Revalidation Workshop for Sessional GPs: Collecting Supporting Information for Appraisal and...

Revalidation Workshop for Sessional GPs:

Collecting Supporting Information for Appraisal and Revalidation

Dr Sahar Hassan

GP Tutor, St Peter’s PGEC

4th December 2012

INTRODUCTION

December 2012 start date, notification of revalidation year

Responsible officers RO (role is to recommend you to the GMC for revalidation) first to be revalidated in first 4 months, April 2013 roll out to all doctors

SOME OF US REVALIDATED from our appraisal 2012-2013

Sessional GPs Collecting Supporting Information for Appraisal and Revalidation

INTRODUCTION

Revalidation requires– RO shown you have participated in an annual

appraisal of ALL your medical practice (GPwSI, teaching, etc), AT LEAST ONE APPRAISAL SIGNED OFF BY YOUR APPRAISER with good medical practice as focus

– Relevant Supporting information brought to appraisal

– No unresolved concerns regarding your performance as a doctor


INTRODUCTION

General Information Keeping up to date

– CPD Review of practice

– Quality improvement activity QIA- audits, SEA, other examples

– Significant events Feedback on practice

– Colleagues, patients, complaints/ compliments


The Must Do

Register with GMC online and confirm your designated body and your responsible officer

Identify and start the dialogue with your appraiser, find out by contacting [email protected]


GPs in “non standard practice”to maintain your licence to practise

Contact the GMC if you unsure who is your designated body and responsible officer

Must take into account ALL your work when providing supporting information

Examples- peripatetic locum, OOH/ walk in centre, rural GPs, GPs in Defence Medical Services and secure environments, extended career breaks, non clinical roles


If “non standard practice” may have difficulty accumulating supporting information in a “standard portfolio” and may have to produce “equivalent portfolio” in discussion with appraiser so speak to your appraisers SOONER RATHER THAN LATER if experiencing difficulties with collecting supporting information

Include in exceptional circumstances rationale for “equivalent portfolio”

Equivalent portfolio reflects working environment of the doctor and should still fit the attribute of each area of supporting information

GPs in “non standard practice”to maintain your licence to practise


Supporting InformationOther considerations- RCGP

Part time and private GPs need to maintain skills at the SAME level as full time/ NHS colleagues

Salaried, retainer, long term locum fixed practice expected to produce “standard portfolio”

Can include notes in portfolio of special circumstances such as ill health or maternity leave which have affected amount information collected or other difficulties


Other considerations RCGPCareer breaks

Clinical standard portfolio- Can only take out 2 years of a 5 year revalidation cycle, 50 CPD credits per year in the remaining 3 years, demonstrate 200 half day clinical sessions (1/7 per week), 100 in 2 years prior to revalidation

Further guidance page 9 http://www.rcgp.org.uk/revalidation-and-cpd/~/media/Files/Revalidation-and-CPD/Guide%20to%20Revalidation%20v70.ashx


Supporting information

We are all doing CPD, most of us lack the time or space to document our reflective learning


How can we collect supporting information?


Register RCGP eportfolio or clarity appraisal toolkit- start collecting supporting informationPractical tips to collecting supporting information “on the hoof”- some suggestions

phone app (evernote, microsoft one note), laptop/ ipadUSB card – word document include reflective log, PUNS/ DENS, open documents during surgery and add reflections in real time/ after the surgeryTry to document reflective learning during/ evening of the event

Reflective learning

key to success as it underpins appraisal process Plato’s directive “know thyself”- self knowledge

as an outcome of learning John Dewey “we do not learn from experience…

we learn from reflecting on experience” Jenny Moon’s grades of reflective learning Reflection can be before, during or after the

event


Reflective learning

What did you want to learn? What did you learn? How will this change what you do? Has this highlighted any other learning needs?

4 domains of good medical practice– Knowledge, skills and performance, Safety and quality,

Communication, partnership and teamwork, Maintaining trust


Supporting Information- General

Personal details Scope of practice- clinical/ non clinical Record of annual appraisals PDP and their reviews Probity-honest, trustworthy, acting with integrity Health- register with a GP, Immunisation,

serious medical conditions


PDP- keep it fun + don’t make a rod for your own back

SMART (Specific, measurable, achievable, realistic, time scaled)

5 Ps (personal, patient, practice, population, problems) No limit but keep it to 2 or 3 Goals - clinical , leadership, managerial, teaching Statement of development, how this will be addressed,

date of completion, intended outcome, review by appraiser


Continuing Professional Development – continuous learning process

GMC– Personal, reflects scope of practice, REFLECTION,

outcomes, needs based, clinical governance processes

RCGP– 50 credits / year, “1 hour of education accompanied by a

reflective record” = 1 credit, if learning implemented in practice with positive benefit (you/patient/ practice)- claim 2 credits

– Credits SELF ASSESSED and verified at appraisal with your appraiser


Continuing Professional Development – examples

Reflect ALL working life- GPwSI, teaching, commissioning etc.

