Registered charity no 212808

Revalidation in Surgery

[name][Council Member] Royal College of

Surgeons of England

Registered charity no 212808

Background

Bristol and other events

Proposals on revalidation

Stalled by Shipman Inquiry criticism

2006 Chief Medical Officer’s report Good

Doctors Safer Patients

2007 White Paper Trust Assurance and Safety

Registered charity no 212808

But this time…

Revalidation would have two parts:

RelicensureAnd

Recertification

All doctors

Every 5 years

Mainly through appraisal

Must include a multi-source feedback exercise (360˚ feedback)

Only doctors on the specialist register (finished training, got their CCT – ALL consultants)

Every 5 years

Variety of evidence/ assessment methods

College Responsibility

GMC

Registered charity no 212808

Recertification

“Recertification, like relicensure, will be a positive affirmation of the doctor’s

entitlement to practise, not simply an absence of concerns.”

The purpose of recertification is therefore to:– further ensure patient safety;– encourage continuous professional

improvement; and– allow early warning of potential difficulties.

Registered charity no 212808

What we know

• Enhanced appraisal is the main mechanism for revalidation

• There will be a new “revalidation module” for appraisal

• Responsible Officers will make the recommendation of revalidation to the GMC

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Key Players

• GMC (responsible for the whole thing)• Colleges and Associations (setting

standards and supporting surgeons)• NHS (including the NHS Revalidation

Support Team)• Employers (SHAs, Trusts and other

employers)• Department of Health

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Timetable

• Early 2009: Pan-Specialty Project Board need to come up with the standards and evidence requirements

• 2008-2009: College need to set up implementation and support systems

• 2009-2010: Piloting• 2011 onwards: Implementation

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What’s happened so far

• Standards – finalising with specialties• E-portfolio – tested, developing for release• CPD –requirements set• Advice, support and remediation –options

being considered• Regional Structures –piloting in South

West and West Midlands – four new pilots from August 2009

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Standards framework

• Only standards dealing with:– Surgical practice; and/or– Consultant level generic practice.

• Addition to relicensure standards• Follows GMC model of standards• Surgical specialty specific standards being

added

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CPD requirements

• 250 points evenly spread across five years• 1 point/hour (but some points/activity

when difficult to measure)• Balanced across categories (clinical,

professional, managerial) and context (internal, external, personal)

• Dependent on practice and career aims

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Outcomes• Different evidence for different surgeons:

– National Audit– Hospital Episode Statistics (HES) or

similar– Local Audits– PROMs

• Specialty associations determine:– Best evidence– Best indicators (not always mortality!)

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Outcomes

• Outcomes will be one source of evidence for recertification – a tile in a mosaic

• Concerns about data especially HESBUT

• Impetus for change• Profession’s opportunity to tell the NHS

how to do it

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Outcomes – when concerns are raised

Problems with the data

Environment/Process/Team issues

Case mix

Individual

Problems with the data

Environment/Process/Team issues

Case mix

Individual

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What next?

• Specialty Associations adding specialty informed standards and evidence

• Waiting for Academy guidance on MSF• Colleges developing implementation plans• Colleges and associations to think about

support for surgeons• Knowledge testing – something for the

future

Registered charity no 212808

Implementation

• GMC consulting on models for the revalidation process

• All Colleges are discussing them with their Councils

• Discussions ongoing at Academy level• Trusts and SHA’s also feeding into debate

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GMC model for revalidation

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College proposal

• Local process to take into account local circumstances

• College to play key roles in:– Setting and maintaining standards– Quality assurance of process– Support for surgeons

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Our model for revalidation

Registered charity no 212808

•Specify what is required•Guidance•E-Portfolio to collect•Advice from Professional Affairs Board

•Standards for appraisal and appraisers•Education and training provision for appraisers •Representative from

Regional Professional Affairs Board to quality assure the work of this Panel

•National level involvement

•External QA – ?periodic visit

C&A

C&A

C&A

C&A

C&A

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Support• Three big areas for Colleges and Associations to

consider:– CPD (in the broadest sense)

• Providing courses and events• Sign posting• Guidelines and guidance and advice• Event and course accreditation

– Advice, support and remediation– E-portfolio

Registered charity no 212808

Key Contact

• Claire SteelRecertification Project Managercsteel@rcseng.ac.uk020 7869 6224