Preparing for revalidation:evidence is the key

Dr Cliona Ni Bhrolchain

What is the GMC?13. The GMC is the independent regulator for doctors in the UK. Our

purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine

a. By controlling entry to and maintaining the list of registered and licensed medical Practitioners

b. By setting the educational standards for medical school

c. By determining the principles and values that underpin Good Medical Practice

d. By taking firm but fair action against doctors’ registration where the standards of Good Medical Practice have not been met

What is revalidation?

14. The purpose of revalidation is to assure patients and the public, employers and other healthcare professionals that licensed doctors are up to date and are practising to the appropriate professional standards.

Although it is widely understood that the delivery of medical care to patients will always involve an element of risk, revalidation will help doctors, employers and the GMC to provide further assurance to patients and the public that doctors working in the UK are fit to practise.

What standard is required?

What will happen?

5-year cycle Based on annual appraisal Performance against

professional standards from GMC and Royal College

Clinical governance information Paper based exercise for majority Decision by Trust’s Responsible Officer

Producing the evidence

Too many standards for individual evidence! Reduced to 4 domains:

Knowledge, skills and performance Safety and quality Communication, partnership and teamwork Maintaining trust

Each domain has attributes

Collating the evidence

Portfolio for appraisal

Electronic appraisal/revalidation pilots

MUST START NOW!!

What do I collect?

To what standard?

Independent evidence where possible

Triangulation important, avoid multiple use

Enough evidence to make a judgement

Much more reflective practice

Standard of evidence

Mapped to domains and attributes

Self assessment of evidence and practice

Appraiser assessment of evidence and practice

All domains/attributes covered over 5 years

What tools do I have…? (Very similar to trainee requirements) Patient feedback) 1 per 5 yrs + Colleague feedback (MSF/360)) before

Y3

Personal Development Plan every yr CPD record incl reflective notes* every yr Significant events) 2 per yr Case reviews) Audit data 1 per yr* Now includes electronic recording and GMP domains

And……

Complaints (all) every yr Teamwork e.g. peer review meetings, audit

meetings Performance data every yr Job plan every yr Probity (self declaration) every yr Health (self declaration) every yr Teaching

What do I need to do?

Continue with usual appraisal, but make sure evidence is more robust

Are you registered somewhere for CPD? If not, are you collecting evidence?

Worked example:case review Learning point from clinical practice

Identified learning need (DEN)

How I will meet that learning need

Microsoft Word Document

Aide memoire

Knowledge, skills and performance Maintain your professional

performance Apply knowledge and

experience to practice Keep clear, accurate and

legible records Safety and quality

Put into effect systems to protect patients and improve care

Respond to risks to safety Protect patients and colleagues

from any risk posed by your health

Communication, partnership and teamwork Communicate effectively Work constructively with

colleagues and delegate effectively

Establish and maintain partnerships with patients

Maintaining trust Show respect for patients Treat patients and colleagues

fairly and without discrimination Act with honesty and integrity

Aide memoire

Knowledge, skills and performance Maintain your professional

performance Apply knowledge and

experience to practice √ Keep clear, accurate and

legible records Safety and quality

Put into effect systems to protect patients and improve care

Respond to risks to safety Protect patients and colleagues

from any risk posed by your health

Communication, partnership and teamwork Communicate effectively Work constructively with

colleagues and delegate effectively

Establish and maintain partnerships with patients

Maintaining trust Show respect for patients Treat patients and colleagues

fairly and without discrimination Act with honesty and integrity

Aide memoire

Knowledge, skills and performance Maintain your professional

performance Apply knowledge and

experience to practice √ Keep clear, accurate and

legible records Safety and quality

Put into effect systems to protect patients and improve care

Respond to risks to safety Protect patients and colleagues

from any risk posed by your health

Communication, partnership and teamwork Communicate effectively Work constructively with

colleagues and delegate effectively √

Establish and maintain partnerships with patients

Maintaining trust Show respect for patients Treat patients and colleagues

fairly and without discrimination Act with honesty and integrity

Colleague and patient feedback Trusts will have to set up systems GMC will define standards but not stipulate

providers RCPCH piloted tool with peer comparison WUTH using commercial company Patients

Usually recommend minimum of 20 or so for analysis

Will child feedback be addressed?

