Professor Nigel Sparrow explains how revalidation works and how GPs can gain CPD credits flexibly in a variety of ways to suit their own individual learning needs
Revalidation is the process by which doctors demonstrate that they are up to date and fit to practise. It was introduced to:
- assure patients, employers, and other healthcare professionals that licensed doctors are up to date and are practising to the appropriate professional standards
- provide a focus for doctors’ efforts to maintain and improve their practice
- facilitate the organisations in which doctors work, to support them in keeping their practice up to date
- encourage patients and the public to provide feedback about the medical care they receive from doctors.
The process of revalidation requires each Royal College to have a system for recording and quantifying the continuing professional development (CPD) of each doctor in their specialty. The Royal College of General Practitioners (RCGP) is unique in that its system of CPD credits enables doctors to claim additional credits for the impact that the learning activity has on their practice, rather than credits solely being determined by time spent on CPD. The CPD system encourages and rewards reflection on the learning activity and its integration into a doctor’s practice. The system has been designed to:
- ensure that every GP updates and applies his or her knowledge and skills
- promote patient confidence
- ultimately improve patient care.
What is a credit?
A CPD credit is defined as an hour of learning activity (including planning and reflection) recorded in a way that demonstrates the learning achieved relevant to the working situation of the GP. Credits are self-assessed and verified at appraisal with relevant supporting information, and account should be taken of the need for GPs to use their CPD to ensure that they are up to date in all areas of their work, using a variety of learning methods.
In the RCGP credit-based system, demonstration of impact enables time-based credits claimed for an activity to be multiplied by a factor of two. Impact in this context refers to the demonstration of implementation of learning with regard to:
- patients (e.g. a change in practice, implementing a new clinical guideline, initiating and monitoring a new drug for the first time)
- the individual (personal development, e.g. development of a new skill or further development of existing skills)
- service (e.g. developing and implementing a new service, developing a local patient pathway, teaching others)
- others (teaching and training, leadership within the NHS locally or nationally).
The RCGP guide to the revalidation of general practitioners is available on the RCGP website (www.rcgp.org.uk/revalidation-and-cpd/new-revalidation-guidance-for-gps.aspx).1 The guide provides examples of learning credits and describes how impact can be demonstrated. Although GPs have different learning styles and learning needs, it is important that a variety of learning opportunities is used and that the GP’s full scope of practice is covered in their learning log during a 5-year revalidation cycle.
All medical Royal Colleges have adopted a learning credit system that requires doctors to collect 50 credits a year and 250 credits in a 5-year cycle to support a positive revalidation decision. Although most GPs collect many more than 50 credits a year, the RCGP recommends that they select 50 ‘good quality’ and representative credits to include in each appraisal submission. There may be exceptional circumstances that prevent a GP from collecting 50 credits in 1 year, in which case they should try to accumulate more credits the following year.
‘Educational activity’ can include formal courses, lectures, seminars, small group or practice-based learning events, online learning, reading, learning a new skill, mentoring someone, action learning, becoming a trainer, undertaking individual reflective activity, etc.1 The RCGP does not prescribe a specific balance of credits to be gained through each type of activity, but would suggest that credits are balanced between the following ‘dimensions’:
- ‘personal’—involving only the GP
- ‘local’—based around the GP’s usual team
- ‘external’—at a regional or national level.
Furthermore, learning should be balanced between the following areas:
- clinical—anything directly relating to the clinical care of patients
- managerial—anything related to managing a GP’s clinical practice or the clinical service. An example would be setting up a new system for repeat prescription monitoring, or developing a new service through practice-based commissioning
- professional and academic—anything that advances the profession directly. This will include all teaching.
Learning should be a continuous process throughout the appraisal year and e-portfolio platforms are designed to allow GPs to update their learning log regularly. A forthcoming article by Dr Honor Merriman in the electronic publication RCGP Revalidate will offer the following advice to GPs:2
‘Keep your learning log up to date as you attend meetings, do online learning or reflect and learn from recent events. Shortly after the event is a good time to clarify what you learned and how you might change what you do in future. Recording it is a good way of making sure you have a plan, it’s better than having an idea at the back of your mind that never quite becomes reality.’
A few examples of the variety of ways in which CPD can be used to gain credits are described below. This list is by no means exhaustive. See also Box 1.
Box 1: Royal College of General Practitioners CPD resources
- RCGP guide to the revalidation of general practitioners. Version 8.0 (2013). Available at: www.rcgp.org.uk/revalidation-and-cpd/new-revalidation-guidance-for-gps.aspx
- RCGP guide to the credit-based system for CPD. Version 3.0 (2013). Available at: http://bit.ly/2aCVQI4
- Personal development plan toolkit (2014).* Available from September 2014 at: www.rcgp.org.uk/revalidation-and-cpd/revalidation-additional-resources.aspx
- Online learning environment: elearning.rcgp.org.uk
- Personal Education Planning (PEP): elearning.rcgp.org.uk/course/category.php?id=17
- * Toolkits are situated in the members’ area of the website. College members can access the materials using their RCGP username and password. Non-members are required to register with (not join) the College before they can access materials.
