What is Revalidation?

It is hard to keep up to date with the latest advice on revalidation and to be entirely clear about what it will look like when it goes live in 2012/13.

However, Wessex Deanery Appraisal and Revalidation Service endeavours to keep abreast of new developments, such as the Medical Appraisal Guide being produced by the Revalidation Support Team, and to let you know what is, and what is not, currently known.

Definitions

The aim of medical appraisal: to facilitate and support personal and professional development, within the context in which an appraisee works. This will include supporting individuals in ensuring that their portfolio of supporting information is such that it will meet the requirements of revalidation and challenging them to produce personal development plans (PDPs) that are going to meet their learning needs going forward.
The aim of medical revalidation: to demonstrate that doctors are up to date and fit to practise.

There is a new legal entity, the Responsible Officer (RO), who will be responsible for making a recommendation to the General Medical Council (GMC) about whether a doctor should be allowed to revalidate or not. The ultimate decision will still lie with the GMC, as it does now, if a doctor is thought to have serious fitness to practise issues.

It is thought that around two percent of doctors will come under increased scrutiny from the Responsible Officer, as a result of significant concerns about their health, professional practice or professional conduct. Most of these will be flagged up through clinical governance processes but it is possible that a doctor might reveal something during their annual appraisal that led to a need for further scrutiny by the RO. The RO will also be responsible for ensuring that the clinical governance and appraisal processes are robust and quality assured so that s/he can have confidence in the information that s/he receives in order to make the recommendation to the GMC.

For this reason, it is thought possible that a further proportion of those appraisees, who apparently have no difficulties, will be spot checked at random to ensure that the systems are robust, and to identify those with genuine difficulties appropriately.

There are still likely to be 98% of doctors, who have no difficulty in demonstrating that they are up to date and fit to practise, for whom the appraisal and revalidation process needs to deliver a useful structure. It needs to help them with their personal and professional development, and to improve the quality of their clinical care, in order to justify the time and cost involved to the individual and to the NHS. It is known that the RST pathfinder pilots have resulted in very clear recommendations that the process of strengthened medical appraisal used in the pilots should be “streamlined and simplified” to ensure that the process of appraisal and revalidation is proportionate and appropriate.

Appraisal

Annual appraisal will be core to the appraisal and revalidation processes. Highly trained appraisers can help individuals to benchmark themselves and their performance by encouraging them to reflect on supporting information brought to the appraisal and added to their portfolio. The appraisal discussion will remain a confidential, formative and developmental process.

The baseline supporting information for revalidation should be supplemented by any other supporting information the appraisee wants to bring to discussion, regardless of it being on any official checklist, within the appraisal portfolio. During appraisal, doctors will benefit from the chance for reflection, and personal and professional development planning in a confidential and supportive environment.

Facilitating self-reflection will remain a core role of appraisers. However an increased emphasis on helping the individual review their own progress towards revalidation, both in terms of supporting information about performance already gathered, and in planning what else may be needed, is likely to be introduced. There will be a new training requirement for appraisers to learn enough about the standards expected of a “good enough” doctor, to enable them to support the doctor during this process, without frightening individuals with “gold star” standards.

Revalidation

Revalidation is a continuous five year process.

At any point in time a doctor, who is found not to be up to date and fit to practise, can have their license to practise revoked. All other doctors will be reviewed on a predictable five yearly timetable, with annual “checkpoints” at the time of the annual appraisal, during which the appraisee will be able to review whether they are “on track” to revalidate.

In the transition period from 2012/13, when the first doctors to revalidate will “go live” – probably towards the end of 2012 – to 2017/18, there will be a sliding scale of requirements, such that those at the beginning of the cycle will not have to produce as much supporting information as those who have had the full 5 years to collect it. It is not yet clear how the doctors to be revalidated in any given year will be determined.

In March 2011, the GMC produced a Framework which set out the principles under which a doctor should be collecting supporting information to demonstrate that they are up to date and fit to practise. This will be supplemented by more specific speciality related guidance from the Royal Colleges and Faculties, moderated, so that the requirements are similar no matter what speciality a doctor has trained in, and refined with experience.

The RCGP is considered to be ahead of the game in having produced a consultation document with its developing draft ideas for GPs (The “RCGP Guide to Revalidation for General Practitioners”, latest version published Dec 2010). Although this is not definitive, all GPs would be well advised to read the document and adopt the ideas about providing supporting information that are most appropriate to their own practice. Changes subsequently required to bring standards into line with the other disciplines can then be incorporated when the definition has been refined.

The requirements for relicensing over the five year period are set out in the DoH White Paper (Medical Revalidation – Principles and Next Steps) (July 08) and include:

Satisfactory engagement in annual appraisal (x5).
One Multi Source Feedback (MSF) – including patient satisfaction survey where this is appropriate.
Confirmation from robust clinical governance processes (which need to be set up, and/or strengthened where they already exist) that there are no outstanding concerns that bring the individual doctor’s fitness to practise into question.

This is encouraging because there is already a process that appraises 100% of eligible appraisees in Wessex Deanery areas, and many appraisees are already gathering all (and more) that is likely to be required in their appraisal portfolio. The baseline principle is to keep it simple. If the requirements are too onerous, they will detract from patient care, not support improvements in it. No-one has an interest in making things difficult for doctors. However, we do need is a system that commands the respect of the profession and the public, is open and fair from bias or prejudice, and does not penalise any particular group for example: locums or single handed doctors.

We are moving towards just such a system and we are currently being encouraged to shape the evidence set required and the exact details to ensure that it really does deliver increased standards of patient care. By encouraging individuals to work on providing supporting information about their own performance and their own development year on year, appraisal and revalidation together can provide assurance that patient safety is being protected and that standards of patient care are being improved.

by Dr Susi Caesar, June 2011
Wessex Deanery Appraisal and Revalidation Service Lead

Welcome to Wessex Deanery

What is Revalidation?

Definitions

Appraisal

Revalidation