and “find resources”

This is the resource locator and the hierarchy maps to that in the PDP – our CPD coordinators add meetings, books, PowerPoint presentations and online resources with a brief description and whether they are free, subscription or pay for use. The locator is openly available on the WWW at http://gp.cardiff.ac.uk/index.php clicking on CPD. Lets go back to our example of the general diabetic update

This is the result from typing diabetes and hitting the find resources button – as you can see there is a selection of resources as well as further categories listed below – you can also search via the “tree” When you link it opens the description – see next slide

Then the link opens a new page – next slide

Helping doctors in Wales with their development • On line system – 6 years • Quality managed – assured and controlled • Central, regional, local and individual information – held electronically • Completing the loop to delivery of CPD needs • Deanery run with PCO responsibility – partnership and co-operation

The appraisers view • Login as appraiser1 (same password as doctor1) • Click on appraisal database • Find form 4 on the left column and click

From here change the URL from “form4” to “form5” then click select doctor

Page should look like this and this If it does click on select appraisal interview

Play with this but please do not press mark form 4 as complete This is an appraisers view (note this screen shot uses the old form 3 GMP categories)

The future • The Wales deanery are rebuilding the site from scratch • It will be available in April 2009 as a modular system for individual PCOs at cost • There are innumerable improvements – including solutions for:- • Sessional GPs • Out of hours • Revalidation “scoring” system • Training and CPD • Appraiser monitoring, feedback and training • 360’ feedback

Further details • Please contact • Chris Price – associate dean Cardiff University • chris@pustule.demon.co.uk

Wales: building on success