The RCGP Guide to the Revalidation of General Practitioners

Transcription

1 The RCGP Guide to the Revaidation of Genera Practitioners Version 8.0 September 2013 CPD & Revaidation

2 Version 8.0 September 2013 The RCGP Guide to the Revaidation of Genera Practitioners

3 The Roya Coege of Genera Practitioners was founded in 1952 with this object: To encourage, foster and maintain the highest possibe standards in genera practice and for that purpose to take or join with others in taking steps consistent with the charitabe nature of that object which may assist towards the same. Among its responsibiities under its Roya Charter the Coege is entited to: Diffuse information on a matters affecting genera practice and issue such pubications as may assist the object of the Coege. Roya Coege of Genera Practitioners 2013 Pubished by the Roya Coege of Genera Practitioners Euston Square, London NW1 2FB A rights reserved. No part of this pubication may be reproduced, stored in a retrieva system, or transmitted, in any form or by any means, eectronic, mechanica, photocopying, recording or otherwise without the prior permission of the Roya Coege of Genera Practitioners. Pease note: this document is intended as the definitive guide to revaidation for genera practitioners. It is continuay evoving in the ight of poicy decisions from the Genera Medica Counci, Departments of Heath and the Academy of Medica Roya Coeges. If you wish to refer to it, we strongy recommend that you downoad the document from the RCGP website where the atest version wi be posted.

4 Contents Acknowedgements v Revaidation summary 1 How revaidation wi work 4 Genera information: providing context to what you do in a areas of your professiona practice 11 Keeping up to date: maintaining and enhancing the quaity of your professiona work 15 Review of practice: evauating and improving the quaity of your professiona work 16 Feedback on practice: how others perceive the quaity of your professiona work 22 Other sources of advice 28 Gossary 31

5 Acknowedgements The RCGP acknowedges the work of the many peope who generousy aowed their documents to be used to create The RCGP Guide to the Revaidation of Genera Practitioners. It is based on the RCGP s Revaidation Criteria, Standards and Evidence and this, in turn, was based on the GMC s Framework for Appraisa and Assessment. Other sources used incude the GMC s Good Medica Practice, Good Medica Practice for Genera Practitioners, Essentia Evidence to Support Appraisa from the Wesh Deanery, the Leicester 2007 conference statement on Evidence for Medica Appraisa, Appraisa Evidence for Out of Hours GPs prepared by Dr Peter Berrey for NHS Education Scotand, the NHS Revaidation Support Team s Enhanced Appraisa Unified Form and RCGP Scotand s Revaidation Tookit. The Revaidation Support Team has given vauabe advice both to the RCGP and to the wider profession. Later editions of the Guide were deveoped in ine with the GMC s Supporting Information for Appraisa and Revaidation guidance and the Academy of Medica Roya Coeges Supporting Information for Appraisa and Revaidation: core guidance framework. The Revaidation Support Team s Medica Appraisa Guide (MAG) shoud be considered an essentia adjunct to this guide. We woud aso ike to acknowedge the input of the RCGP Speciaty Advisers in the deveopment of version 8.0 of the Guide, and that of a number of stakehoders, particuary the BMA Genera Practitioners Committee (and Sessiona GP Subcommittee) and Dr Di Jeey and Dr Paua Wright from the Northern Deanery. We woud aso ike to thank individua GPs who have contacted us with questions, comments and concerns, and heped deveop the Guide around identified information needs.

6 Revaidation summary Revaidation is the process by which icensed doctors are required to demonstrate on a reguar basis that they are up to date and fit to practise. Revaidation aims to give extra confidence to patients that their doctor is being reguary checked by their empoyer and the Genera Medica Counci (GMC). Revaidation started in December By March 2016 it is expected that virtuay a icensed doctors wi have been revaidated for the first time. In most circumstances, icensed doctors wi revaidate at 5-year intervas after their first revaidation. 1 This section summarises what most GPs need to know for their revaidation. You wi have been icensed to practise by the GMC. For estabished doctors these icences were issued in November Most icensed doctors have a connection with one organisation that wi provide them with a reguar appraisa and hep them with revaidation. This organisation is caed a designated body. Each designated body has a responsibe officer who wi make a recommendation about you to the GMC normay every 5 years after your first revaidation that you are up to date, fit to practise and shoud be revaidated. If you are on an NHS Performers List, your designated body is the UK primary care organisation (PCO) 2 that manages the ist you are on. 3 If you are a GP in Engand working in the NHS, your designated body is NHS Engand and your responsibe officer is based in one of the 27 Area Teams. 4 If you are not working in an NHS PCO, you are ikey to have a connection to one of a number of non-nhs designated bodies. The GMC provide a ist of designated bodies. 5 If you are in training in Scotand, your designated body is NHS Education for Scotand. If you are training in Waes or Northern Ireand, your designated body is your postgraduate deanery. If you are training in Engand your designated body is one of the 13 new Loca Education and Training Boards (LETBs) known as, for exampe, Heath Education North West. Your revaidation recommendation wi be made by your postgraduate dean based upon your training activities and Annua Review of Competence Progression (ARCP) submissions. You do not need to coect additiona supporting information. 1. See 2. The acronym PCO is used throughout this document to denote NHS Area Teams in Engand, NHS Boards in Scotand, Heath and Socia Trusts in Northern Ireand and NHS Heath Boards in Waes. 3. The exception woud be if you are on an NHS Performers List but the majority of your practice is with the armed forces, in which case your designated body woud be the service that you practise in, either the Army, Roya Air Force or Navy. Simiary, GPs who spend the majority of their time working for the Foreign and Commonweath Office (FCO) woud have a prescribed connection to that organisation. 4. As above, this woud not appy if the majority of your practice was with the armed forces or FCO. 5.

