Appraisal and Revalidation 2012 September Part of NEPCSA/northern

Appraisal and Revalidation 2012 September Part of NEPCSA/northern

Appraisal and Revalidation 2012 September Part of NEPCSA/northern deanery revalidation roll out programme Dr Paula Wright GP tutor for Newcastle Deanery lead for sessional GPs Revalidation the core principles Revalidation 1. demonstrates that you are up to date and fit to practise 2. should not be overly onerous on GPs but be sufficient to provide confidence to the public 3. must take account of the different working lives of

GPs, the process must be objective, fair and equitable Dont Panic ! You will be recommended for revalidation if you: Are are having an annual appraisal Providing the required Supporting Information Have no unresolved performance concerns There is nothing more that you need to do beyond continuing to engage in the appraisal process What will the revalidation process involve? Revalidation is done by the GMC based on a recommendation by

your local Responsible Officer (every NHS organisation will have one) recommendation based on appraisal record [from 1/4/12 unless unusual circumstances eg Maternity leave , Sick leave etc] RO for North of Tyne is Mike Guy When will revalidation be introduced? ROs and appraisal leads will be revalidated before April 2013 all other doctors from April 2013 GMC must give doctors at least 120 days notice of their revalidation date Aim is for all doctors to get through the first cycle

of revalidation by 2016 NE GPs will be revalidated in relation to their birthday months Revalidation schedule for NE GPs Appraisal year GP month of Birth Revalidation 2013-2014 May 1/7/13-30/9/13

August 1/10/13-/12/13 November 1/1/14-31/3/14 February 1/4/14-30/6/14 June 1/7/14-30/9/14

September 1/10/14-/12/14 December 1/1/15-31/3/15 March 1/4/15-30/6/15 April

1/7/15-30/9/15 July 1/10/15-1/12/15 October/January 1/1/16-31/3/16 2014-2015 2015-2016 The Revalidation Process- Options

for RO 1. recommendation for revalidation to the GMC 2. Defer if insufficient information [eg maty leave] or performance concerns under active review 3. Administrative removal for non-engagement if no documentation and no good reason for this NB. Revalidation will be done electronically for all doctors. You must register at GMC on-linehttp://www.gmc-uk.org/doctors/information_for_doctors/ gmc_online.asp What will happen to doctors who do not revalidate? Aims is for early detection and support of at risk drs A few doctors [??1-2 %] will not be

revalidated/ lose their licence to practise if remediation fails-most are already known to performance structures Remediation- recent agreement to provide funding via NHSCB What is appraisal for revalidation ? 1. a supportive discussion between two peers. 2. based on Good Medical Practice by the GMC (new domains 4) 3. PDP is key (old and new one) 4. 5 sign off statements for appraiser

to agree or disagree Good Medical Practice Framework- new domains 1.Knowledge, Skills and Performance 2.Safety and Quality 3.Communication, Teamwork and Partnership 4.Maintaining Trust The domains and attributes of the GMC framework for Good Medical Practice Domain 1 Knowledge, skills and performance

Domain 3 Communication, Partnership and Teamwork Attribute 1 Maintain your professional performance Attribute 2 Apply knowledge and experience to practice Attribute 3 Keep clear, accurate and legible records Attribute 1 Communicate effectively Attribute 2 Work constructively with colleagues and delegate effectively

Attribute 3 Establish and maintain partnerships with patients Domain 2 Safety and Quality Domain 4 Maintaining Trust Attribute 1 Put into effect systems to protect patients and improve care Attribute 2 Respond to risks to safety Attribute 3

Protect patients from any risk posed by your health Attribute 1 Show respect for patients Attribute 2 Treat patients and colleagues fairly and without discrimination Attribute 3 Act with honesty and integrity Information required for appraisal GENERAL INFORMATION +

SUPPORTING INFORMATION General information Personal details Scope of work list of all the roles undertaken (documents showing review of these roles should be submitted to your appraiser ) Record of previous annual appraisals Personal Development Plan and its review Probity and health declarations Supporting Information Is based on: GMC Supporting information for appraisal

and revalidation (mandatory) & RCGP Guide To revalidation for GPs (version7) (Advisory) Supporting Information -GMC guidance General information, plus Evidence of Continuing Professional Development Quality improvement activity (e.g. Audit, case reviews, review of teaching, QIP) Significant Event Audits (SUIs) Patient feedback Colleague feedback Complaints/compliments

