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Revalidation for SAS doctors John Bache FRCS RST Associate NHS Revalidation Support Team SASG Annual Conference Manchester 13th January 2010
How did we get here? … 1999 Supporting Doctors, Protecting Patients - CMO 2004 Shipman Inquiry Report (plus Bristol, Alder Hey etc..) 2006 Good Doctors, Safer Patients – CMO 2007 Trust, Assurance and Safety – White Paper on ‘Regulation of Health Professionals in 21st century’ 2008 Medical Revalidation - Principles and Next Steps - CMO
2008Medical Revalidation – Principles and Next Steps “In the NHS, appraisal is patchy geographically and is not fit for the purpose of re-licensing. …To address this will require a standardised module of appraisal, agreed by the GMC, to be included in all appraisal systems. This module will be derived from Good Medical Practice… and will inform a judgment on whether the evidence presented supports revalidation or not over a five year cycle…”
Purpose of medical revalidation • To confirm that licensed doctors practise in accordance with the GMC’s generic standards • (re-licensure) • For doctors on specialist or GP register, to confirm that they meet the standards appropriate for their speciality (re-certification) • To identify for further investigation, and remediation, poor practice where local systems are not robust enough or do not exist 4
What is needed for revalidation? The key elements required for implementation are: • a revised system of appraisal • a regional network of GMC Affiliates • a network of Responsible Officers • the issuing of licences to practise - done! • standards for assessment and evaluation methods for specialist recertification (+ generic standards for all doctors) 5
Changes needed … Piloted introduction of revalidation through careful introduction of ‘new’ appraisal: - new appraisal forms - electronic support Standards for assessment (Royal Colleges) Improvements in Trust/PCT/etc infrastructure to support ‘new’ appraisal
GMC, RST, NCAS, Royal Colleges • GMC • Ultimate decision on whether doctor revalidated • Concerns about fitness to practise • RST • Design, support and piloting for strengthened appraisal • NCAS • Advice to RO in support of local remediation • Royal Colleges • Specialty standard setting + formal assessment
The legislation - ensures that there is investment in systems of clinical governance, audit, and multi-source feedback - ensures that RO decision making is rigorous, high quality, and consistent - ensures that appraisal systems are mandatory, high quality, and consistent
GMC: Good Medical Practice • 4 Domains – insufficiently sensitive for comprehensive assessment • 12 Attributes – pragmatic level on which to base reasonable assessment • 75 Standards – too complex to expect all doctors to present evidence on each one
Multi-source (“360”) feedback • From colleagues • From patients (where appropriate) • Appraiser must know how MSF works, including statistical validity • Feedback of results must be done well
Timetable • Licenses issued to all doctors who requested them and on the GMC register in November 2009 • Re-licensing will be based on future participation in appraisal • Re-certification proposals to be piloted in all specialities in 2010/11, to start probably in 2011 • Guidance on approved MSF tools shortly
What do I need to do now? 1. Gather detailed evidence • CPD • Workload - hospital episode statistics • Audits • Teaching and other roles • Reviews of significant events or interesting cases • Complaints or concerns • MSF - colleagues (and patients) • Health - and reflect!
What do I need to do now? 2. Establish contact with relevant Royal College • Website • Colleagues • Direct They are defining standards and methods of evaluation
What do I need to do now? 3. Keep up to date with developments • GMC • Royal Colleges • Revalidation Support • Websites • Literature • Colleagues • Direct