7 2 version 8.0, september 2013 A sma number of GPs wi not have a connection to a designated body. The GMC can accept recommendations about doctors who do not have a responsibe officer from a suitabe person. 6 This is somebody who performs the same function as a responsibe officer. You shoud contact the GMC if you beieve you fa into this category. If you do not know your designated body, you shoud use the GMC s onine hep toos in the first instance and contact the GMC if you are sti uncear. 7 A doctors with a icence to practise are required to participate in revaidation. Doctors who are working whoy outside of the UK shoud consider reinquishing their icence. 8 The GMC wi have given you a date for your first revaidation. If you have not received a date, then you need to contact the GMC. In order to recommend you for revaidation your responsibe officer wi need to be satisfied that: o you have participated in an annua appraisa process that has covered your fu scope of work, and that you and your appraiser have signed off appraisas that have had Good Medica Practice as their focus since the start of revaidation in December 2012 o you have brought to your appraisas appropriate supporting information (see Tabe 1) o there are no unresoved concerns about your performance as a doctor. If your appraiser thinks that your eigibiity for revaidation is in doubt, he or she shoud seek advice from your responsibe officer so that things can be put right if possibe; revaidation is a continuous process, not a high-stakes examination at a fixed point in time. When your date for revaidation comes due, your responsibe officer can recommend to the GMC that your icence is continued (in other words that you are revaidated); that the decision is deferred; or that it is impossibe to make a recommendation because you have not engaged with the process. A responsibe officer can notify the GMC that a doctor is not engaging with the revaidation process at any time; he or she does not need to wait unti a doctor s recommendation is due. The vast majority of doctors wi be recommended for revaidation and the GMC (which makes the fina decision) wi continue your icence; you wi then be tod when you wi need to be revaidated again usuay after a further five years. A these points are covered in more detai in the rest of this Guide, as is advice for those GPs whose circumstances are not standard. Key things to do now Ensure that you have a responsibe officer if not, inform the GMC. 9 Ensure that your annua appraisas are conducted propery with Good Medica Practice as their focus. Use an eectronic portfoio or MAG form to coect your supporting information for appraisa and revaidation. Record your CPD and PDP objectives and outcomes. If you haven t participated in a Patient or Coeague Feedback survey in the past two years, pan to do one. Ensure that you are participating in annua quaity improvement activity, providing SEAs or individua case reviews each year. If you haven t competed a fu-cyce cinica audit or quaity improvement project since Apri 2011, pan to do one. 6. See

8 RCGp GuiDe to the RevALiDAtion of Gps 3 Tabe 1: Summary of supporting information recommended for appraisas before your revaidation date Supporting information Quantity Genera information persona detais At a minimum, reevant to the period from December 2012 scope of your work Record of annua appraisas persona Deveopment pans (pdps) probity decaration Heath decaration Keeping up to date Continuing professiona deveopment (CpD) At a minimum, 50 earning credits each year from the start of revaidation in December 2012 Review of your practice Annua quaity improvement activity, to incude significant event audits (seas) (or individua case reviews) At east two quaity improvement activities are required each year. these can be seas 10 or individua case reviews. the GmC requires ALL significant adverse events to be incuded in your appraisa portfoio. must be reevant to scope of work Cinica audit or quaity improvement project Feedback on your practice Coeague feedback patient feedback Forma compaints once per revaidation cyce. must be reevant to scope of work one of each in the five years before your revaidation recommendation, and each must be reevant to the scope of your work at the time of revaidation After their first revaidation, doctors may consider coecting coeague and patient feedback in the first three years of the cyce to aow time for foow-up questionnaires if issues are identified A description of any forma compaints (incuding compaints that have activated a practice/organisation s compaint procedure) and your response to them in the period since December In the GMC document Supporting Information for Appraisa and Revaidation, the term Significant Events refers to critica or serious untoward incidents in a secondary care setting. It is carified, however, that in genera practice Significant Event Auditing is used to describe case reviews (as described in an earier section of that document) and is used to iustrate events that may not have a serious outcome but highight issues which coud be handed with greater cinica effectiveness and patient safety, and from which essons coud be earnt.