These must cover your scope of practice- ie all your roles Summary of supporting information RCGP version 6 October 2011 Evidence Frequency Significant Events 2 per year Clinical audit 1 in 5 years [others options for some

Sessional GPs] Colleague and patient feedback 1 in 5 years Complaints All reviewed every year PDP Reviewed every year and new one produced each year

CPD credits 50 per year- 250 over five years Continuing Professional Development CPD log must demonstrate at least 50 CREDITS 1 hour=1 credit CPD should cover whole scope of practice-ie all clinical and other roles Impact multiples hours by 2 Record of educational activities [meetings, conferences, reading etc] and core learning points

Supporting information: non standard GPs peripatetic locums, OOHs doctors, rural remote GPs, etc may have difficulty with some of these evidence requirements , especially audit /SEA and MSF All GPs need to demonstrate that they regularly review and evaluate the quality of their work . See guidance from NEPCSA: on supporting information for non standard GPs. Audit and sessional GPs No Access to records outside of consulting time Lack of Skills and help with in searches No specific clinical role to audit;

No organisational influence Mobility between practices if locum Numbers with a single conditions seen by locum or part-time GP is very small personally delivered care means process based for which there is no evidence base (e.g. Record keeping) Key is to demonstrate reflection, learning and improvement-RCGP Quality improvement activities (GMC)

Clinical audit (1/5yr, or alternative) Case review, (GMC) Quality Improvement Plan [QUIP], (GMC) Review of referrals, review of record keeping * Review of 20 consultations in random surgery with feedback from colleague * Prospective condition based review * Audit effectiveness of teaching or health policy change (GMC) Key is to demonstrate reflection, learning and improvement *NEPCSA interpretation of RCGP statement above

Detailed guidance for sessional Gps Deanery Sessional GP page: NEPCSA Guidance on Supporting Information for NonStandard GPs http://northerndeanery.ncl.ac.uk/NorthernDeanery/primary-c are/continuing-practice/retainer-scheme/information-for-ses sional-gps Also Career Break Advice December 2011 Significant events unexpected event which could or did harm patient [s] two SEAs each year [RCGP guidance] Personal to you (involvement in the care not just the

discussion meeting) Lessons learnt , areas for future learning and actions taken as a result of SEA should also be discussed SEAs can be discussed in a learning/study group if practice meeting not accessible Significant events unexpected event which could or did harm patient [s] SEAs are defined a bit differently in primary and secondary care SEA = SUI [serious untoward incident ] in hospital context Unless your SEA has led to loss of life or serious injury , include it under Quality Improvement Activity section of the appraisal form Patient and Colleague Feedback

Formative and developmental not pass fail Feedback should come from whole scope of practice [all the roles eg clinical, academic etc] Will be needed for your first revalidation cycle however short. Try and do this as close as possible to the date of your annual appraisal [birthday month] so that you can discuss the feedback with your appraiser soon after it is received. Your local GP tutor can also provide support Certain groups have different benchmarks (locums/ sessionals)

Patient and Colleague Feedback-how to collect it The surveys must be independently collected/analysed You need to choose a commercial provider of feedback tools approved by the RCGP include- NE discount prices here CFEP approx 105 give code DJ8482 when you apply http://www.cfepsurveys.co.uk/products/general-practice/360.aspx

Edgecumbe approx 75 code is nucapf http://www.edgecumbehealth.co.uk/edgecumbe-doctor-360.php Please read the FAQs recently circulated to help guide you in the collection and interpretation of this feedback Complaints All patient complaints must be discussed each year at appraisal, reflection using NEPCSA template Learning points and actions must be recorded Compliments can be listed in this section Scope of work an example

Area of work Detail Qualifications /experience Length of time Organisation Clinical Regular

GP MRCGP 20 yrs Surgery Ad hoc OOH MRCGP

10 years NDUC Education Regular Trainer Dip MEduc 5 years VTS Ad hoc Managerial

Regular CCG lead 1 year CCG Ad hoc Appraiser 7 years PCSA

Other roles Team GP 5 years Falcons Ad hoc Mandatory training- NEPCSA CPR certification up date every 18 months Safeguarding children =GPs must achieve competence at LEVEL 3 which means over 3 year period

