REVALIDATIONREVALIDATION“Just what you’ve been waiting “Just what you’ve been waiting

for”for” What is revalidation Why the wait 12 years of waiting- what now Latest time table Prof Hugo Mascie-Taylor report Revalidation pathway Good medical Practice Framework Check list for appraisal & revalidation Issues to be resolved What should I do now

Bristol Scandal1991 to 1995 significant mortality than other

centres in England

Alder Hey inquiry and the Donaldson report recommendations

The Alder Hey inquiry report says Professor Dick van Velsen, the doctor at the heart of the Alder Hey scandal, is to be referred to the General Medical Council (GMC), the doctor's regulatory body. He should never be allowed to practice in the NHS again.

Dr Howard Martin Shipman

Shipman murdered at least 215 victims by giving lethal morphine

injections during a killing spree lasting from 1975 to 1998.

Recommendations Shipman Inquiry

Five-yearly checks - known as medical revalidation

More GMC members to be lay people GMC to be directly accountable to parliament.

Patients to be told when their doctors have been disciplined. It is now possible to see if a doctor has been suspended or investigated on the GMC website.

Disciplinary and criminal records of doctors to be held centrally and shared with staff in healthcare organisations. The government has yet to decide how this information would be disseminated.

Closer scrutiny of doctors with a history of drug misuse. new fitness to practise procedures have been in place since 2004.

Checks for abnormally high death rates at GP practices. this has been implemented.

Whistleblower helpline to advise NHS staff and public on making complaints. this has been implemented

What is Revalidation?What is Revalidation?

““A single process by which all A single process by which all doctors with a licence to practice in doctors with a licence to practice in the UK will need to satisfy the GMC the UK will need to satisfy the GMC of their continued fitness to practice of their continued fitness to practice …and for specialist doctors, to …and for specialist doctors, to demonstrate that they meet the demonstrate that they meet the standards that apply to their standards that apply to their particular medical specialty”particular medical specialty”

What is Revalidation?What is Revalidation? ““Contribution to quality of care”Contribution to quality of care” ““Competence assurance”Competence assurance” Threat or opportunity?Threat or opportunity?

232,000 licensed doctors232,000 licensed doctors > 700 “designated” organisations > 700 “designated” organisations

providing healthcareproviding healthcare Deaneries are designated orgs. for Deaneries are designated orgs. for

doctors in training doctors in training

Why the wait?Why the wait?

Lots of stakeholdersLots of stakeholders Circular progressCircular progress Change in legislationChange in legislation Reports from pilot sitesReports from pilot sites Appointment and training of ROsAppointment and training of ROs Enhanced appraisal trainingEnhanced appraisal training Generic and Specialty standardsGeneric and Specialty standards Lots of treesLots of trees

After 12 years of waiting—After 12 years of waiting—what now?what now?

The “latest” time tableThe “latest” time table May/June 2012: May/June 2012: Final organisational state of Final organisational state of

readiness assessmentreadiness assessment Summer 2012: Summer 2012: Assessment of readiness and Assessment of readiness and

business case prepared for ministersbusiness case prepared for ministers Sept/Oct 2012: Sept/Oct 2012: Ministerial decisionMinisterial decision

End of 2012End of 2012: : Enablement of necessary legislationEnablement of necessary legislation

31 March 2013: 31 March 2013: All ROs to have been revalidatedAll ROs to have been revalidated

31 March 2014: 31 March 2014: At least 20% of doctors revalidated At least 20% of doctors revalidated with all designated bodies having begun the processwith all designated bodies having begun the process

31 March 2016: 31 March 2016: All remaining doctors revalidated All remaining doctors revalidated ie 40% each yearie 40% each year

Remediation ReportRemediation ReportProf Hugo Mascie-Taylor Dec 2011Prof Hugo Mascie-Taylor Dec 2011

1.1. Performance problems, including Performance problems, including clinical competence and capability clinical competence and capability issues, should normally be managed issues, should normally be managed locally wherever possible.locally wherever possible.

2.2. Local processes need to be Local processes need to be strengthened to avoid performance strengthened to avoid performance problems wherever possible, and to problems wherever possible, and to reduce their severity at the point of reduce their severity at the point of identificationidentification

3.3.The capacity of staff within The capacity of staff within organisations to deal with organisations to deal with performance and concerns needs to performance and concerns needs to be increased with access to be increased with access to necessary external expertise as necessary external expertise as required.required.

4. 4. A single organisation is required to A single organisation is required to advise and when necessary to co-advise and when necessary to co-ordinate the remediation process and ordinate the remediation process and case management so as to improve case management so as to improve consistency across the serviceconsistency across the service

5. 5. The medical royal colleges should The medical royal colleges should produce guidance and also provide produce guidance and also provide assessment and specialist input into assessment and specialist input into remediation programmesremediation programmes

6. 6. Postgraduate deaneries and all Postgraduate deaneries and all those involved in training and those involved in training and assessment need to assure their assessment need to assure their assessment processes so that any assessment processes so that any problems arising during training are problems arising during training are fully addressedfully addressed

Good Medical Practice Good Medical Practice FrameworkFramework

4 Domains:4 Domains:

1.1.Knowledge, skills and performanceKnowledge, skills and performance

2.2.Safety and qualitySafety and quality

3.3.Communication, partnership and Communication, partnership and teamworkteamwork