9 How revaidation wi work background The GMC introduced icences to practise in November A registered doctors were given the opportunity to request a icence to practise; a doctors eigibe for registration with the GMC since November 2009 have aso been icensed. From its introduction, the GMC icence rather than GMC registration signifies to patients that a doctor has the ega authority to write prescriptions and sign death certificates etc. GPs working in the NHS, either on a permanent or ocum basis, wi need to be: icensed by the GMC isted on the GMC s Genera Practice Register incuded on an NHS Performers List. Ony icensed doctors are subject to revaidation. In common with a doctors, GPs wi need to be reicensed periodicay. This is being achieved through a process caed revaidation, for which GPs provide supporting information that shows that they are keeping up to date and remain fit to practise. Revaidation is not concerned with the GMC s Speciaist or Genera Practice Registers, ony the doctor s icence. This means that GPs who are no onger in active cinica genera practice but who are active as doctors (for exampe those in medica management, occupationa heath or doing referra surgica procedures) wi continue to be on the Genera Practice Register, but wi be revaidated for what they do. In order for doctors to maintain their icence to practise they are expected to have annua appraisas based on the GMC s core guidance for doctors, Good Medica Practice. 11 Revaidation invoves a continuing evauation of doctors fitness to practise and is based on appraisa and oca systems of cinica governance. The GMC has set out its generic requirements for medica practice and appraisa in three main documents: Good Medica Practice 12 Good Medica Practice Framework for Appraisa and Revaidation 13 Supporting Information for Appraisa and Revaidation

10 RCGp GuiDe to the RevALiDAtion of Gps 5 For doctors in Engand, the GMC guidance shoud be read in conjunction with the NHS Revaidation Support Team s MAG document, which is designed to hep doctors understand what they need to do to prepare for and participate in annua appraisa. Equivaent guidance to MAG exists in the devoved countries of the UK. The RCGP has the responsibiity to support the above documents with speciaty specific guidance for GPs and to give advice to responsibe officers on the interpretation of our guidance. A Roya Coeges and facuties have agreed a core set of supporting information for revaidation, 15 and GPs are not being asked for any more or any ess than other doctors. Changes in this eighth edition of the RCGp guide to revaidation The key changes to this version (Version 8.0) of the Guide are as foows. Changes to primary care structures in Engand are refected, as is the fact that revaidation has commenced. We have removed the recommendation that a responsibe officer shoud be abe to consider a portfoio for recommendation if a minimum of 200 cinica sessions are documented over the 5-year revaidation period. Instead, we woud emphasise that consideration shoud be made at appraisa as to whether a doctor is up to date and fit to practise in a aspects of his or her work. We have removed the concept of standard and non-standard practice, pacing emphasis instead on scope of work. The Review of Practice section has been substantiay revised in order to refect the many forms that quaity improvement can take, depending on the working context of the GP. We have revised the Feedback on Practice section to give further carity on the processes for coecting coeague and patient feedback. We have referenced a number of new RCGP revaidation web resources, hosted on the RCGP Additiona Revaidation Resources web page. 16 Your position in 2013 A doctors undertaking cinica work in the UK must hod a GMC icence and have a connection to a responsibe officer (or suitabe person ). In addition a those GPs working in the NHS must be on a Performers List and be on the GMC s Genera Practice Register. Doctors in non-cinica practice may be required to have a icence depending on the empoyment requirements of their organisation. If you do not have an attachment to a designated body and responsibe officer, the GMC wi advise you on how to make a connection. If you are not currenty working in the UK but start to do so in the future, you wi be attached to either an NHS or other designated body at the time you start working here. If you are not working in the UK, the GMC woud recommend that you consider giving up your icence unti you return to the UK. You can however choose to remain on the GMC s register, athough that does not give you the rights of a doctor such as prescribing. When you wish to return to work as a doctor in the UK, you wi need to re-appy to the GMC for your icence to practise you are entited to a icence on the basis of your quaifications uness there are unresoved concerns about your practice. 17 Then you wi need to become attached to a designated body and responsibe officer

