Dr Honor Merriman, GP and CPD tutor in Oxfordshire, discusses new advice that sets out what GPs need for revalidation and what steps they can take now
After a decade of anticipation, the revalidation processes in NHS organisations will be introduced in late 2012.1 Reports have recently been published from several national revalidation pilots, and GPs are waiting for the final announcements of their local arrangements for revalidation. Many areas have already appointed Responsible Officers in line with Government legislation.2 Under pilot schemes, many GPs and their appraisers have been involved in trying out new appraisal software, which has sometimes been a difficult process as some versions have shown that they are not yet ready for use.
Advice from the RCGP and GMC
The Royal College of General Practitioners (RCGP) has provided much advice to help GPs, and its Guide to revalidation,3 in particular, is succinct, yet covers the breadth of GP practices. In addition, the RCGP has provided a guide to the Credit-based system for CPD,4 and it has developed supporting evidence for revalidation for GPs as part of the work of the Academy of Royal Medical Colleges.5 It is important to note that the General Medical Council (GMC) has not defined how much CPD any doctor needs to do, the 50 credits each year advised by the RCGP is a helpful prompt but is not an absolute requirement.
The RCGP electronic revalidation portfolio (www.rcgp.org.uk/revalidation_eportfolio_home.aspx)6 has been developed to prompt GPs in their preparation. Although many PCTs are not yet using this for medical appraisal, this situation may change.
The information all doctors need to provide is set out in the GMC document Supporting information for appraisal and revalidation, and includes:7
- keeping up to date
- general information about themselves and their professional work
- review of practice:
- quality improvement activity
- significant events
- feedback on professional practice:
- colleague feedback
- patient and carer feedback
- complaints and compliments.
The NHS Revalidation Support Team has recently shared the draft version of the Medical Appraisal Guide,8 which has been developed in collaboration with key stakeholders. A final version is expected to be available in March 2012, but this pilot will give everyone an idea of what will soon be expected from GPs. This guide brings together standards from the (GMC) as defined in Good medical practice9 and supporting information already published by the GMC on its website (www.gmc-uk.org/doctors/revalidation.asp).
Actions for general practitioners
While all this is happening at the RCGP and the GMC, GPs need to be preparing their portfolios for both appraisal and revalidation. The GMC framework provides a simple basis. The four domains of good medical practice are:10
- knowledge, skills, and performance
- safety and quality
- communication, partnership, and teamwork
- maintaining trust.
The GMC Good medical practice framework (see Table 1) provides examples for reflection and for gathering supporting information,9 and the RCGP checklist (see Box 1) specifies what information GPs can be gathering now for their next appraisal.3
In preparation for appraisal, GPs should still feel free to reflect in writing about their experiences and should look forward to the appraisal discussion as an opportunity to think aloud about ‘where am I now’ and ‘where would I like to be’. Skilled appraisers can help in the session by raising new areas for consideration, and by challenging comments made by appraisees that might seem unclear or unrealistic. If GPs have key supporting documents (as defined by the RCGP3) for the current year’s appraisal to hand, it will make preparation for revalidation an easy progression.
GP appraisers need to ensure that they support their peers both in preparation and through providing them with suitably detailed documentation after the discussion, so that there is a record of the reflections on the data provided and of the possible changes to be made on the basis of those ideas.
Table 1: Attributes and examples from Good medical practice9 | ||
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Domain 1: Knowledge, skills, and performance | ||
Attribute | Examples of principles and values from the Good medical practice framework* | |
Maintain your professional performance |
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Apply knowledge and experience to practice |
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Ensure that all documentation (including clinical records) formally recording your work is clear, accurate, and legible | ||
Domain 2: Safety and quality | ||
Contribute to and comply with systems to protect patients |
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Respond to risks to safety |
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Protect patients and colleagues from any risk posed by your health |
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Table 1 (continued): Attributes and examples from Good medical practice9 | ||
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Domain 3: Communication, partnership, and teamwork | ||
Attribute | Examples of principles and values from the Good medical practice framework* | |
Communicate effectively |
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Work constructively with colleagues and delegate effectively |
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Establish and maintain partnerships with patients |
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Domain 4: Maintaining trust | ||
Show respect for patients |
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Treat patients and colleagues fairly and without discrimination |
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Act with honesty and integrity |
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*Numbers following the principles and values in this framework refer to paragraph numbers in Good medical practice, except where preceded by MfD, which refers to the booklet Management for doctors; or Research, which refers to Good practice in research. |
Summary
There is still much to do but in the next few months the final details will be much clearer. The Revalidation Support Team is arranging sessions for Appraisal Leads in all localities so that training can be cascaded to all medical appraisers. This is called ‘revalidation ready’ training/top-up training. It will assist standardisation of the appraisal process in all areas and will ensure that all GPs having appraisals in the next 12 months will be fully prepared for the requirements of medical revalidation. In this way everyone will be able to make the transition into the new system as smoothly as possible.
Box 1: Revalidation checklist3 |
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Each GP should record:
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- General Medical Council, Chief Medical Officers for England, Northern Ireland and Wales, the Deputy Chief Medical Officer for Scotland and the Medical Director of the NHS in England. Revalidation: a statement of intent. 2010. Available at: www.gmc-uk.org/doctors/revalidation.asp (accessed 22 December 2011).
- Department of Health website. Responsible officers. www.dh.gov.uk/en/Managingyourorganisation/Responsibleofficers/index.htm (accessed 12 January 2012).
- Royal College of General Practitioners. Guide to the revalidation of general practitioners. Version 6.0 September 2011. London: RCGP, 2011. Available at: www.rcgp.org.uk/PDF/Guide%20to%20Revalidation%20for%20GPs_sixth_edn_210911.pdf
- Royal College of General Practitioners. Guide to the credit-based system for CPD. Version 2.0 January 2010. London: RCGP, 2011. Available at: www.rcgp.org.uk/PDF/Credit-Based%20System%20for%20CPD_2nd%20version_110110.pdf
- Royal College of General Practitioners. Guidance on supporting information for revalidation for general practitioners. London: RCGP, 2011. www.rcgp.org.uk/pdf/RCGP%20-%20%20supporting%20info%20guidance.pdf
- Sparrow N. RCGP ePortfolio will simplify revalidation and assist CPD logging. Guidelines in Practice 2011; 14 (3): 35–44. Available at: www.eguidelines.co.uk/eguidelinesmain/gip/vol_14/mar_11/sparrow_rcgp_mar11.php
- General Medical Council. Supporting information and revalidation. GMC, 2011. Available at: www.gmc-uk.org/supporting_information.pdf_42293176.pdf
- NHS Revalidation Support Team. The medical appraisal guide (MAG) testing and piloting draft. Available at: www.revalidationsupport.nhs.uk/medical_appraisal_guide/
- General Medical Council. The good medical practice framework for appraisal and revalidation. GMC, 2011. Available at: www.gmc-uk.org/doctors/revalidation/revalidation_gmp_framework.aspG
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