VARIETY educational activity- local/ national lectures, on line learning modules (BMA, e-GP), reading, learning new skill (IUDs, joint injections), reflective log, PUNS/DENS, discussions with colleagues

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


QIASignificant Event Audits/ Case reviews (any event which you can learn from)

2 SEA each appraisal year, directly involving you Serious incident/ significant event/ serious untoward

event – actual or potential effect on patient safety must be included

Headings for writing up event- anonymous– title, date, date discussion and roles of team present,

description of event, what went well, what could have been done differently, reflections (4 domains good medical practice), agreed changes, implemented changes and their effect


SEAs- sessionals

Peer group – chambers, educational group, forum to exchange/ discuss SEAs, support, learn from each other

Regular locum cover GP practice- ask to attend their SEA sessions

SEA in an Ad hoc session in GP practice - ask practice if consider holding SEA session including you


Quality Improvement Activity- Audit

Audit, separate hand out, during this early phase of revalidation can state you’ve started a 2 cycle audit and plan to complete full cycle in PDP for next year– RCGP “can be a team audit if individual clearly shows how

they contributed properly to the choice of topic, standards set, directly involved in care delivery in first and second cycle, states changes made and effects of changes”

– RCGP- if not possible to do audit must at least have 2 SEAs/ year (page 8 http://www.rcgp.org.uk/revalidation-and-cpd/~/media/Files/Revalidation-and-CPD/Supporting%20information%20for%20appraisal%20and%20revalidation%20for%20GPs.ashx


Quality Improvement Activity- Audit

Standard audit and the sessional GP- often not feasible or appropriate– Constant moving between practices- thus not able

to follow changes through– Dr’s role does not include the ability to influence

or improve systems outside their own personal practice (locums, most salaried GPs)

– Unable to access medical records outside consultation time (locums, OOH)


Sessionals – ideas for audit and other options for QIAs

Audits for non clinical work- use same headings Based in a practice-easier to utilise guidelines from a

standard audit– QOF, NICE guidelines, NHS Surrey Medicines Management

Options for peripatetic/ OOH/ walk-in GP– SOAR examples antibiotic prescribing, analgesia prescribing,

investigations– List provided- topics in admin, referrals, antibiotic/ COC

prescribing, febrile child


Other QIAs for sessional GPs

Reviews- Surgery cases, referrals, referral letters, challenging cases, follow up patients and reflective learning of outcomes

Random Case analysis/ Action audit- review 20 cases (random or defined clinical nature), assess (clinical decision making, record keeping, standards of care) with peer group / experienced colleague- document reflections, agreed improvements, demonstrate change


Other QIAs for sessional GPs

Records Audit- review record keeping in a series of consultations, highlighting key elements of information which could be improved, e.g. safety netting/ red flags/ READ coding, RCGP can not use this as only evidence of QIA

Condition based review- choose clinical area which learning need (e.g. from PUN/DEN, SEA- which common and has evidence based guidelines, e.g. asthma- collect 10 prospective cases, assess management in context guidelines, learning points, aspects of diagnosis/ care omitted or needs improvement


QIA

MUST BRING ANY INFORMATION ON CLINICAL GOVERNANCE THAT YOU HAVE BEEN ASKED TO BRING TO YOUR APPRAISAL

Commissioning– Demonstrate cost aware, efficient use of

resources– Our role through referrals and prescribing


Feedback- colleague and patient

GMC- 1 every 5 year revalidation cycle – Questionnaires

http://www.gmc-uk.org/colleague_questionnaire.pdf_48212261.pdf http://www.gmc-uk.org/patient_questionnaire.pdf_48210488.pdf On line RCGP or clarity or manually collate via colleague/buddy- keep

anonymous Written summary in portfolio

– Reflect on the feedback- implement changes+ PDP, CPD opportunities, cover whole practice, results benchmarked – compare to peers similar scope of work


Feedback

Colleagues- distribute 20 – hope to have 15 responses

Junior peer, senior peer, nurse, receptionist, pharmacist, admin staff, practice manager, consultant, sessional support group

Reflect multiple roles

Patients- distribute 45 – hope to have 37 responses

Reflect multiple roles


Feedback – issues for sessionals

Colleagues- Inform appraiser of difficulties experienced

– On line if possible, manual may be only option peripatetic

– Rural practices- insufficient number– Walk in / OOH/ peripatetic – not known for a length of

time – Think broadly on who can give feedback


Feedback – issues for sessionals

Patients- inform appraiser difficulties– On line may not be option- OOH, walk in centres– Less able to develop long term patient relationship– Think broadly on who can give feedback (carers, families,

customers, suppliers)– Inform practice/ nurse manager – ask for support, receptionist

role (handing out questionnaires, pens, collecting forms)– Keeping anonymous- ideas, buddy system to formulate results– Patient groups- e.g. secure environments may not be suitable


Review of Complaints and Compliments

Reflection discussed appraisal- lessons learnt, changes made, future implications

GMC- Another type of feedback, aware complaint procedures, GMC good medical practice advice, actions taken (personal/ practice), opportunities, MPS guide handing complaints- add to CPD

RCGP - description event, assessment, resulting actions, outcome, reflection

Sessionals- Difficulty access, log of verbal complaints, compliments, if none- declare in portfolio


Avoiding isolation peer support keeping up to speed with your

revalidation

Working environments (GP practices, walk in centres, OOH organisations) should support the conduct of patient surveys, inform you of any complaint/ SEA relating to your work, access to patient records for audit/ QIA

Educational groups – GP Lunch Club, ASPH meetings, locum groups, St Peter’s sessional GP support meetings (term time, monthly), peer group support

Professional organisations NASGP


Resources for Sessionals

SOAR Scottish On Line Appraisal Resource http://www.scottishappraisal.scot.nhs.uk/appraisal-preparation/sessional-gps.aspx

SOAR OOH GPs http://www.scottishappraisal.scot.nhs.uk/appraisal-preparation/ooh-gps.aspx

NEPCSA guidance on supporting information for non standard GPs -http://www.gpappraisals.nepcsa.nhs.uk/nepcsa-guidance-for-sessional-gps/


Questions? Future Topics?


Revalidation Workshop for Sessional GPs: Collecting Supporting Information for Appraisal and...

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