- CPD =continuing professional development; RCGP=Royal College of General Practitioners
Online learning is an important and easily accessible way of acquiring knowledge. General practitioners will work at different speeds through exactly the same online resource. These resources usually offer a certificate that mentions hours or credits. The individual should remember that in the RCGP scheme, credits are self-assessed and, therefore, any credits claimed should reflect actual activity rather than merely following what is stated on the certificate.
Essential Knowledge Updates (EKU) are online learning modules produced by the RCGP to help GPs to meet their CPD and revalidation commitments by assimilating and applying new and changing knowledge in clinical practice.3 Two updates are produced each year and each is associated with an Essential Knowledge Challenge (EKC), an applied online knowledge test. Completion of an entire EKU (and associated EKC) is likely to generate between 10 and 15 credits. The credit value of this claim may be increased if impact on practice can be demonstrated.3 For example, completion of an online learning module on chronic obstructive pulmonary disease, with associated reading of source material, might take an hour, which earns one credit. However, implementation of that learning in practice will double the credits earned.
Meetings or courses
Attending a meeting or course will attract credits for the time taken. For example, attending a meeting for an hour on heart failure, in which you learn about the indications of beta blockers and spironolactone, will allow you to claim one credit if accompanied by reflection, but if you then go back to the practice and start implementing that learning, you can double the credits. Impact in this situation can be illustrated with documented case histories or significant event analysis. A clinical meeting with colleagues will also attract credits. A 1-hour meeting to discuss the management of chronic kidney disease will provide one credit. However, the lead GP for the meeting might have researched the literature, completed an EKU module, and read the relevant NICE guideline. Preparation for the meeting will also attract credits based on the time taken. Implementation of that learning in clinical practice, again illustrated either as case histories, significant event analysis, or audit, will allow the time-based credits to be doubled.
To claim points for impact, a GP needs to demonstrate evidence of change (see Table 1, for some examples).
The RCGP Impact toolkit4 highlights a number of ways in which impact can be demonstrated.
It is not acceptable to claim for implementation of learning in practice as a result of general statements such as ‘I am more confident in managing this condition’ or ‘I am now more aware of changes in this area.’ There need to be specific examples of how change has occurred.
|Performing an audit with evidence of change||If the learning point was the use of beta blockers in heart failure, an audit can provide evidence of implementation of learning with improved patient care|
|Writing up a case report demonstrating how the newly acquired knowledge has been applied in practice||Submitting a case report on management of a patient with newly diagnosed atrial fibrillation using the recently acquired knowledge from a learning activity|
|Developing a protocol with evidence of applying this in practice||Implementation of a new protocol for use of antibiotics in a practice with evidence of reduction in prescribing antibiotics following implementation|
|Improvement in patient or colleague survey results following learning activities or practice development||Following completion of a communication or leadership course|
|Developing and implementing a new service in the practice following a learning event||Joint injections, insertion of contraception devices|
|Taking on a new role following training and documentation of learning points||Undergraduate tutor, staff appraisals|
|Evidence of changes in the practice as a result of significant event audits||Implementation of anticipatory care planning for palliative care patients following an event where treatment was delayed. A case report describing the implementation of the new changes with positive feedback from a family is an example of impact|
Identifying learning needs
The RCGP’s Personal Education Planning (PEP) (see www.rcgp.org.uk/courses-and-events/online-learning/ole/pep.aspx) and PEP Plus (see www.rcgp.org.uk/courses-and-events/online-learning/ole/pepplus.aspx) online self-assessment tools help GPs to identify their learning needs for GP training, CPD, and revalidation. By asking a series of multiple-choice questions, based on everyday general practice scenarios, they enable GPs to spot the strengths and weaknesses in their current knowledge and help them to formulate their Personal Development Plan (PDP).
Although the PDP should be written by the GP, the appraiser can help the process by asking the GP to:
- define exactly what it is they wish to achieve, making the learning specific rather than wide and general, e.g. ‘learn how to use a dermatoscope in diagnosing pigmented skin lesions’ is a more helpful statement than ‘learn more about dermatology’
- find several ways to achieve the objective. This is likely to make achievement much more probable
- envisage what could be measured as a result of the new learning.
There are many ways in which GPs can gain credits, given that they all work and learn in different ways. The key feature of the RCGP credit-based system is that it allows flexibility for individual needs and does not significantly encroach on either learning or patient care. The system allows GPs to demonstrate that the learning they undertake results in an improvement in patient care.
The author would like to acknowledge the following, all of whom have contributed to the content of this article: Mat Lawson, RCGP Revalidation Programmes Manager, and RCGP Specialty Advisers Dr Mei Ling Denney, Dr Honor Merriman, and Dr Sally Al-agilly.
- Royal College of General Practitioners. RCGP guide to the revalidation of general practitioners. Version 8.0. London: RCGP, 2013. Available at: www.rcgp.org.uk/revalidation-and-cpd/new-revalidation-guidance-for-gps.aspx
- Royal College of General Practitioners website. Revalidate. The dog ate my homework. Summer 2014 issue. Available at: www.rcgp.org.uk/publications/revalidate.aspx
- Royal College of General Practitioners website. Essential knowledge updates and challenges. elearning.rcgp.org.uk/course/category.php?id=2 (accessed 30 June 2014).
- Royal College of General Practitioners website. Impact toolkit. Available at: www.rcgp.org.uk/revalidation-and-cpd/revalidation-additional-resources.aspxG