revalidation for general practitioners n.
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  2. Much of the detail may still change.

  3. Why now? • Autumn 2009: all GPs need licence to practice • All registered doctors will entitled to a licence • Licence to practice to be introduced before 5 yearly renewal (Revalidation)

  4. Autumn 2009 • Some doctors may choose to maintain registration only • 240K registered (150K active) • Only licensed doctors will be subject to Revalidation

  5. The Purpose of Revalidation • To ensure that doctors are up to date and fit to practice • Improve and demonstrate the quality of care that all GPs provide to patients. • Identify GPs for whom there are concerns about their fitness to practice

  6. Revalidation is the name for the whole process One set of processes with two outcomes • Relicensure • Recertification

  7. Relicensure • To demonstrate that licensed doctors continue to practice in line with the generic standards set out by the General Medical Council.

  8. Recertification • To confirm that GPs on the GP register continue to meet standards that apply to the discipline.

  9. Government and GMC have yet to publish their timescales for relicensure and recertification

  10. RCGP is putting steps in place to ensure that GPs have as much information and lead-in time as possible to familiarise themselves and fully prepare for the process. 

  11. ENHANCED APPRAISAL • Annual appraisal will be central • But it will be ‘enhanced’ appraisal. • The future nature and content of appraisal remains under discussion. • RCGP proposes and GMC approves(standards required and the methods used)

  12. SUBMISSION OF EVIDENCE • Every year: a portfolio of evidence for annual appraisal • Every five years: a portfolio of evidence for revalidation. • Electronic portfolio hoped for

  13. Evidence Standardisation (Consistency) • Common requirements for evidence • Regardless of PCT and appraiser you will be assessed on a consistent basis.

  14. Using “Good Medical Practice” • GMP is being modernised to define the qualities required of a good GP • New GMP will guide the range of annual and 5 yearly evidence • 4 domains (currently 7) become 12 generic standards from which criteria are developed • Translation questionable

  15. Four Future Domains • Knowledge, skills and performance • Quality and safety • Communication and teamwork • Maintaining trust

  16. The RCGP are proposing that every 5 years, every GP, in whatever environment, should be able to provide:

  17. RCGP CPD Scheme“Impact and Challenge Model” Developed by the RCGP

  18. Learning Credit System • Self-accreditation of learning credits • Minimum of 250 over the 5 year revalidation cycle • Credit value based on the effort required (challenge) and impact on patient care(not time based) • Credits are self-attributed and verified at appraisal.

  19. Why Impact and Challenge? • Encompass the value of the learning • Not simply the time spent in CPD • Table combining Impact and Challenge

  20. Impact? • Impact on patients • Impact on the individual • Impact on service • Positive weighting of impact compared to challenge

  21. Challenge? Challenge is context related • Related to effort expended • Related to circumstances • Related to personal ability

  22. Un-answered questions about appraisal (pilots) • Is this definition of a credit acceptable? • Is the system easy to understand and use? • Are GPs able to produce evidence easily? • Are the examples of credits self-accredited justifiable? • Are appraisers easily able to verify an individual’s credits in terms of challenge or impact? • What if an appraiser disagrees with the doctor? • Are appraisers comfortable with this system? • Are GPs comfortable with this system? • Are we seeing diversity of subject? • Are we seeing diversity of method? • Is this an appropriate system for all GPs (sessional, OOH, overseas)? • Are there further training issues for GPs or appraisers? • What are the local resource issues of the system?

  23. Pass or Fail: Who Judges?

  24. Role of the GP appraiser Judges • Quality of a PDP • Adequacy of a CPD folder • Whether PDP of previous year’s appraisal has been completed • Whether and how learning needs have been identified / prioritised • Credits scoring And • Guides future learning needs • Suggests upskilling or remedial action where required

  25. Traffic Lighting of appraisals • Green, Amber and Red. • This could make the retention of the formative aspect of appraisal even more difficult.

  26. THE RESPONSIBLE OFFICER • Responsible Officer (RO) in every NHS Trust • Final say on the revalidation of doctors. • Every doctor will have one RO only

  27. Evidence Assessment • Four tiers • RO • Local Group (RO, RCGP and Lay assessor) • National RCGP • GMC

  28. Uncertainties • Possibly 2% (?underestimate) of doctors under raised scrutiny. • Need for increased resources for both investigatory work and remedial training. • Much of the detail may still change. • UK Revalidation Programme Board (first meeting was held on 10.2.09)

  29. Possible Curriculum and Optional Exam • The RCGP will provide a six monthly Essential Knowledge Update of new and changing knowledge that every UK GP should have assimilated • The linked Essential Knowledge Challenge will be a voluntary assessment for the GP to provide evidence of keeping up to date

  30. The End