11 6 version 8.0, september 2013 You shoud be experiencing an annua appraisa with an appraiser who is trained and approved by the designated body. the revaidation timetabe The GMC has given a doctors a date for their revaidation. If you have not received your date, contact the GMC as soon as possibe. In the first four months (December to March 2013) the responsibe officers and other doctors in eadership roes were revaidated. The ro out of revaidation started in Apri 2013 and the intention is that the vast majority of doctors wi be revaidated for the first time by March the revaidation process You need to ensure that each of your annua appraisas covers the requirements for revaidation, and that you are sharing the required supporting information with your appraiser. Your appraiser is key to your revaidation. Your appraiser reviews your supporting information with you and offers your responsibe officer reassurance that your supporting information and your refection on it are appropriate. Your responsibe officer is required by aw to deiver effective annua appraisas, cinica governance and revaidation oversight to the doctors within your designated body. Your responsibe officer wi need to be continuousy satisfied that there are no unresoved concerns about your practice or that if there are any concerns they are being managed appropriatey. The responsibe officer shoud not wait unti your revaidation date to act on any concerns; rather any concerns shoud be addressed as soon as they become apparent. Revaidation is a continuous process to protect the pubic and promote better practice, not a once in 5 years test. However, your responsibe officer is required to make a revaidation recommendation to the GMC when your revaidation date becomes due. He or she wi recommend revaidation if your appraiser and you have signed that your appraisa has been propery conducted and if there are no oca unresoved concerns about your performance. When your responsibe officer makes a positive recommendation to the GMC, the GMC wi check their fies and, provided they have no concerns, they wi normay revaidate you. However, it is important to note that the definitive revaidation decision ies with the GMC, not your responsibe officer. Your responsibe officer wi have two other choices concerning your revaidation. In addition to a positive recommendation, he or she can request a deferra of the recommendation because there is a need for more information (e.g. after a period of sick eave or maternity eave) or the competion of a oca performance process. He or she can aso notify the GMC that you have faied to engage in the oca processes and systems, such as appraisa, which support revaidation. A responsibe officer can notify the GMC of a doctor s non-engagement at any point in the revaidation cyce. How you shoud coect and store your supporting information for revaidation Athough some GPs sti present information to their appraiser on paper, most are now submitting their appraisa information eectronicay and storing their supporting information in an eectronic portfoio or form. There are a number of resources avaiabe for GPs to store and

12 RCGp GuiDe to the RevALiDAtion of Gps 7 submit their appraisa revaidation, incuding the RCGP Revaidation eportfoio, 18 the Revaidation Support Team s MAG Mode Appraisa Form and those from other commercia tookit providers. The RCGP and the British Medica Association (BMA) Genera Practitioners Committee (GPC) have agreed that GPs shoud have a choice of the portfoio they use (if they have chosen to use one), as ong as the resource used faciitates the storing, submission and receipt of the information required by the GMC for appraisa and revaidation. scope of work Licensed doctors must provide supporting information that covers the fu scope of their work. The GMC describes six types of supporting information that doctors are expected to provide and discuss at their appraisa: 19 CPD quaity improvement activity significant events feedback from coeagues feedback from patients review of compaints and compiments. With the exception for patient surveys for those who do not see patients, 20 doctors are expected to provide the information isted above and a portfoios have to refect the circumstances and context in which a doctor works, incuding extended roes (described in more detai in the Genera Information section of this Guide). The requirement to ensure that a doctor is up to date and fit to practise is the same for a doctors and the overa standard must be the same. However, the particuar roe of the doctor must be taken into account when deciding the precise nature of the supporting information. In a cases supporting information must meet the underying attributes that each area of supporting information is intended to demonstrate. Genera practice is a heterogeneous professiona group that incudes, among others, GP partners, ocums (some highy peripatetic), sessiona and empoyed doctors, GPs in secure environments, out-of-hours GPs (and those working in simiar cinica contexts such as in wak-in centres), GPs in the Defence Medica Services, private GPs and GPs who work in very remote or sma practices. Additionay, many GPs have portfoio careers, working in a variety of contexts. This Guide seeks to refect the diverse nature of genera practice in ater sections that address specific supporting information requirements. Furthermore, the RCGP has deveoped a seection of Exampe Portfoios that demonstrate how GPs in a diverse range of roes can show that they are meeting the requirements for revaidation. 21 non-cinica Gps Non-cinica GPs are a sma but important group, especiay prevaent in NHS management, academic practice and independent heathcare systems. These doctors must be in good standing with the GMC in order to undertake the work they do, but they may not be in active cinica practice for significant periods of time. If the doctor does any cinica work in the NHS he or she wi need to meet the Performers List requirements and demonstrate being up to date and fit to practise in his or her cinica roe The GMC recommends that doctors think broady about what constitutes a patient in their practice. If a doctor does not see patients he or she may consider coecting feedback from other sources, such as famiies and carers

