Revalidation Hints and Tips

`30/11/2015

Dr Janice Oliver, Local Appraisal Adviser for Greater Glasgow and Clyde and CPD Associate Adviser at NES, offers some handy tips on how to navigate through the GMC's requirements for revalidation with ease.

Revalidation is the process by which all licensed doctors must demonstrate that they are fit to practice on a five yearly basis. This means having an annual appraisal, during which doctors will discuss their practice and performance with their appraiser and use supporting information to demonstrate that they are continuing to meet the principles and values set out in the GMC's Good Medical Practice.

Appraisal will continue to be a supportive process, while allowing a doctor to provide supporting information to satisfy the requirements of revalidation.

What should we be doing now to prepare for revalidation?

Ensure that you have an annual appraisal and take the advice of your appraiser about what you will need to do to satisfy the requirements of revalidation, as they are all well informed.

Read the Health Board Revalidation newsletters and look at SOAR (Scottish appraisal website), RCGP and GMC websites, as they are very informative.

You should ensure that you are registered with GMC Online to ensure you receive up to date information from the GMC. http://www.gmc-uk.org

How does revalidation work?

The GMC has been communicating with doctors from December 2012 onwards to advise them of their exact revalidation date. This is the date by which the Board Responsible Officer has been making a recommendation to the GMC as to whether a doctor's licence to practise should continue. It is different from the appraisal date. Twenty percent of doctors are being revalidated from 1^st April 2013 to March 2014. Then forty percent in each of the next two years. Most doctors should have been Revalidated over this three year period.

The local Appraisal Advisor is being asked if a GP has engaged with appraisal and is on track for revalidation. This information, along with clinical governance information, is being used to inform the Responsible Officers decision. If a doctor is on track and there are no other issues of concern, the RO will make a recommendation to the GMC and the GP will receive a letter from the GMC advising that their licence has been renewed.There is no interview, no exam and no need to present large bundles of paperwork going back ten years.

What sort of evidence should we be gathering?

The supporting information gathered should reflect your different roles, your educational needs and demonstrate reflective practice.

Doctors should maintain a portfolio of supporting information demonstrating that they have collected and reflected on the following supporting information at an annual appraisal

(a) Continuous Professional Development, 50 credits per year.

(b) Quality Improvement Activity such as audit, case review or discussion or review of clinical outcomes. This can also include your MSF or patient questionnaire. You may also wish to bring along your QOF QP, Prescribing date, review of referrals etc. Audit is not compulsory

(d) Multisource Feedback ; colleague survey; the online tool available on SOAR is recommended; once every five years

(e) Patient Questionnaire - the CARE questionnaire is the preferred one. Care Measure Website www.caremeasure.org which allows collation of your CARE questionnaires and produces a summary report which can be uploaded onto SOAR; once every five years

(f) Review of complaints and compliments - if any

These should relate to the preceding 12 months with the exception of the Patient Questionnaire and Multisource Feedback which have been completed within 5 years of their revalidation date.

If you are in the first tranche of doctors being revalidated in 2013/14 or the second tranche in 2014/15, you should ensure that you have fulfilled the above for the appraisal prior to your Revalidation date.

If you are unsure you should contact your appraiser. Details of what is required for the initial revalidation is available on the GMC and RCGP websites-see links below.

What should I do if I haven't received my revalidation date?

You should contact the GMC. The GMC revalidation team can be reached on 0161 923 6277 (or +44 161 923 6277 from outside the UK), and by email at revalidation@gmc-uk.org

What are CPD credits and do we need to collect them?

It is a requirement of revalidation that doctors demonstrate that they keep up to date, that this is relevant to their practice, and that they can demonstrate reflective learning.

The RCGP credits system is a method of recording this.

http://www.rcgp.org.uk/revalidation-and-cpd/cpd-credits-and-appraisal.aspx

The RCGP recommends 50 credits in order to demonstrate that we are keeping up to date. They have produced a document which is quite helpful:

http://www.rcgp.org.uk/revalidation-and-cpd/~/media/Files/Revalidation-and-CPD/Credit-Based-System-for-CPD-2nd%20version-10110.ashx

A CPD credit is defined as an hour of learning activity which is relevant to the work of the GP. In its simplest form 1 hour of activity equates to 1 credit. If impact is demonstrated, points can be doubled. Credits are self-assessed and verified at the appraisal. It is the demonstration of learning achieved and relevance to the work that the GP undertakes that defines the credit. Your appraiser will be interested in what you did with the information and your reflections, not simply that you collected it and maintained it in a portfolio.

Do I need to use the online forms and can I link these with e portfolio?

Yes, the SOAR website Forms 1-3 are compulsory now.

The SOAR website and the RCGP portfolio are not interconnected at present, but e portfolio information can be uploaded to appraisal Forms 1-3 on SOAR.

All other "evidence" or supporting information can be uploaded to Forms 1-3 once you have a date for your appraisal. You will usually be offered a date for your appraisal with 2-3 months notice.

What sort of tips do you have for recording CPD evidence?

The best way to record your CPD is to keep a learning log. This can take many forms, as long as it allows you to record and demonstrate your learning activities, what you have learned and any impact/CPD credits claimed. You can simply make up your own excel spreadsheet. Appraisers have a template for this which they can make available.

Which patient and practice colleagues' questionnaires can be used for Revalidation?

Every five years we are expected to undertake a colleague (Multi source feedback) and patient feedback questionnaire (25 questionnaires). Those undertaken five years prior to the Revalidation date may count, but please check with your appraiser. The national patient access questionnairedoes not count. If a GP is VT trained within 5 years of their Revalidation date (approximately), then the MSF and PQ undertaken in the third year of VT counts. The tools used are compliant with the GMC requirements. There must have been an opportunity to reflect on these either as a GP trainee or at an appraisal prior to your Revalidation date.

