Professor Nigel Sparrow explains the CPD credit scheme and provides everyday examples of how doctors can implement the learning and impact elements
Revalidation will allow doctors to demonstrate on a periodic basis that they are keeping up to date and are fit to practise. It has been introduced to:1
- confirm that licensed doctors practise in accordance with the General Medical Council’s generic standards
- confirm that those doctors on the GP or specialist register of the General Medical Council meet appropriate standards for their speciality
- identify poor practice (for investigation/remediation).
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.2 The Royal College of General Practitioners (RCGP) is unique in proposing a system of CPD credits that 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.2 This system should also:
- ensure that every GP updates and applies his or her knowledge and skills
- promote patient confidence
- ultimately improve patient care.
Development of the scheme
A pilot of the CPD scheme, based on impact, and to a lesser extent, challenge was carried out between September 2008 and May 2009. Dr Chris Price, RCGP CPD Fellow, conducted the pilot at 10 sites across the UK. Impact was calculated as a result of the positive change brought about by the activity of the individual GP or their practice; challenge was calculated as a product of time and other factors involved in the CPD activity. The aim of the pilot was to test the feasibility of self-assessment of learning without a time component. The feedback from the pilot was very positive in that GPs appreciated the opportunity to value the outcomes of learning rather than simple participation. The full results of the pilot were published in June 2009.3 Based on the feedback from the pilot, and internal and external consultation, the RCGP has simplified the credit system so that challenge is replaced by a time-based element.4 The system is less complex and less subjective than that used in the pilot and should be acceptable to all GPs whatever their working circumstances. The credit system will help GPs meet their revalidation needs by providing them with a mechanism to record their CPD based on the time spent on the activity and the impact it has on them, their patients, and the service.
What is a credit?
A credit at its simplest is each recorded hour spent on a CPD activity. Both planning and reflection count as a credit; additional credits can be earned by demonstrating the impact of the learning. Credits are self assessed and verified at appraisal. A GP’s CPD should reflect the work that the GP undertakes and that should be considered in the appraisal discussion.
Impact In the RCGP credit-based system, demonstration of impact would enable time-based credits claimed for an activity to be multiplied by a factor of two. Impact can affect:5
- patients (e.g. a change in practice, implementing a new clinical guideline, initiating 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, becoming a training practice, teaching others)
- others (teaching, training, NHS locally or nationally).
A guide to the credit-based system for CPD has now been published on the RCGP website.5 This includes examples of learning credits taken from the pilot. The guide describes how impact can be demonstrated (e.g. case studies, patient scenarios, significant event analysis, or a record of how learning has influenced practice).
Although GPs have different learning styles and learning needs, it is important that a variety of learning opportunities is used and that the broad work that a GP covers is included in the CPD record during a 5-year revalidation cycle. It is expected that GPs will accumulate 50 credits year-on-year leading to 250 credits in a 5-year period. Most GPs will collect many more than 50 credits a year. However, if exceptional circumstances prevent a GP from collecting 50 credits in 1 year, it is possible to accumulate more credits the following year.6 Suggestions on the balance between different types of activity are shown in Table 1, but these are by no means prescriptive.
A few examples of the variety of CPD that can be used for credits are illustrated below. This list is by no means exhaustive.
Online learning is becoming a more important and easily accessible form of knowledge accumulation. General practitioners have different speeds of working through exactly the same online resource. These resources usually result in a certificate that mentions hours or credits. The individual should remember that in the RCGP scheme, credits are self-assessed and as such those credits claimed should reflect actual activity rather than merely following what is said on the certificate.
Essential Knowledge Updates (EKU) are online learning modules produced every 6 months by the RCGP that help GPs to meet their CPD and revalidation commitments by assimilating and applying new and changing knowledge in clinical practice. Two updates are produced each year and each is associated with an Essential Knowledge Challenge (EKC), an applied online knowledge test.5 It is likely that the completion of an entire EKU (and associated EKC) would generate between 10 and 15 credits. The credit value of this claim may be increased if impact on practice can be demonstrated.
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.
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, 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, done an EKU module, and read the relevant NICE guideline. The preparation undertaken 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.
|Table 1: Balance of type of activity5|
|Activity||Notes||Suggested maximum claim out of 50 credits|
|Personal unstructured reading||For example, reading a medical journal regularly||10|
|Targeted reading||Acquiring knowledge in response to a stimulus is a very important part of developmental activity. However, it does not attract an impact rating||10|
|Changes made as a result of reading||This can be both target and unstructured reading||No upper limit|
|Attending meetings||It gives the opportunity to network and discuss things above and beyond the agenda of the meeting. Pure attendance and gaining knowledge, however, does not attract impact||20|
|Changes made as a result of attending meetings||This attracts impact||No upper limit|
|Online learning||Unstructured (the resource was available so I used it)||10|
|Targeted (i.e. I identified a need and one way of completing this was using an online resource)||10|
|Changes made as a result of online learning||This attracts impact||No upper limit|
|Activities that are likely to attract impact include: learning in the workplace or from experience; identifying learning needs through patient contact and by self or peer evaluation of practice. The important factor is implementation of change||No upper limit|
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 will allow GPs to demonstrate that the learning they undertake results in an improvement in patient care.
- General Medical Council website. Licensing and revalidation. www.gmc-uk.org/doctors/licensing.asp (accessed 20 November 2009).
- Royal College of General Practitioners. RCGP guide to the revalidation of general practitioners. Version 2.0. London: RCGP, August 2009.
- Price C. Impact and challenge model of CPD credits: Pilot report. London: RCGP, June 2009. Available at: www.rcgp.org.uk/docs/CPD%20Credits%20Pilot%20%20-%20final%20report.doc
- Price C, Sparrow N. Credits based system for continuing professional development. London: RCGP, June 2008.
- Royal College of General Practitioners. RCGP guide to the credit-based system for CPD. London: RCGP, 2009.
- Howard J, Sparrow N, Turnbull C et al. Continuing professional development and revalidation: an analysis of general practitioners’ recorded learning. Education for Primary Care 2009; 20 (4): 298–303.G