Medical Appraisal and Revalidation

These two processes were extensively piloted throughout 2010/11 appraisal year, including in NHS Dorset and some areas of South Central SHA. The final outcome of the pilots is still being evaluated but it is useful for doctors to understand a little about the direction of travel.

Medical appraisal and revalidation are inextricably interlinked and valuable in that they allow us to collect one set of supporting documentation to meet two needs. Revalidation is a five year continuous process where a doctor can come under increased scrutiny, potentially leading to additional early intervention and support, if identified as not being on track to revalidate, at any point. Annual appraisal, alongside clinical governance processes, provides one of the opportunities to identify doctors who may not be on track to revalidate.

What are the standards used in the pilots?

The GMC has divided “Good Medical Practice” into 4 domains. Each domain has 3 attributes and appraisal for revalidation will use supporting information which is able to cover those 12 attributes. Under each attribute, there are additional standards, which come directly from particular sentences and paragraphs in “Good Medical Practice” (about 75 in all), but it is not essential to drill down to this level of detail for revalidation.

The four domains are:

Knowledge, skills and performance
Safety and quality
Communication, partnership and teamwork
Maintaining Trust

Each domain has 3 attributes:

Knowledge, skills and performance

Maintain your professional development
Apply knowledge and experience to practice
Keep clear, accurate and legible records

Safety and quality

Systems to protect patients and improve care
Respond to risks to patient safety
Protect patients from risks posed by your health

Communication, partnership and teamwork

Communication skills
Work constructively with colleagues and delegation
Establish and maintain partnerships with patients

Maintaining Trust

Show respect for patients
Treat patients fairly and without discrimination
Act with honesty and integrity

The purposes of strengthened medical appraisal in the pilots

to support personal and professional development in an ongoing way throughout a doctor’s career, taking into account the context within which they are working,
to support progress towards revalidation

What should medical appraisal do?

Give focus and energy to professional development
Encourage reflection
Encourage synthesis of lessons from the past
Encourage and challenges development of skills
Direct planning for the future
Ensure the individual has time to consider their own needs
Ensure the individual has time to consider service needs

What were the differences in strengthened medical appraisal in order to support revalidation?

Prior to the appraisal, the appraisee was asked to collect supporting information throughout the year and share that in a revalidation portfolio, plus any other supporting information that they wished to use during the appraisal discussion.

The appraiser was asked to assess the supporting information before the appraisal meeting ever took place. There was a facility to let the appraisee know in advance if there was an issue with any of the supporting information so that it could be put right before the appraisal.

The appraisee was asked to “map” supporting information against the attributes

The appraisee was asked to self assess performance in practice and the quality of the supporting information against each of the attributes

The appraisee was asked to sign off various statements covering areas relating to probity and health

The appraisal discussion was still confidential, formative and developmental (when it wasn’t dominated by the Revalidation Pilot Toolkit and technical issues)

At the end of the appraisal, the appraiser and appraisee agreed a summary of the discussion and a PDP that derived from the priorities discussed

The appraiser then signed off four statements:

The appraiser confirmed that there were no immediate concerns about patient safety in the evidence presented, including the discussion
The appraiser made a statement about whether or not the appraisee appeared to be “on track” to revalidate for the stage of the revalidation cycle and the circumstances in which the appraisee was working
The appraiser signed off the objectives on the previous year’s PDP (not completing an objective was acceptable as long as it was justified and not a recurrent issue)
The appraiser formally confirmed that the PDP was appropriate to the learning needs that arose from the discussion

Some of the elements of strengthened medical appraisal were felt to be too arbitrary or confusing or time consuming to carry forward into revalidation. The specific statements are being reviewed to see what the most appropriate declarations by the appraisee and statements by the appraiser as outputs of the appraisal discussion should be. It seems likely that the structure will be simplified and the wording will be refined as a result of the pilot work.

Useful resources:

<http://www.revalidationsupport.nhs.uk/>

<http://www.rcgp.org.uk/_revalidation/revalidation_guide.aspx>

<http://www.gmc-uk.org/>

NHS Revalidation Support Team: November 2009

Please have a look at a proposal paper for piloting from the NHS Revalidation Support Team

Strengthening NHS Medical Appraisal to Support Revalidation in England

Welcome to Wessex Deanery

Medical Appraisal and Revalidation

NHS Revalidation Support Team: November 2009