The NES colleague MSF is recommended and can be accessed through SOAR. The names and e mail addresses of at least fifteen colleagues needs to be provided. It is recommended that the doctor complete this exercise at least four weeks before the appraisal date, to ensure that they have the necessary feedback available at their appraisal. A reflective template, available on SOAR, is available for the doctor to reflect on the feedback from their colleagues and also patient questionnaire.

Many GPs have used the GMC patient and colleague questionnaires. However, the results need to be collated by the practice or GP and this is cumbersome. The CARE patient questionnaire results can be uploaded to the website and a report produced automatically. Likewise, the MSF tool on SOAR culminates in an automated report which can be uploaded to SOAR with your other supporting information.

How about locum GPs, any specific advice?

Sessional and out of hours GPS may find it more complicated gathering supporting information, but there are toolkits available on SOAR which are really useful in guiding them to satisfy the needs of appraisal and revalidation.

It is a good idea to get involved in a peer group, for example RCGP First Five or PBSGL, available through NES. This allows an opportunity to share, for example, SEAs, learning outcomes and also gain support from colleagues.

Appraisers are aware of the difficulties of sessional and out of hours GPs and would be happy to advise. Or use the resources at NES who offer support for sessional GPs.

How does working part time affect revalidation?

Working part time does not mean that you can provide less documentation.

Many doctors now also have multiple roles and appraisal and Revalidation supporting information will need to reflect this. For example, the raters chosen for your multi source feedback might be selected from all of your roles and this is acceptable. This could include colleagues from out of hours, sexual health, occupational medicine etc

Part time work just means that you need to represent all your roles and be aware that you need to provide supporting information which allows you to demonstrate your practice.

What if I work in primary and secondary care?

We are moving towards single appraisal, which will affect doctors working across primary and secondary care. This means that you will likely be offered an appraisal in the speciality where you do most of your work, but are expected to bring evidence of all you different roles to that appraisal.

Retiring from practice?

Retired doctors may continue to work in many different capacities (such as pharmaceutical companies, providing advice, working with universities, in out of hours work, charity work).

Whether you need to revalidate depends upon whether you require a licence to practise to undertake any or all of the work that you do. You should speak to the organisation that you are working or volunteering for to ascertain whether that organisation requires you to hold a licence to practise. If you continue to treat patients you will require a licence. This means that you will need to have an annual appraisal and be Revalidated every five years. This is not necessary if you simply wish to be registered with the GMC.

Going abroad to work? Do I still get appraised and stay on the performers list?

It depends on how long a doctor is away for. It is important to keep in touch with the appraisal team at NES, who need to know what the doctor's plans are so that they know when to plan the next appraisal, if it is to be brought forward or delayed. It is ok to go away for a year or so, but the health board may write to a doctor who does not provide services for more than 12 months. A few months beyond that is ok as long as the plan is to come back. They then start to breach the contractual requirements of the performers list, which is to provide GP services and undertake an annual appraisal.

We don't want to disadvantage GPs going abroad, but it is important to seek advice from the health board or the appraisal team at NES.

How many sessions in General Practice do I have to do in order to be appraised and Revalidated?

Doctors, who undertake very little General Practice, need to consider if they are doing enough to maintain their skills. To this end, Greater Glasgow and Clyde Health Board is of the opinion that GPs would be expected to do an average of 50 sessions per year to demonstrate that they are maintaining their clinical skills.

In view of the above, it would be difficult for the Responsible Officer to make a recommendation to the GMC on revalidation where clinical work was below this level.

Doctors who are on either long term sick or maternity leave will automatically have their appraisal and revalidation dates deferred until they return to work. The Appraisal Office should be notified in writing of the dates when they are off work.

Similar schemes are in place in Health Boards throughout Scotland and we do not anticipate that this will be an issue for the vast majority of GPs. If, however, you feel that you are unable to fulfil the required number of sessions per annum you should notify the Appraisal Office at NES when you arrange your appraisal. From 1^st April 2014, you will be asked to confirm the number of sessions you are carrying out at appraisal.

Whose decision is it to revalidate me as a GP and what happens if there is a problem?

The only body that will ultimately make a decision is the GMC. The responsible officer will make one of three communications to the GMC based on information received including but not exclusively related to appraisal. These are;

recommendation for revalidation
asking for the revalidation decision to be deferred for a specific time and reason e.g. maternity leave or sick leave
Indicating that despite reasonable support the individual has not engaged with the revalidation process.

Poor engagement with the appraisal process, failure to provide the supporting information required for Revalidation at your appraisal may result on the Responsible Officer not recommending a doctor for Revalidation. In addition, other clinical governance information may influence the ROs decision.

Failure to be recommended for Revalidation may result in the loss of a doctor's license to practice.

Any Final Tips?

Get organised. Don't leave it to the last minute and risk having your Revalidation date deferred or not being allowed to practice.
Keep an Appraisal and Revalidation folder and add to it throughout the year, including your learning log and reflections on your practice.
Use your appraiser as a resource. They are very well informed.
Get your paperwork to your appraiser on time, at least two weeks before your appraisal. Or it may be too late for them to advise you that you are not on track for Revalidation.
You must now complete the appraisal paperwork online, using the new NHS Scotland paperwork available on SOAR.https://online.scottishappraisal.scot.nhs.uk.
If your circumstances change; going abroad, maternity leave or sick leave, change of role, retirement, please let the appraisal team know so that we can advise on any impact on your appraisal or Revalidation.

Seek help if you are having technical problems -e mail the Helpdesk on the Scottish Appraisal websiteSOAR@nes.scot.nhs.uk Please reference your GMC number.