13 8 version 8.0, september 2013 Non-cinica GPs wi submit a portfoio to their responsibe officer that demonstrates that they are fit to undertake their non-cinica roes. This wi incude supporting information in a areas except patient surveys athough the GMC recommends that doctors think broady about what constitutes a patient in their practice (e.g. a GP educator may seek feedback from trainees or students). This wi incude evidence of satisfactory annua appraisa, PDPs agreed and reviewed, and evidence that they are keeping up-to-date in their area of practice. They shoud submit a coeague survey and a description of any cause for concern or forma compaint. They shoud provide a statement on probity and heath, and documentation that meets the requirements of extended practice. For doctors who undertake very imited cinica work, they need to be abe to demonstrate that they are up to date and fit to practise in the cinica component of their work with appropriate CPD, quaity improvement activity and refection. Gps working part time Part-time GPs need to maintain their skis at the same eve as their fu-time coeagues. They wi normay be expected to submit a fu portfoio, with any notes reating to specia circumstances that have affected the amount of information coected, such as maternity eave or i heath. Gps taking a break from uk practice Doctors who continue to hod a icence to practise whie working overseas and outside a UK designated body wi need to revaidate if they wish to keep their icence. They wi need to remain connected to a UK organisation that wi support them in their appraisa and revaidation. 22 In most cases, supporting information for revaidation wi need to be coected within the context of the NHS or a UK designated body, such as the Defence Medica Services. However, utimatey the responsibe officer wi make a decision as to whether supporting information coected outside a UK setting can be reied upon for the purposes of revaidation. It is recognised that some doctors have roes that wi require them to work overseas for some periods in the revaidation cyce. We woud advise that such doctors discuss their revaidation with their responsibe officer or appraiser. Doctors shoud, where possibe, maintain their CPD whie working abroad and keep up to date with evidence-based guideines etc. in the UK as this wi hep them on their return. Doctors who do not undertake any work in the UK might want to consider whether they shoud reinquish their icence to practise. 23 Such doctors can remain registered without a icence whie overseas, and this wi indicate that they are in good standing with the GMC. When the doctor pans to return to UK practice he or she can appy for the icence to be restored the icence is an entitement based on quaifications provided there are no unresoved concerns. The doctor may, however, be required to be revaidated within, say, two years. It is important that doctors provide the GMC with an up-to-date contact address at a times. If a returning doctor wishes to be entered on a Performers List and to start working as a GP, the PCO may want evidence that the doctor is suitabe. In reaity this woud normay mean that, after sustained absence from cinica genera practice in the UK, a doctor woud require an assessment that may indicate the need for a targeted re-entry educationa experience before returning to cinica genera practice. If a GP has been working in, for exampe, New Zeaand as a GP, his or her re-entry education may be soey to re-famiiarise that doctor with the UK heath service, such as evidence-based cinica guideines, pathways and referras, safeguarding vunerabe peope, etc. At present, if a doctor has not been in cinica practice for two years or more, a

14 RCGp GuiDe to the RevALiDAtion of Gps 9 forma re-entry or returners scheme is required. The Committee of Genera Practice Education Directors (COGPED) recommends a re-entry assessment and a course in an approved setting after a GP has had an absence from UK genera practice for a period of two years or more. It is the duty of the doctor to ensure that he or she is safe to return to UK genera practice, whether foowing work overseas or for other reasons, and responsibe officers must estabish systems to evauate and support doctors to ensure their safe return to the workpace. NHS Engand is deveoping a poicy for entry and management of the Engand Performers List that is expected to introduce a standardised approach to re-entry across Engand. There are many doctors who wi be absent from UK cinica genera practice for periods of two years or ess due to pregnancy, iness, career breaks, sabbaticas, working abroad or taking on non-cinica roes. The revaidation process is designed to be fexibe and accommodate these circumstances. A responsibe officer wi consider any portfoio submitted but may make a decision to defer revaidation unti he or she fees there is sufficient supporting information. The responsibe officer may consider: the environment in which the GP has worked and whether the supporting information of cinica governance and annua appraisa from that environment can be reied upon the GP s earning credits both over the revaidation period and within each appraisa year the supporting information of annua appraisa, annua PDP and PDP review the supporting information of feedback from coeagues and patients (patient and coeague surveys) any assessment of cinica skis or knowedge any outcome from a re-entry programme. Utimatey the revaidation decision wi be taken by the GMC based on the information avaiabe to it, incuding the opinion of the responsibe officer. Gp registrars whose icence becomes due for renewa The introduction of revaidation means that the Postgraduate Dean, as responsibe officer, wi be in receipt of any reevant information about trainees that reside with their empoying organisations(s). Through the use of an enhanced Form R, this information is avaiabe to the ARCP panes so that any issues or concerns can be recorded and monitored. The majority of GP trainees wi revaidate at the point of Certificate of Competion of Training (CCT) via their fina ARCP pane. 24 Fu engagement in Workpace-Based Assessment is ikey to suffice. In most cases, GPs wi revaidate 5 years after CCT. If, however, a doctor takes onger than 5 years to compete training from the point that they are icensed, the Postgraduate Dean woud (in most cases) make a recommendation to the GMC prior to the competion of CCT and again at competion of CCT. 25 organisationa and peer support One key aspect for peripatetic ocums and doctors who work in out-of-hours services or in wakin centres is the frequent absence of organisationa and peer group support. The empoyers of GPs who work as ocums or in out-of-hours services have a responsibiity to incude a doctors working for them in educationa activities. They aso need to share their own quaity assurance processes with the GPs they empoy. An exampe of this is the audit of teephone consutations that out-of-hours providers shoud be carrying out. Information from this audit can be used by GPs in their professiona deveopment and as a supporting documentation for revaidation. 24. In order to accommodate changes in the CCT date, revaidation occurs approximatey 60 days foowing CCT

