Appraisal & Revalidation

Dr. Alastair Baker

Responsible Officer, MAAR Gateway Ltd.

ro@maargateway.com

Some history Daniel Ubani was on his first UK shift as a locum when he injected Mr Gray suffering from renal colic with 100mg of diamorphine – 10 times the recommended maximum dose on 16 February 2008.

On 31 January 2000, a jury found Harold Shipman guilty of 15 murders. He was sentenced to life imprisonment and the judge recommended that he never be released. An inquiry concluded the probable number of Shipman's victims between 1971 and 1998 was 250. In total, 459 people died while under his care, but it is uncertain how many of those were victims, as he was often the only doctor to certify a death.

Bristol inquiry set up in 1998 to investigate the deaths of 29 babies undergoing heart surgery in the late 1980s and early 1990s, It provided a blueprint for wider reform of the NHS, lifting the lid on an "old boy's" culture among doctors; patients being left in the dark about their treatment; a lax approach to clinical safety; low priority given to children's services; secrecy about doctor's performance, and a lack of external monitoring of NHS performance.

Etc. etc. (Wikipedia)

What is revalidation?

Revalidation of doctors is a key component of a range of measures designed to improve the quality of care for patients; it is the process by which the General Medical Council will confirm the continuation of doctors’ licences to practise in the UK. The purpose of revalidation is to assure patients and the public, employers and other healthcare professionals that licensed doctors are up to date and fit to practise.!It is UK Law:!GMC (License to Practice) Regs Order of Council 2009!Came into effect 3/12/2012!!

Changes the nature of being a UK doctor!

• Revalidation

• Appraisal

• 360 (= multisource) feedback (MSF)

• Personal Development Plan (PDP)

• Designated body / Prescribed Connection

• Responsible Officer (RO)

• Good Medical Practice Framework

• (Annual) appraisal portfolio

• GMC connect

A few definitions

• Key point in formative cyclical process for personal

improvement

• Annual - on ‘appraisal date’ • Compulsory to hold a license to practice in the UK

• Based on development of the old appraisal process

• Added components focus on communication,

patients, feedback, SIs

• An opportunity for personal development

• A positive challenge

What is appraisal?

• A test

• A trial

• An examination

• Performance management

• A tick box exercise

• A last minute job

• The same as licensing elsewhere

What is appraisal not?

• Engagement

• Reflection

• Evidence

Key Aspects

Appraisal

• A yearly structured process of:

• Collecting & preparing evidence

• Feeding in external information

• Reflection and comparison

• Constructive discussion with a trained

appraiser

• Creating a PDP

• Signing off

• 1. Communication, partnership and teamwork

• Communicate effectively

• Work constructively with colleagues

• Establish and maintain partnerships with

patients

• Examples of evidence = MSF, feedback from patients, complaints and compliments.

GMP Framework

• 2. Maintenance of trust

• Show respect for patients

• Treat patients and colleagues fairly and

without discrimination

• Act with honesty and integrity

• Examples of evidence = MSF and personal statements

GMP Framework

• 3. Knowledge, skills and performance

• Maintain your professional performance

• Apply knowledge and experience to

practice

• Keep clear, accurate and legible records

• Examples of evidence = CPD record, MSF, teaching

GMP Framework

• 4. Safety & Quality

• Put into effect systems to protect patients

and improve care

• Respond to risks to safety

• Protect patients, colleagues from any risk

posed by your health

• Examples of evidence = clinical audit, clinical outcomes, case reviews critical incidents

GMP Framework

•  3-6 Items

•  Aim towards accepted (e.g. College) standards

•  Specific: i.e. well defined.

•  Measurable: Use numbers, dates and times to represent clear objectives.

•  Achievable: Ask yourself, do you have the resources to achieve this objective?

•  Realistic (or Relevant): How important is the goal? Do you need to make it more realistic? Is it achievable in the time?

•  Time-bound: Give a deadline for achieving your goal.

Personal Development Plan (PDP)

•  Any previous appraisal in any format that was signed off

•  360 degree feedback (within 1 year)

•  Notes, letters, affidavits, references, feedback

•  Certificates, CPD printouts, attendance forms

•  Reflective writing esp. related to events

•  Clinical letters, notes entries - anonymised

•  Make sure they are named, dated, relevant and

attributable

•  UK relevant and majority UK based

What counts as evidence?

• Good Medical

Practice

Framework for

Appraisal and

Revalidation

(GMC, 2011)

www.gmc-uk.org/

doctors/

revalidation/

revalidation_gmp

_framework.asp

The MAG form

• MAAR Gateway dynamic PDF takes you through it

• Evidence ALL professional roles & times - paid or

not

• Evidence statements of achievements

• Evidence PDP plans where necessary

• Evidence feedback with reflection

• Sign statements completeness, health, probity

• Misleading/dishonest information = non-engagement

The Appraisal Portfolio

•  Doctors fill in appraisal PDF (on line)

•  Doctors upload evidence as JPEGs etc. and submit as

portfolio

•  Appraisal and date is organised between doctor and

appraiser

•  Appraiser reviews submissions for completeness (in time)

•  - may return any application to doctor for further attention /

information

•  Doctor and appraiser agree PDP and sign off

Process

• Read ‘Good Medical Practice Framework’ • Identify their DB and RO

• Assemble a portfolio based on MAG with

evidence including events

• Reflect on their achievements benchmark

• Reflect on ALL their needs especially feedback

• Demonstrate full engagement

• Build annually on previous appraisals

What the doctor needs to do

• Review portfolio & evidence from doctor

• Create a list of questions/issues to consider at

appraisal

• Prepare suggestions for PDP

• Ensure appropriateness of appraisal interaction

•  Look for evidence of reflection and engagement

• Discuss portfolio to create PDP with doctor

• Challenge

• Sign off appraisal if no concerns

What the trained appraiser will do

Concerns

• Anything that represents a risk to patients,

employers/Trusts, staff or doctor him/herself

• Lack of reflection/insight

• Lack of engagement - e.g. defensive

• Inadequate/conflicting evidence

• Poor communication skills

• Arrangements - plan ahead

• Equipment

• IT - Broadband

• Environment

• Identification

• and MAAR Gateway suggestions

• 1 in 5 ‘live’ appraisals

The SKYPE interview

• About 5 SMART commitments

• Specific stated tasks and outputs

• Time line stated

• Relevant to any professional (e.g. college)

recommendations - particularly CPD

• Concordant with contexts of current and future

employment

• Unreserved agreement between doctor and

appraiser

The PDP output and signing off

A few comments

• How many appraisals for revalidation?

• How do I determine my Designated Body?

• How long do I need to work in the UK/year?

• How much evidence can come from outside UK?

• What is Duty of Candour?

• Is deferral a stigma?

• How should I use reflection?

• What information can I get from the GMC?

• What if I don’t agree?