4.4.Maintaining trustMaintaining trust

Each has 3 attributesEach has 3 attributes

Knowledge, skills and Knowledge, skills and performanceperformance

1.1 Maintain your professional performance

1.2 Apply knowledge and experience to practice

1.3 Ensure that all documentation (including clinical records) formally recording your work is clear, accurate and legible

Safety and qualitySafety and quality

2.1 Contribute to and comply with systems to protect patients

2.2 Respond to risks to safety

2.3 Protect patients and colleagues from any risk posed by your health

Communication, Communication, partnership and partnership and

teamworkteamwork 3.1 Communicate effectively

3.2 Work constructively with colleagues and delegate effectively

3.3 Establish and maintain partnerships with patients

Maintaining trustMaintaining trust

4.1 Show respect for patients

4.2 Treat patients and colleagues fairly and without discrimination

4.3 Act with honesty and integrity

Principles for Principles for Supporting InformationSupporting Information Must be relevant to Must be relevant to youryour scope of scope of

practice, including non NHS workpractice, including non NHS work

Consultants are required to Consultants are required to substantiate not only the quality of substantiate not only the quality of care they give to individuals but care they give to individuals but also those seen by other doctors also those seen by other doctors within the departments for which within the departments for which they share responsibilitythey share responsibility

SUPPORTING INFORMATION FOR APPRAISAL AND REVALIDATION

CHECKLISTAnnual Confirm continuation of GMC number /License to practice  Medical qualifications Confirm unchanged / provide commentary on changes  Description of practice Confirm unchanged / provide commentary on changes  Description of voluntary roles or additional work undertaken in capacity as a doctor Confirm unchanged / provide commentary on changes  Description of indemnity  Appraisal documentation Signed –off summary of previous year’s appraisal/s (for all relevant organisations )

CHECKLISTCHECKLIST Personal development plans

Submit for review the previous year’s PDP.

Any learning and development needs / goals for inclusion

in forthcoming PDP

Complaints / concerns (if any) and their resolution

Self-declaration confirming that you are unaware of any

complaints / concerns ideally with written confirmation from employing authority(ies)

If complaint(s) or concern(s); statement indicating how resolved and whether completed or on-going

Self-declaration statements

Probity including interests and gifts; Health to confirm ability to undertake practice as described; Registration with G.P.

CHECKLISTCHECKLIST Record of educational provision with feedback Necessary only if you are an educational supervisor or have any formal teaching or training responsibilities

Incidents – including contributions to NPSA, confidential enquiries and relevant coroner’s inquests

Self-declaration of no involvement in serious untoward or critical incidents and/or adverse events that triggered a formal process or record of management required if any involved

Record of clinical activity

Evidence of numbers and case mix of patients seen, including those as senior “sign-off”.

Availability will be dependent on trust/department IT systems

Evidence of ability to lead resuscitation teams

ATLS/ALS/APLS certificates or equivalent. Alternatively evidence of competence in appropriate skills by WBA

 

CHECKLISTCHECKLIST Guidelines – compliance

Self-declaration statement and (if available) examples of incorporation of national guidelines into local/departmental documents 

Clinical audit

Evidence of participation in departmental/personal audit

Medical records review

Can be done as part of departmental audit. 10 sets of notes should be included. (suggested frequency every 2 years)

Continuing professional development

Certificate of meeting CEM CPD requirements (minimum of 50 hours per year/250 per 5 years - can include e learning) and activities related to job plan and PDP Evidence

of reflection on learning gained

CHECKLISTCHECKLIST Local mandatory training

Evidence of participation

Meetings – attendance and participation in departmental and trust clinical governance and relevant committees

Evidence in the form of action logs or minutes

Documentation demonstrating activity to improve quality of care

E,g. 2 detailed case reviews per year / relevant audit / details of any guidelines, protocols, patient pathways or information documents you have been involved in developing

If available

Outcomes and performance data based on individual and team practice with reflection and commentary on personal input

 

CHECKLISTCHECKLIST Departmental complaints and resulting changes

Compliments

Personal and/or Departmental

During each revalidation cycle

Multisource feedback, including patient questionnaires

Appropriate forms should be provided by employing trusts and meet GMC criteria, an alternative MSF questionnaire will be available on CEM web site

Completed audit cycle

Participation in minimum of one completed cycle over 5 year period

Issues to be resolvedIssues to be resolved

E portfolioE portfolio Funding for remediationFunding for remediation Future of NCASFuture of NCAS Method of “roll out” uncertainMethod of “roll out” uncertain Orphans / Locums / Retired Orphans / Locums / Retired Overseas / Prolonged absenceOverseas / Prolonged absence Conflict of interest for ROsConflict of interest for ROs

What should I do now?What should I do now? Set up a GMC on line account. Set up a GMC on line account.

(GMC number, e mail, bank account (GMC number, e mail, bank account details details)details details)

Start gathering “stuff”Start gathering “stuff” Populate “Enlighten me” dashboardPopulate “Enlighten me” dashboard Develop departmental portfolio for Develop departmental portfolio for

common, shared informationcommon, shared information

Go to : Go to : www.collemergencymed.ac.uk www.gmc-uk.org/revalidation

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