15 10 version 8.0, september 2013 The RCGP is supportive of the deveopment of mechanisms to reduce the professiona isoation that many of these doctors experience. The modes for this that have been identified incude the foowing. Genera practices, federations and out-of-hours organisations that frequenty empoy GPs on short-term, sessiona contracts must recognise their responsibiity to a their empoyees, incuding these doctors. They shoud inform and invove the doctor in any significant event or compaint that reates to them; they shoud faciitate access to the cinica records of patients treated by these doctors for the purposes of cinica audit and quaity improvement; and they shoud support the conduct of patient surveys. Professiona organisations that support the working ives and professiona deveopment of peripatetic ocums are becoming more estabished. The Nationa Association of Sessiona GPs ( has deveoped the chambers mode through which contracts, bookings, education and quaity assurance are supported coectivey by other ocum doctors. Other organisations such as the North-East Sessiona GP Group ( act as an information forum in a specific area, advertising oca educationa events, running educationa meetings and providing space for ocums and practices to advertise. The GPC s Sessiona GP sub-committee ( genera-practitioners-committee) considers and reviews a matters affecting saaried and ocum GPs, incuding revaidation, and provides reguar updates. Educationa groups (ocum groups, sef-directed earning groups, etc.) are aso deveoping. In these, doctors working outside supportive organisations in an area meet to share experience and to earn together. Such educationa groups may we be virtua if that works for the participants. Athough there are some circumstances in which such mechanisms are impractica, it is the view of the RCGP that a GPs need to consider how they achieve peer support to prevent professiona isoation. For some this is a supporting practice; for others it may be a singe-handed doctors group, a new practitioners group, a chambers or an educationa group. Doctors who work in professiona isoation miss out on many of the benefits of working in a team. They have fewer opportunities for peer support and to receive informa feedback, and fewer chances to exchange new information, which may make them fee disconnected from the profession and may make them more vunerabe to stress, exhaustion and burn-out. Importanty, the ack of opportunities to discuss day-to-day cinica work resuts in missed opportunities to benchmark their practice against that of their peers a key mechanism that operates informay amongst more connected doctors in maintaining standards. This may aso ead to them finding it more difficut to identify areas in which they coud improve their knowedge and care standards. One potentia benefit of revaidation activities may be the encouragement of inter-professiona inking and joint earning throughout the revaidation cyce. supporting information for revaidation: overview As described in the GMC s document Supporting Information for Appraisa and Revaidation and the Academy s Supporting Information for Appraisa and Revaidation: guidance for genera practitioners, 26 your supporting information, grouped into four main headings, is as described in Tabe 1 (see p. 3). It is important to note that, even in the first cyce of revaidation, the GMC expects responsibe officers to be satisfied that supporting information has been seen at appraisa for a areas. This Guide wi now ook in detai at what is required for each item of supporting information Supporting-information-for-appraisa-and-revaidation-for-GPs.ashx.

16 Genera information Providing context to what you do in a areas of your professiona practice persona detais Your revaidation portfoio shoud incude the foowing detais: tite and name emai address work address and teephone number preferred contact address and teephone number primary medica degree and awarding institution professiona and medica quaifications GMC number, registration date, icence date and date of entry onto the Genera Practice Register date of ast revaidation (when appicabe). scope of work You need to record your professiona roes and update your entries annuay. This shoud incude: a current posts and those within the revaidation period date started, time commitment, contracting authority or empoyer (incuding address); if cinica, whether within an organisation with a quaity-assured system for cinica governance; 27 roe content/description and performance review/appraisa within this post any vountary roes undertaken in the capacity of a doctor and which requires you to have a icence to practise to carry out the roe free-text eaboration of any unusua supporting information. Revaidation is based on what a doctor actuay does in practice. In order for appraisers and responsibe officers to understand what the GP does, a posts undertaken as a doctor, whether paid or not, must therefore be incuded. GPs in the Defence Medica Services, for exampe, need to provide detais of their extended responsibiities in cinica areas. These may incude pre-hospita emergency medicine, occupationa medicine, trave medicine, sports and exercise medicine, pubic heath, environmenta heath, aviation medicine, diving medicine and miitary community psychiatry. For sessiona doctors who ocum for mutipe providers over the revaidation period there is no 27. Organisations with quaity-assured systems for cinica governance wi incude: the NHS; independent providers of primary care such as the Defence Medica Services and the Prison Service; and PCO-endorsed out-of-hours providers.

