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
Registered charity no 212808
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
Registered charity no 212808
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
Registered charity no 212808
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
Registered charity no 212808
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
Registered charity no 212808
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
Registered charity no 212808
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
Registered charity no 212808
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 [email protected] 7869 6224