Dr Honor Merriman explains how updated RCGP guidance clarifies what is required in supporting information for appraisal and revalidation
Read this article to learn more about:
- RCGP guidance updates for GPs on the revalidation process
- the importance of quality improvement activities
- the phasing out of 'increasing credits by demonstrating impact'.
On 11 March 2016 the Royal College of General Practitioners (RCGP) published an updated version of the Guide to supporting information for appraisal and revalidation.1 The guidance update was needed to clarify what GPs need to provide for revalidation and what supporting information is needed to support discussions in their appraisal meetings.
The General Medical Council (GMC) guidance is broad and covers what every doctor in every speciality needs to provide.2,3 Additional generic guidance from the Academy of Medical Royal Colleges (AoMRC) provides further details for all doctors,4 including about supporting information.5 The new guidance from the RCGP1 removes inconsistencies from previous guidance and aims to keep the revalidation process straightforward for all GPs. The guidance is clear that appraisal needs to retain a supportive and developmental focus and that supporting information should not place an increase in workload on GPs.1
The main changes relate to:1
- scope of practice of the GP
- probity and health statements
- continuing professional development (CPD)—how GPs demonstrate that they remain up to date in all aspects of their scope of practice over the 5-year revalidation cycle
- regular review of practice in quality improvement activities
- significant events, some of which relate to patient risk and others to aspects of CPD and quality improvement activities
- feedback surveys from colleagues and patients and how these can be compliant with GMC standards.
Scope of practice
It is necessary for GPs to state all professional work roles, paid or voluntary, where a licence to practise is needed. The appraisal documentation needs to describe how the GP keeps up to date in all these roles and how review of practice takes place to ensure standards are maintained. A simple example is a GP trainer who provides information about updates attended and feedback from learners and training practice visits.
The probity statement
As well as stating compliance with the GMC requirements for probity set out in Good medical practice (2013),6 the GP should provide a reflection on potential probity challenges, for example possible conflicts of interest between roles, or whether they have appropriate indemnity cover for the full scope of their work.
The health statement
The compliance statement (as above) should be supplemented by reflections on how the GP’s own good health is maintained, including access to treatment from their own GP outside of their own practice.
Continuing professional development
There are some helpful pointers in the new guidance:1
- it is important that at least 50 hours of CPD (but not much more than that) are demonstrated to have been completed in any 12-month period of work and that change in practice has been reflected on. Not every learning event needs to be included in the portfolio, but items need to be chosen that show learning across the scope of GP practice. This applies to all GPs, whether part time or full time, to ensure that good quality care can be delivered
- one credit = 1 hour of learning activity with a reflective note on what has been learned and changes made as a result
- the possibility of increasing credits by claiming impact is to be phased out and will no longer apply from the end of March 2016
- learning needs to take place using a balanced range of methods and experiences and should not be by one method only (e.g. not just via online learning)
- GPs who do not complete a full 12 months of work due to maternity leave or illness should submit a portfolio with a number of credits proportionate to their time in work; plans to address gaps should be added to the personal development plan
- there is no requirement to scan in attendance certificates where learning has been reflected on; however, some organisations may need to see these, so it may be necessary to save them in paper files.
Box 1: The six types of supporting information required by the GMC for a positive revalidation recommendation3
- Continuing professional development
- Quality improvement activity
- Significant events
- Feedback from colleagues
- Feedback from patients
- Review of complaints and compliments.
- GMC=General Medical Council
- General Medical Council. Supporting information for appraisal and revalidation. Manchester: GMC, 2012.
Quality improvement activities
The ability to show that GPs review and learn from practice remains important:
- quality improvement activities (QIA) may take several forms; reflection on at least two items per year needs to be shown and a balanced spread over all areas of practice demonstrated over the 5-year cycle
- a new emphasis in the updated guidance1 is that significant events that reach the GMC definition of harm must be included in 'significant events'. Other good examples of learning and change from significant event analysis can be included, and it is not essential that all significant events are included. The proforma used to describe the event and its discussion needs to be uploaded with patient-identifiable data removed
- review of specific skills (e.g. minor surgery), with reflection on outcomes, is needed in the revalidation cycle
- for any activity, a repeat of at least one QIA is needed over the 5-year cycle so that the effectiveness of changes can be shown (so-called 'closing the loop').
Feedback from colleagues and patients
In the first cycle of revalidation, interpretation of GMC guidance3 about feedback surveys led to differing ideas among GPs about what was required. In the second cycle from the end of March 2016, the AoMRC advice (which is in line with GMC advice) is that surveys should:4
- be consistent with the principles, values and responsibilities set out in the GMC's core guidance, Good medical practice
- be piloted on the appropriate population, and demonstrate that they are reliable and valid
- reflect and measure the doctor's whole practice
- be evaluated and administered independently from the doctor and their appraiser to ensure an objective review of the information
- provide appropriate and useful information that can be used in discussions with a supervisor or mentor, or through appraisal
- help the doctor to reflect on their practice and identify opportunities for professional development and improvement.