17 12 version 8.0, september 2013 requirement to specify every one in which they worked. Instead they are expected to give the dates and sessions over which they have been working, practices/organisations in which they have worked reguary or frequenty, and to indicate the genera nature of the roe(s) they have undertaken. For most, the atter wi be cinica primary care in undifferentiated genera practice consutations but you shoud aso describe other medica roes if appropriate. This area of recording is aso used for two other types of supporting information: detais of extended practice any exceptiona circumstances. Extended practice is: an activity that is beyond the scope of GP training and the MRCGP, and that a GP cannot carry out without further training (e.g. surgica services); or an activity undertaken within a contract or setting that distinguishes it from standard genera practice (such as work as a GP with a Specia Interest); or an activity offered for a fee outside of care to the registered practice popuation (teaching, training, research, occupationa medicas, medico-ega reports, cosmetic procedures, etc.). Some GPs wi indicate that they have nothing to incude in this supporting information area. However, many doctors do have areas of extended practice and they wi be required to demonstrate that they are fit for these roes. In essence extended roes are those for which the GP is remunerated on a reguar basis. They shoud not incude occasiona (ess than once a quarter) activity for which an honorarium is paid (such as deivering continuing education to coeagues or writing opinion artices), but shoud incude a cinica activities undertaken for which any payment is made. There is a group of common activities for which the supporting information shoud be straightforward: teaching of undergraduates a review of performance statement from the university department GP training a statement from the postgraduate organisation (deanery etc.) incuding the date and outcome of the ast trainer approva research (incuding coaboration in research studies) a statement from recognised research institution(s) invoved and a statement from the Research Governance Team in the oca PCO appraisers a record of annua review of their work as an appraiser out-of-hours work a statement from the out-of-hours provider that reguar reviews have been satisfactory GPs with a Specia Interest under contract to a PCO a statement from their contracting organisation that they have maintained accreditation for the roe. For other non-cinica activities a statement from a responsibe organisation wi normay suffice. For cinica activities, you shoud describe in detai the roe and provide supporting information that satisfactoriy answers the foowing three questions: 1. How did you quaify to take on this roe? This shoud incude prior experience, education and quaifications. 2. How do you keep up to date in this roe? This shoud incude reference to a new and refresher education or deveopment, and refresher education and training undertaken for this roe in the

18 RCGp GuiDe to the RevALiDAtion of Gps 13 revaidation period, incuding any earning credits recorded. 3. How can you demonstrate that you are fit to practise in this roe? This shoud incude appropriate audits of care deivered, incuding reference to any information from third-party observation of your work, and sign-off from an appropriate consutant/expert/coeague who knows your work. This section of the portfoio is aso the opportunity for you to expain any unusua aspects of your working ife during the revaidation period that may hep the appraiser and responsibe officer to understand and interpret your supporting information. There wi be an opportunity to record anything reevant incuding: proonged or significant iness career breaks incuding sabbatica or maternity eave periods working abroad (incuding for charities and non-governmenta organisations) important changes in working circumstances incuding the dissoution of a partnership or a move to another practice. This ist is not intended to be exhaustive there may be other circumstances that you may wish to incude. This supporting information area is used by appraisers and responsibe officers to provide context in evauating your portfoio. Annua appraisas A GPs are expected to take part in reguar annua appraisa and they must bring supporting information for their revaidation to their appraisa. A doctors on an NHS Performers List or working within an organisation with a quaity-assured system of cinica governance, incuding ocums, shoud receive administrative support in undertaking annua appraisas. If you experience significant probems, which are not resoved satisfactoriy with your PCO or empoyer, you shoud draw this to the attention of your responsibe officer at an eary point in the revaidation period and incude it in your portfoio as exceptiona circumstances. An annua PDP shoud be derived from participation in each annua appraisa. It shoud be signed off by you and your appraiser, and shoud represent the agreed pan for the forthcoming year. The portfoio shoud contain one PDP for each year in the period of revaidation. A PDP consists of a number of objectives. There is no minimum or maximum number of objectives. For exampe, a doctor setting the objective of achieving recognition as a vocationa trainer might regard that as a sufficient singe objective for a year; most GPs wi set themseves between three and five objectives that refect the breadth of their practice, responsiveness to the heath needs of their oca popuation, and their own deveopment needs. A objectives need to be SMART (Specific, Measurabe, Achievabe, Reaistic and Time-bound) athough some may, of necessity, be ess measurabe and time-bound than others. A vaid PDP must contain the foowing key eements for each objective: a statement of the deveopment need an expanation of how the deveopment need wi be addressed (the action to be taken and the resources required); objectives are more ikey to be achieved if consideration is given to severa ways of meeting them

