Revalidation Update March/April 2010 How will it work? What will doctors need to do? How will patients be involved? When will it be introduced?
2 Chair s introduction Ihope you will find this publication a useful explanation of where we have got to with revalidation and that you will contribute to the consultation on our proposals. As doctors, we are among the most trusted of all professionals. However, we practise in a less deferential age where patients are more questioning and where the knowledge of what medicine can do increases expectations. We have to ensure that the trust patients have in us continues to be justified. For the past 150 years, the GMC has sought to provide assurance through the register of medical practitioners. It remains today one of the most robust and well-used registers anywhere in the world. But it has always been a historical record of examinations passed and qualifications earned not of competence or performance. As such, it offers limited public assurance about how each of us is maintaining the high standards expected of us throughout our careers. Revalidation will plug this gap. It will provide visible assurance and a focus for every one of us to maintain and improve our practice. It will also help to ensure that the organisations in which we work support us in doing this. In this way it should lead to better care for patients. In the difficult financial climate of the next few years, when the pressure on all doctors is certain to grow, it is all the more important that revalidation is neither bureaucratic nor costly. I am determined it will not divert attention and resources away from front-line care. In one sense, what is being proposed is no more than what should be happening already. It will be based on local systems of annual appraisal over a five-year period and will simply affirm periodically what has already been demonstrated through the appraisal process. It is important to stress that revalidation will not be a pointin-time assessment of our knowledge and skills but instead will be based on a continuing evaluation of our practice in the context of the environment in which we work. I do hope you will respond to the proposals and contribute to the consultation. This is the start of a process we will not get everything right from the outset but with further input from the profession and others, and opportunities to test these proposals in practice, we believe we can create a robust and workable system that will command the confidence of doctors and reinforce the public s continuing trust in the profession. Professor Peter Rubin Chair, GMC GMCtoday will return at the end of May. The views expressed in articles contributed by external authors are those of the authors and are not necessarily shared by the GMC. General Medical Council 350 Euston Road, London NW1 3JN. Tel: 0161 923 6602 The GMC is a charity registered in England and Wales (1089278) and Scotland (SC037750). 2010 The General Medical Council All rights reserved. No part of this publication may be copied, reproduced, transmitted, recorded or stored on any retrieval system without prior consent of the GMC. Mixed Sources. Product group from well-managed forests and other controlled sources. www.fsc.org Cert no. SGS-COC-0993205 1996 Forest Stewardship Council
3 Your opportunity to shape the way ahead This publication is designed to keep you up to date with revalidation. At the beginning of March the GMC launched a major consultation on revalidation, setting out proposals for how it will work and how it will be introduced. