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Road to revalidation


29 October 2010

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Just when you think you know what lies ahead, the rules
change. This is just as destabilising for GPs, appraisers and practice managers as it is for us who are trying to help design
and deliver revalidation.

In early June the year, the Secretary of State for Health,
Andrew Lansley, asked for an extra year of piloting before
revalidation is introduced.

For many, this might have seemed like the welcome
Just when you think you know what lies ahead, the rules

Just when you think you know what lies ahead, the rules
change. This is just as destabilising for GPs, appraisers and practice managers as it is for us who are trying to help design
and deliver revalidation.

In early June the year, the Secretary of State for Health,
Andrew Lansley, asked for an extra year of piloting before
revalidation is introduced.

For many, this might have seemed like the welcome
Just when you think you know what lies ahead, the rules
change. This is just as destabilising for GPs, appraisers and practice managers as it is for us who are trying to help design
and deliver revalidation.

In early June the year, the Secretary of State for Health,
Andrew Lansley, asked for an extra year of piloting before
revalidation is introduced.

For many, this might have seemed like the welcome
reprieve that they have been praying for. Revalidation has always seemed to be two years away and now was no different.

However, Mr Lansley also said: “Revalidation is something that the public expects doctors to undertake and, if implemented sensitively and effectively, is something that will support all doctors in their innate professional
desire to improve their practice still further."

So, it seems that the commitment to introduce revalidation is undimmed. The current date for ‘go live’ is January 2013 after the second year of ‘Pathfinder pilots’ have been evaluated and lessons learnt.

The Royal College of GPs (RCGP), feels that the extra year is a necessary part of the preparation of the NHS for revalidation. Although some parts of the country have good annual appraisals linked to effective clinical governance, there is much variation. This extra year will be used to get all NHS organisations ready.

At the same time, we need to streamline the current proposals. The requirements for revalidation for alltypes of doctors should be similar, and the minimum of supporting evidence should
be included while still ensuring that revalidation is
fit for its purpose. Already, the RCGP is working with
other colleges, the British Medical Association (BMA)
and the General Medical Council (GMC) to achieve
this simplification.

What is the problem to which revalidation is the solution?

If we are to ensure that revalidation is fit for purpose, we need to agree on the purpose. The original aim, developed out
of the Bristol inquiry into paediatric cardiothoracic
surgery deaths, was to ensure that all doctors are up-todate
and fit to practise. In other words, it was to be a way of identifying and dealing with bad doctors.

This function is now largely done by clinical governance under the leadership of medical directors (and soon the new Responsible Officers). In our case, when concerns are raised about a GP, the local systems should investigate and exonerate
or act. Most primary care organisations are now taking this responsibility seriously so that no poorly performing doctor should, in theory, come to light at the time of revalidation.

So in this area of public protection, revalidation is the catalyst for improved NHS processes and the quality assurance that they are working properly. The more important purpose
of revalidation is to offer reassurance to patients, the public, colleagues and employers that each and every doctor is maintaining their standards. It is this positive role that is
so important for the maintenance of trust and confidence in modern medicine.

For most doctors, who are delivering a great service at the open door of the NHS, revalidation offers a framework for
demonstrating what they do routinely – keeping up-todate,
learning new skills, improving their practice year by year. It will be the system to make annual appraisal meaningful and
to promote continuous improvement.

How will revalidation be introduced?
The answer to this question is: in an evolutionary way
over five years. The current Pathfinder pilots involve up
to 2,000 GPs. The RCGP has conducted pilots for
‘normal’ GPs and sessional doctors (especially peripatetic
locums). We are launching pilots for doctors working in
secure environments and the defence services. These have
been very useful in refining our proposals. However the
Pathfinders are the ‘dress rehearsal’.

The first year is likely to concentrate on the Pathfinder sites and others that are most ready for revalidation. Then there
will be discussions locally to allocate all doctors to each subsequent year. Those with unusual careers or clinical
activities are likely to be allocated to later years.

As soon as you know which year group you are in, you’ll know what your portfolio should contain – the contents build up
each year so the GPs in early years will have less minimum
supporting information than those going later.

Once you’ve submitted your portfolio, your Responsible
Officer will recommend that the GMC revalidates you.
Provided the GMC agrees, and in the vast majority of
cases it will, your licence will be renewed for five years.

What will be expected in a revalidation portfolio?
Providing you have an effective appraisal at the moment, most of the required supporting information will come as no surprise. You’ll be asked to agree an annual personal development plan with your appraiser and review
it at the next appraisal. As now, you’ll be expected to review any complaints, do significant event auditing
and clinical audits.

Almost all GPs record their continuing education for their
appraisal. In addition, you’ll be asked to record how long
each session lasts and award one learning credit for each
hour. If you can show that you used that education to
improve your care for patients, then you can claim two credits
for each hour. You’ll normally be expected to do 50 learning
credits a year.

One area of supporting information is familiar to all of us but we may not have been doing it in the past few years. We’ll be
expected to do a survey of attending patients, much as we did in the early years of the Quality and Outcomes Framework (QOF).

Only one item of supporting information is new and that is a colleague survey. In fact, over half of all GPs have now done one of these, so it is becoming a familiar experience for
many. You’ll need to ask a number of colleagues – say six clinical and six non-clinical – to complete a questionnaire on your records, teamworking and communication skills.

This seems threatening at first, but the general experience is positive. If there are learning points, it can be a good opportunity to reflect and change.

What should I do now?
Continue with your annual appraisals, being sure that both you and your appraiser take them seriously. I recommend that
you record your continuing education, allocating hours to
each event. Remember that education includes in-practice
quality improvement sessions, reading, online education, etc.

When you take part in a significant event review, I suggest that you write it up and keep that record, preferably electronically.

When you do a clinical audit, on your own or with colleagues, again keep the record electronically.It is too soon to
recommend that you do patient or colleague surveys
for revalidation, but of course if you want to do so for your own purposes, it would be a good experience.

What will the RCGP be doing to help you?
The RCGP will be supporting all GPs, not just its members. It is offering guidance on its website at www.rcgp.org/revalidation,
including the Guide to the Revalidation of GPs, which
is an evolving ‘bible’ to revalidation proposals.

The RCGP is developing an ePortfolio in which GPs can record their information for appraisals and then identify the information that they want to go forward to revalidation. The first ePortfolio version will be released in November 2010
and more sophisticated versions will be released after that.

The RCGP also offers Essential Knowledge Updates and Essential Knowledge Challenge to help you with your continuing education. We have our eGP electronic learning environment, and we will be offering advice and support with significant event auditing and clinical audits.

For those with special careers, including sessional doctors and locums, and those working overseas, there are documents on
the website offering advice.

And finally…
Revalidation will only achieve its aims if it becomes part of everyday practice, if it becomes a low-effort, high-yield
activity, if it is equitable for all doctors, and if it protects the public and promotes good practice. All the partners involved
in revalidation are trying to achieve these characteristics.

You can help shape revalidation by having yoursay. If you have any ideas or concerns please contact the RCGP team at revalidation@rcgp.org.uk or through the website.

Professor Mike Pringle
RCGP Clinical Lead
for Revalidation

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