19 14 version 8.0, september 2013 the date by which the objective wi be achieved the intended outcome(s) from the objective. For each PDP objective submitted there shoud be a coumn recording the outcome of the objective. The entries in this coumn shoud be agreed between the appraiser and the GP at the appraisa foowing the one in which the PDP was agreed. The entries reviewing the outcome of agreed objectives are ikey to refect the foowing: the fact that the objective has been competed and the extent to which the intended outcome from that objective has been achieved; or the fact that the objective has not been competed and an expanation such as: o the objective became irreevant due to changing circumstances in the year o the objective became unachievabe as the impications became cearer o the time for achieving the objective was agreed to be onger than the time to the next appraisa. It is very important that you refect on the objective, the deveopment achieved and any reasons for not achieving the objective. This refection is an important attribute of your fitness to practise. Over a 5-year period you shoud not ony consider cinica earning and deveopment but aso non-cinica competencies, which may incude eadership, management or teaching, recognising the importance of a a doctor s roes in the provision of a safe system of heath care for patients. statements on probity, heath and use of heath care You wi be asked to verify a standard statement or to provide an aternative statement. The standard statement wi cover: that there are no issues of probity in your work whether you have been suspended, had restrictions paced on your practice or been subject to an investigation since your ast appraisa whether your designated body or responsibe officer has requested you to bring specific information to your appraisa that there are no heath issues that might affect your abiity to deiver safe care to patients (incuding infections, immunisation status such as against hepatitis B, probems with drugs and acoho, menta heath concerns and other significant diagnoses or probems) a statement that you have a heath condition that is being treated adequatey and that your doctor has no concerns shoud be acceptabe that you are in a position to receive independent, impartia heathcare advice (for exampe you are not consuting a famiy member) 28 and that you access heath care appropriatey. Uness there is a good reason it is best practice for a GP to be registered in a practice in which he or she does not work that you have appropriate and current insurance or indemnity cover for a aspects of your work. You wi be asked to provide the name of the organisation providing insurance or indemnity cover and the membership number. 28. Paragraph 30 of the GMC s Good Medica Practice says: You shoud be registered with a genera practitioner outside your famiy.

20 Keeping up to date Maintaining and enhancing the quaity of your professiona work A medica roya coeges are using earning credit systems with a minimum of 50 credits in a year and 250 credits in a 5-year cyce to support a positive revaidation decision. However, unike other coege schemes, the RCGP credit system 29 is not purey based on time spent but aso refects the impact of earning. In essence, 1 hour of education accompanied by a refective record is 1 earning credit. However, if you can demonstrate to your appraiser that a particuar episode of earning was impemented in practice with positive benefit for patients, yoursef or the practice, you can caim 2 earning credits for each hour of such education. The RCGP Impact Tookit incudes severa exampes of ways in which impact can be demonstrated. 30 Your credits are sef-assessed and verified at appraisa. The pattern of credits shoud, over the revaidation cyce, refect the working ife of the GP. For exampe, a GP with a specia interest in respiratory medicine shoud have a mixture of genera practice and respiratory earning credits. You wi, therefore, be expected to record your educationa activity and award yoursef credits based upon the hours invoved and the impact of the education on yoursef, your patients or the service in which you work. Educationa activity can incude forma courses, ectures, seminars, sma group or practice-based earning events, onine earning, reading, earning a new ski, mentoring someone, action earning, becoming a trainer, doing individua refective activity, etc. A refective og of earning shoud satisfy an appraiser that each recorded activity was educationa. Over a revaidation cyce you wi be expected to demonstrate a broad range of genera practice education appropriate to the work you do, with at east 50 earning credits being achieved and confirmed by the appraiser each year

21 Review of practice Evauating and improving the quaity of your professiona work The GMC states that quaity improvement activities coud take many forms depending on the roe the doctor undertakes and the work that he or she does. The RCGP has defined SEA/case reviews and cinica audit as the core information to be incuded under Review of Practice. GPs who do not fee that it woud be feasibe for them to participate in cinica audit activity shoud produce aternative evidence of quaity improvement and discuss this with their appraiser. 31 Simiary, if it is not feasibe for a GP to submit SEAs because of his or her working circumstances, the GP may wish to incude individua case reviews that have been discussed with coeagues and demonstrate refection and earning in his or her portfoio instead. It is important that a GPs record and refect upon any serious cinica incidents in which they have been invoved. Most GPs are invoved with a broad range of quaity improvement activities, incuding case discussions and briefer reviews of cinica and other work, and these shoud aso be submitted. You shoud submit evidence of quaity improvement activity for every appraisa to show that you reguary review your practice and earn from events, concerns, errors, audits, etc. seas/individua case reviews Significant event auditing (aso known as earning event audits, critica incident anaysis or significant event anaysis) is a routine part of genera practice and is based on individua events or case reviews. Significant event auditing, as described here, is referred to by the GMC as case reviews. It is a technique to refect upon, and earn from, individua cases or events to improve quaity of care overa. The expectation is that you provide an anaysis of at east two significant events in which you have been directy invoved for each appraisa as a demonstration of annua quaity improvement activity. 32 Athough a significant event suitabe for auditing can be one that demonstrates a eves of care from exceent through to poor, for the purposes of revaidation each of the submitted events must demonstrate, through the anaysis, areas for improvement, refection and the impementation of change. You must ony submit an anaysis of a significant event in which you have been directy invoved, where the event was discussed with other coeagues. For practice-based GPs the expectation woud be that the discussion around a significant event woud occur within the practice-based team meeting (usuay an SEA meeting) with an appropriate 31. The RCGP Quaity Improvement Tookit contains exampes of quaity improvement activity other than cinica audit ( 32. RCGP Significant Event Tookit (