Although only one formal feedback survey from colleagues and one from patients is needed in each revalidation cycle, feedback from patients that makes the GP reflect on their practice and change it, including results from the friends and family test, should be included in each appraisal. The guidance does not specify how many responses are needed; the GP's Responsible Officer will be able to advise on this.
Feedback from patients should use a method that is appropriate to the patient group: for example, email feedback from a patient group where only a few patients use email would be inappropriate.
Feedback from colleagues in different work contexts may give confusing results, so the feedback method that is most suited to the circumstances should be used. For example, for a GP whose work is mostly in clinical practice, formal feedback should be provided by a colleague with whom he or she usually works. Feedback from other roles should also be sought and submitted, perhaps from learners if the GP is a trainer, or GPs who have been appraised if the GP is an appraiser. The additional feedback need not be in a GMC-compliant format but should be supplemented by thoughts on the feedback, particularly if it indicated that changes are needed.
Review of complaints and compliments
All complaints should be noted in the appraisal documentation; if there have been no complaints, this should be stated. These requirements are unchanged from the original guidance. It is important to anonymise any patient data in the documents. The appraisal discussion will help to identify learning points from the complaint and may be the GP’s only source of support. Compliments should be summarised with reflections; individual compliments no longer need to be uploaded separately.
Sometimes GPs are asked to discuss additional items at appraisal that relate to items brought to the attention of the Area Team. Failure to mention this at appraisal represents a probity breach similar to failure to disclose a complaint. General practitioners need to be aware of the seriousness of this type of omission.
Now that most GPs are in the second cycle of revalidation, those who may have had initial anxieties about the process are likely to be feeling more confident.
The new guidance1 simplifies the process for GPs and their appraisers so that the appraisal discussion can remain supportive and stimulate the GP's professional development. Allowing GPs to present examples of learning in all of their roles rather than everything they have done for CPD will make it easier for both GPs and their appraisers.
- The RCGP has issued updated guidance1 on what GPs need to provide for revalidation and to support discussions in appraisal meetings
- GPs need to ensure that all parts of the scope of practice have appropriate supporting information and reflection over the 5-year cycle and to demonstrate how review of practice takes place to maintain standards
- As well as complying with the GMC requirements for probity and health set out in Good medical practice (2013),6 GPs also need to reflect on the implications of the requirements as individuals
- Requirements for appropriate CPD over the 5-year cycle are clarified:
- the definition of a CPD credit is given:
- after 31 March 2016, it will no longer be possible to obtain additional credits for 'demonstrating impact'
- high-quality, representative examples of learning with reflection should be chosen for documentation
- the definition of a CPD credit is given:
- QIAs may take several forms
- The GMC definition of SE is clarified. GP SE analyses should be considered a normal part of review of practice and included in QIA
- Formal, GMC-compliant feedback from patients and colleagues should be obtained once during the 5-year cycle:
- other feedback from patients and colleagues that makes the GP reflect on practice and change should also be included in the appraisal
- regarding additional feedback from colleagues, the feedback method most suited to the circumstances should be used.
RCGP=Royal College of General Practitioners; GMC=General Medical Council; CPD=continuing professional development QIA=quality improvement activity; SE=significant events
- Royal College of General Practitioners. RCGP guide to supporting information and revalidation, 2016. London: RCGP, 2016. Available at: www.rcgp.org.uk/revalidation/~/media/Files/Revalidation-and-CPD/2016/RCGP-Guide-to-Supporting-Information-2016.ashx
- General Medical Council. The 'Good Medical Practice' framework for appraisal and revalidation. Manchester: GMC, 2013. Available at: www.gmc-uk.org/The_Good_medical_practice_framework_for_appraisal_and_revalidation___DC5707.pdf_56235089.pdf
- General Medical Council. Supporting information for appraisal and revalidation. Manchester: GMC, 2012. Available at: www.gmc-uk.org/RT___Supporting_information_for_appraisal_and_revalidation___DC5485.pdf_55024594.pdf
- Academy of Medical Royal Colleges. Appraisal for revalidation: a guide to the process. London: AoMRC, 2014. Available at: www.aomrc.org.uk/doc_view/9772-appraisal-for-revalidation-a-guide-to-the-process
- Academy of Medical Royal Colleges. Supporting information for appraisal and revalidation: core guidance framework. London: AoMRC, 2012; revised 2013. Available at: http://www.aomrc.org.uk/doc_view/9688-supporting-information-for-appraisal-and-revalidation-core-guidance-framework
- General Medical Council. Good medical practice (2013). GMC, 2013. Available at: www.gmc-uk.org/guidance/good_medical_practice.asp (accessed 8 March 2016). G