An Update on Revalidation:A FDSRCS Perspective

Karl BishopConsultant in Restorative Dentistry

GMC March 2010

What is Medical Revalidation?

Revalidation

RCS Role

1. QAs process

2. Contributes to setting standards

3. Supports clinicians

• Independent practitioners will need to link with an LRO and appraisal process

• For small specialties LRO may be from designated organisations e.g. RC Faculties – Occ Med

• CCST curricular and ARCP for trainees will need to ensure it is consistent with revalidation

• Patient questionnaires and MSF an integral part of process and must be accredited by GMC

• These components may not have to be implemented annually

• Pathway pilots being instigated by DoH – recognising that all components e.g. appraisal may not be equally mature in all areas

Development Role of RCS (Eng)• Standards setting: The College and specialty associations have developed

standards and requirements for supporting information.

• Proposing a system: The College has listened to the proposals for systems being discussed and has developed its own position which has been recommended to the GMC.

• External scrutiny: The College needs to check the system is working, that it is fair and that it is upholding surgical standards. A rigorous system is being developed.

• The College has/will:– Put the standards out to consultation– Pilot the standards and review them as required.– Critique proposals emerging from the GMC and Department of Health.– Tell the GMC and other decision makers how revalidation should take place

for surgeons.

What are the GDC Doing ?

What are the GDC Doing ? - RWG• Revalidation WG re-established early 2010 from GDC

members• The election process was completed on 11 January

2010:– Denis Toppin (Chair) (GDP)– Alan MacDonald (Lay member – solicitor)– David Smith (Dental Techncian)– Carol Varlaam (Lay member -Trustee on the St. George’s Hospital Charity)

• Will co-opt• First meeting was the 2nd Feb 2010 and work to start

on specialist RV 2010

S1 Pilots

• Looked at feasibility of S1– ~ 300 dentists– Ability to collect current proposed evidence

• Denplan• Scotland• S. Yorkshire

• Reported to GDC in December 2009

What are the GDC Doing ? - S1 PilotsInitial feedback suggests dentists

– happy with concept of revalidation– want clear and unambiguous guidelines of what is

required and when

– feel patient feedback has little value• GDC feels that has value providing its not related to clinical

competence - communication, management etc

– ‘Practice vs Personal’ evidenceclarification on the management and leadership domain since participants thought that this was only relevant to those managing a practice.

• ? Good practice hides poor practitioner and vice versa

What are the GDC Doing ? – Public View

• Assessment of public view (Ipsos MORI) reported to GDC Dec 2009

– highlighted the expectation that the process should not simply be a self – declarationWork should be checked !

– this may mean changing the balance of Stage 1 so that there is an actual judgement of the quality of particular pieces of evidence .

As a result Stages 1 and 2 may become more unified.

What are the GDC Doing ? – Other Bodies

• Engaged with existing ‘inspection’ groups to ensure consistent with standards required for revalidation:– DRO services– HIW– CQC

Timeline for 2010

• Develop and implement feasibility study for Stages 2 & 3 early 2010

• Formal consultation mid 2010

• Economic evaluation of proposed revalidation system

Timeline for 2010

• Development of a revalidation audit tool -dependent on clarification of the requirements for stage 1.

• Develop revalidation baseline measurement – early 2010;

Timeline for 2010

• Development of the E-portfolio requirements for stage 1, this can only begin when there is more clarity around stage 1.

• Start working with stakeholders to ‘map and gap’ early 2010– Who’s doing what at present– Keen to see groups working together

• Begin work on development of a quality assurance system for third party providers – late 2010.

Implementation

• Role out as new 5 year CPD cycle commencing 2011-2012

• Likely to be 5 year cycle since this can probably be managed simply with minor modifications to current ‘CPD’ legislation

• 5 year cycle likely to allow ‘breaks’ e.g maternity leave – longer breaks ? summative assessment

• Evidence needs to be throughout 5 years

What are we doing ?

What should/could we be doing ?

What are we doing ?• Initiated regular informal contacts with GDC

– what are the GDC’s intentions (‘tickbox’ ?)– GDC have expertise for specialists ?

– encouraging cooption onto RWG– meet with new chair of RWG

• On agenda of next Senate of Dental Specialties Meeting– Colleges– Specialty Associations

What are we doing ?• MyCPD established

What are we doing ?

• MyCPD established• Set up E-portfolio working group

– Discussions with RCS on their E-portfolio(filing cabinet)

• Decide role– Support – Delivery

• For who ?

What should/could we be doing ?

Currently GDC open to suggestions – particularly S2 and S3

Future Role of FDS ?• Defining the relevant specialty standards.• Develop/validate specialty tools for the evaluation of

dentists practice.• Describing the types of supporting information that

will be needed to provide to meet the relevant specialty standards.

• Providing specialty guidance for appraisees, appraisers for those in HDS (and LROs) & QA process

• Provide appraisal process and report to GDC• Work with FGDP and Deaneries for

non-specialists/non HDS dentists

Support ?• Develop and agree standards• GDC state that only 1 standard for revalidation

• GDC looking whether BDS is adequate or whether pre-Reg necessary

• BDS ?• Pre- registration (MJDF/ORE?) ?• MRD (specialists) ?• ICSFE (consultants) ?• Application of ‘Standards for Dental Professionals’ to

registrants actual practise

Adobe Acrobat Document

Support ?

• Develop and agree standards• Develop portfolio components e.g.

– Standardised audits/tools/guidelines– MSF/Pt questionnaires– CPD

• Provide courses and events• Sign posting• Event and course accreditation

• Develop/Identify E-Portfolio• filing cabinet or• interactive e.g. Cf current online appraisal tools

Support ?

• Advice/support/mentoring particularly S2

• Expand role to include non specialists/trainees

• Remediation (with Deaneries/professional societies)

Local Support ?

- Develop and QA existing NHS Appraisal System for HDS

- Expand to non HDS members/specialists/DwSis/GDS

- Use existing FDS/Deanery local structures- New local support structure for surgeons e.g.

Professional Affairs Boards- Each board comprises of a college appointed DPA and nine specialty

association appointed RSPAs- Currently seven in place- Plans for five more in 2010

College Role

1. QAs process

2. Contributes to setting standards

3. Supports clinicians

Supporting Role of FDS ?

GDC

h

• GDC• Faculties• CQC/HIW

Delivery Role for FDS (HDS)

GDC

• GDC• Faculties• CQC/HIW

FDS Role

FDS

h

GDC

• GDC• Faculties• CQC/HIW

FDS Role

FDS

Delivery Role for FDS (HDS)

• For who ?– Specialists

• HDS – modify medical model based on appraisal• Independent/private practice

– Non-specialists• HDS• Independent/private practice• NHS GDP

What should/could we be doing ?

GDC

• GDC• Faculties• CQC/HIW

FDS Role

FDS

Delivery Role for FDS (HDS & PC Specialists)

GDC

• GDC• Faculties• CQC/HIW

FDS Role

FDS

Deans/FGDP

Delivery Role for RCs/Deaneries

(All Professionals)

BUT WE ARE NOT ALONE !

• HDS – NHS/modified appraisal system

• Independent/private practice (non specialist)– HIW/CQC probably responsible for private practice statutory

inspection– 3rd parties – Denplan, BDA– Standards

• Specialist Societies ?• Faculty of Dental Surgery/FGDP• Other 3rd parties ?

• NHS GDP– NHS inspection frameworks– 3rd parties – Denplan, BDA– Standards

• FGDP/Faculty of Dental Surgery ?• Other 3rd parties ?

Non Specialists

Thank-you

How serious are the GDC ?How serious are the RCs?