One approved IT module One session of single agency training [ health care staff only]-approx 2 hours One session of multi-agency training -usually one day (organised by LSCB) Sign Off statements for the appraiser 1. An appraisal has taken place that reflects the doctors scope of work and addresses the principles and values set out in Good Medical Practice. 2. Appropriate supporting information has been presented in accordance with the Good Medical Practice Framework for appraisal

and revalidation and this reflects the nature and scope of the doctors work. 3. A review that demonstrates appropriate progress against last years personal development plan has taken place. 4. An agreement has been reached with the doctor about a new personal development plan and any associated actions for the coming year. 5. No information has been presented or discussed in the appraisal that raises a concern about the doctors fitness to practise. Sign Off statements for the appraiser

Not signing one of the statements does NOT mean the doctor wont revalidate it serves to signpost what additional work needs to be done for the following year PDP- definition (RCGP) a formal agreement, between the appraisee and appraiser, on the learning and development needs of the appraisee, identified at the appraisal interview, with an outcome based learning plan for the subsequent year PDPs - What Goes Into Them Personal development Targeted learning

Practice development OK if also involves personal learning Professional goals Professional or career development Producing supporting information Capture scope of practice Personal Development aims best practice 1. 2.

3. 4. Meet SMART criteria Reflect appraisees approach to learning Link to improving patient care needs identified through reflection on practice, SEAs, case reviews , audit etc 5. aspirations identified by the appraisee 6. Gaps in supporting information Career breaks RCGP talks about minimum portfolio if out of practice for a significant period: 3 out of 5 appraisals

200 clinical sessions (of which 100 should be undertaken in the 2 years prior to revalidation). 150 credits All yet to be tested in real life Appraisal Checklist- identifying problems early 1. Appraiser complete checklist of supporting information for RO 2. significant gaps put in next years PDP 3. Range of actions available to appraiser is they have concerns: 1. Second sign off by GP tutor to check appropriate actions 2. Signposting for support (tutors, occ health, deanery

etc) 3. Flag up for close scrutiny by RO Booking your appraisal 200 appraisers covering North east and 2500 Gps. Appraisals by birthday month Must book via new website being launched 2012 www.gpappraisalsne.nhs.uk Booking early means more choice Select appraiser according to their availability that month Website has Bio/profile on the appraiser Maternity leave, Sabbaticals, Sick leave etc apply for deferment via website Admin will no longer allocate if you are delayed. Its all up to you !

Collecting information for your annual appraisal FREE Options The new Medical Appraisal Guide [MAG] Form GP tools set up by a GP https://www.gptools.org/ SUBSCRIPTION BASED OPTIONS The RCGP Revalidation e-portfolio Clarity Appraisal toolkit [previously NHS toolkit] Its a matter of appraisee choice, however Things to consider when choosing toolkits Must use new GMC domains (all do except RCGP eportfolio) Must :

comply with NEPCSA checklist use NEPCSA templates for SEA/Audit/case review/ complaints etc. No requirements for appraisers to log onto an online toolkit to see your evidence (discretionary) Be prepared to extract your information from your chosen website and email to your appraiser MAG form 1. Writable PDF with facility to store uploaded supporting information (NEPCSA templates) 2. Need latest ADOBE reader 3. Also has place for writing the appraisal summary (form4) 4. after summary agreed appraisers does lock down

which cannot be reversed 5. After this open new year creates new year and keeps only summary and pdp (all supporting information removed)- this version goes to PCT. Guidance from your appraisal lead You should be getting updates and guidance directly from your PCt admin lead. if you are not it means they dont have your email address and you are not in their system. [email protected] Where to get advice Always refer to PCSA web-based booking site

https://gpappraisals.nepcsa.nhs.uk/ Also Your appraiser Your tutor (Paula Wright) GP tutor for Sessional Gps: Paula Wright [email protected] Steve Blades [email protected] Appraisal lead- Di Jelley (specially if career breaks, deferments) Useful websites for further information PCSA web-based booking site https://gpappraisals.nepcsa.nhs.uk/

UK Revalidation Support Team http://www.revalidationsupport.co.uk/ Royal College of General Practitioners http://www.rcgp.org.uk/ revalidation.aspx General Medical Council http://www.gmc-uk.org/

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