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
Domain 1: Knowledge, skills, and performance
Attribute Examples of principles and values from the Good medical practice framework*
Maintain your professional performance
  • Maintain knowledge of the law and other regulation relevant to your work (13)
  • Keep knowledge and skills about your current work up to date (13)
  • Participate in professional development and educational activities (12)
  • Take part in and respond constructively to the outcome of systematic quality improvement activities (e.g. audit), appraisals, and performance reviews (14e).
Apply knowledge and experience to practice
  • Recognise and work within the limits of your competence (3a)
  • If you work in research, follow appropriate national research governance guidelines (71)
  • If you are a teacher/trainer, apply the skills, attitudes, and practice of a competent teacher/trainer (16)
  • If you are a manager, work effectively as a manager (MfD 12 and 17)
  • Support patients in caring for themselves (21e)
  • If you are in a clinical role:
    • adequately assess the patient's conditions (2a)
    • provide or arrange advice, investigations, or treatment where necessary (2b)
    • prescribe drugs or treatment, including repeat prescriptions, safely and appropriately (3b)
    • provide effective treatments based on the best available evidence (3c)
    • take steps to alleviate pain and distress whether or not a cure may be possible (3d)
    • consult colleagues, or refer patients to colleagues, when this is in the patient's best interests (2c, 3a, 3i, 54, and 55).
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
  • Take part in systems of quality assurance and quality improvement (14)
  • Comply with risk management and clinical governance procedures
  • Cooperate with legitimate requests for information from organisations monitoring public health (14i)
  • Provide information for confidential inquiries, significant event reporting (14g)
  • Make sure that all staff for whose performance you are responsible, including locums and students, are properly supervised (17)
  • Report suspected adverse reactions (14h)
  • Ensure arrangements are made for the continuing care of the patient where necessary (40 and 48)
  • Ensure systems are in place for colleagues to raise concerns about risks to patients (45).
Respond to risks to safety
  • Report risks in the healthcare environment to your employing or contracting bodies (6)
  • Safeguard and protect the health and well-being of vulnerable people, including children and the elderly and those with learning disabilities (26 and 28)
  • Take action where there is evidence that a colleague's conduct, performance, or health may be putting patients at risk (43 and 44)
  • Respond promptly to risks posed by patients
  • Follow infection control procedures and regulations.
Protect patients and colleagues from any risk posed by your health
  • Make arrangements for accessing independent medical advice when necessary (77)
  • Be immunised against common serious communicable diseases where vaccines are available (78).

Table 1 (continued): Attributes and examples from Good medical practice9
Domain 3: Communication, partnership, and teamwork
Attribute Examples of principles and values from the Good medical practice framework*
Communicate effectively
  • Listen to patients and respect their views about their health (22a and 27a)
  • Give patients the information they need in order to make decisions about their care in a way they can understand (22b and 27)
  • Respond to patients' questions (22c and 27b)
  • Keep patients informed about the progress of their care (22c)
  • Explain to patients when something has gone wrong (30)
  • Treat those close to the patient considerately (29)
  • Communicate effectively with colleagues within and outside the team (41b)
  • Encourage colleagues to contribute to discussions and to communicate effectively with each other (MfD 50)
  • Pass on information to colleagues involved in, or taking over, your patients' care (40 and 51–53).
Work constructively with colleagues and delegate effectively
  • Treat colleagues fairly and with respect (46)
  • Support colleagues who have problems with their performance, conduct, or health (41d)
  • Act as a positive role model for colleagues (41)
  • Ensure colleagues to whom you delegate have appropriate qualifications and experience (54)
  • Provide effective leadership as appropriate to their role (MfD 50).
Establish and maintain partnerships with patients
  • Encourage patients to take an interest in their health and to take action to improve and maintain it (4 and 21f)
  • Be satisfied that you have consent or other valid authority before you undertake any examination or investigation, provide treatment, or involve patients in teaching or research (36).
Domain 4: Maintaining trust
Show respect for patients
  • Implement and comply with systems to protect patient confidentiality (37)
  • Be polite, considerate, and honest and respect patients' dignity and privacy (21a, b, and d)
  • Treat each patient fairly and as an individual (21c and 38–39)
  • If you undertake research, respect the rights of patients participating in the research (Research 15–20, 28–30, and 31–32).
Treat patients and colleagues fairly and without discrimination
  • Be honest and objective when appraising or assessing colleagues and when writing references (18–19)
  • Respond promptly and fully to complaints (31)
  • Provide care on the basis of the patient's needs and the likely effect of treatment (7–10).
Act with honesty and integrity
  • Ensure you have adequate indemnity or insurance cover for your practice (34)
  • Be honest in financial and commercial dealings (73)
  • Ensure any published information about your services is factual and verifiable (60, 61)
  • Be honest in any formal statement or report, whether written or oral, making clear the limits of your knowledge or competence (63–65 and 67–68)
  • Inform patients about any fees and charges before starting treatment (72a)
  • If you undertake research, obtain appropriate ethical approval (Research 7), and honestly report results (Research 24).

*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.
General Medical Council. The good medical practice framework for appraisal and revalidation. London: GMC, 2011 Reproduced with permission.


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

Each GP should record:

  • a statement of professional roles
  • a statement of exceptional circumstances (if there are any)
  • evidence of active and effective participation in annual appraisals
  • a Personal Development Plan from each annual appraisal, with a review from each annual appraisal
  • learning credits in each year of the revalidation period and in the revalidation period overall (although College schemes require doctors to collect a specific number of learning credits, the General Medical Council does not define exactly what evidence of CPD is needed)
  • multi-source feedback from colleagues
  • feedback from patients
  • a description of any cause for concern and/or formal complaint
  • significant event audits
  • clinical audits
  • a statement on probity and health
  • additional evidence for areas of extended practice.

  1. 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).
  2. Department of Health website. Responsible officers. www.dh.gov.uk/en/Managingyourorganisation/Responsibleofficers/index.htm (accessed 12 January 2012).
  3. 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
  4. 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
  5. 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
  6. 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
  7. General Medical Council. Supporting information and revalidation. GMC, 2011. Available at: www.gmc-uk.org/supporting_information.pdf_42293176.pdf
  8. NHS Revalidation Support Team. The medical appraisal guide (MAG) testing and piloting draft. Available at: www.revalidationsupport.nhs.uk/medical_appraisal_guide/
  9. 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