Worked example:patient feedback Participated in RCPCH pilot 1st patient feedback since 2003

Different attributes Peer comparison

Reflection on results

Adobe Acrobat DocumentAdobe Acrobat

Document

Aide memoire

Knowledge, skills and performance Maintain your professional

performance Apply knowledge and

experience to practice Keep clear, accurate and

legible records Safety and quality

Put into effect systems to protect patients and improve care

Respond to risks to safety Protect patients and colleagues

from any risk posed by your health

Communication, partnership and teamwork Communicate effectively Work constructively with

colleagues and delegate effectively

Establish and maintain partnerships with patients

Maintaining trust Show respect for patients Treat patients and colleagues

fairly and without discrimination Act with honesty and integrity

Aide memoire

Knowledge, skills and performance Maintain your professional

performance Apply knowledge and

experience to practice Keep clear, accurate and

legible records Safety and quality

Put into effect systems to protect patients and improve care

Respond to risks to safety Protect patients and colleagues

from any risk posed by your health

Communication, partnership and teamwork Communicate effectively Work constructively with

colleagues and delegate effectively

Establish and maintain partnerships with patients √

Maintaining trust Show respect for patients Treat patients and colleagues

fairly and without discrimination Act with honesty and integrity

Aide memoire

Knowledge, skills and performance Maintain your professional

performance Apply knowledge and

experience to practice Keep clear, accurate and

legible records Safety and quality

Put into effect systems to protect patients and improve care

Respond to risks to safety Protect patients and colleagues

from any risk posed by your health

Communication, partnership and teamwork Communicate effectively Work constructively with

colleagues and delegate effectively

Establish and maintain partnerships with patients √

Maintaining trust Show respect for patients √ Treat patients and colleagues

fairly and without discrimination Act with honesty and integrity

Aide memoire

Knowledge, skills and performance Maintain your professional

performance √ Apply knowledge and

experience to practice Keep clear, accurate and

legible records Safety and quality

Put into effect systems to protect patients and improve care

Respond to risks to safety Protect patients and colleagues

from any risk posed by your health

Communication, partnership and teamwork Communicate effectively Work constructively with

colleagues and delegate effectively

Establish and maintain partnerships with patients √

Maintaining trust Show respect for patients √ Treat patients and colleagues

fairly and without discrimination Act with honesty and integrity

Colleague multisource feedback (MSF/360)

Provides the opportunity for non-medical co-workers medical colleagues (including trainees and

juniors) to reflect on the professional skills and

behaviour of a doctor

Colleague multisource feedback (MSF/360)Suggestions for community paediatricians Require 1 per 5 year cycle, 1st before Y3

If working in isolated situation might wish to consider doing more

Usually recommend minimum of 11 or so replies for analysis

Questionnaires need to comply with guidance issued by GMC

Adobe Acrobat Document

Who should I ask?Suggestions for community paediatricians

Clinical colleagues Medical

Consultant colleagues SAS/trainees CD/lead clinician

Nursing Therapists

Non-clinical A&C staff Secretary Head teachers/SENCOs Ed Psych Social care

If statutory role Senior managers in

CYPD, HPA, PCT

Worked example:teaching/training Devised a ‘return to work’ programme for UK-

trained comm paed returning to UK practice after 10-yr break

Evidence Anonymised copy of programme Comments from NCAS on programme

Aide memoire

Knowledge, skills and performance Maintain your professional

performance Apply knowledge and

experience to practice Keep clear, accurate and

legible records Safety and quality

Put into effect systems to protect patients and improve care √

Respond to risks to safety Protect patients and colleagues

from any risk posed by your health

Communication, partnership and teamwork Communicate effectively Work constructively with

colleagues and delegate effectively √

Establish and maintain partnerships with patients

Maintaining trust Show respect for patients Treat patients and colleagues

fairly and without discrimination Act with honesty and integrity

Other possibilities for teaching/training GMC/PMETB annual trainee survey

Dept results Deanery quality assurance Feedback forms from teaching/training

activity Example of a presentation, e-learning

material prepared

Worked example:performance Very little official performance data Clinic numbers compared with hospital peers

so hard to interpret MDTs, CP etc not counted electronically Evidence

Use diary to collect information on MDTs

Microsoft Excel Worksheet

Microsoft Word Document

Or another strategy…

Move to Derby where Fawzia Rahman will do it all for you!!

Aide memoire

Knowledge, skills and performance Maintain your professional

performance √ Apply knowledge and

experience to practice √ Keep clear, accurate and

legible records Safety and quality

Put into effect systems to protect patients and improve care √

Respond to risks to safety Protect patients and colleagues

from any risk posed by your health

Communication, partnership and teamwork Communicate effectively Work constructively with

colleagues and delegate effectively

Establish and maintain partnerships with patients

Maintaining trust Show respect for patients Treat patients and colleagues

fairly and without discrimination Act with honesty and integrity √

Worked example: record keeping GMC standard

3(f) Keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given to patients, and any drugs prescribed or other investigation or treatment

3(g) Make records at the same time as the events you are recording or as soon as possible afterwards

51 When you refer a patient, you should provide all relevant information about the patient, including their medical history and current condition

What evidence might be available?

Medical record audits CP peer review SEN(M) reports compliance with code of practice Anonymised letters to patients/colleagues Colleague MSF Any comments received from colleagues on

quality of records/letters SAIL instrument Copying letters to patients (NHS standard)

Summary

We will need a more structured approach to collecting evidence but…..

Most of it is already there and can be collected as we go along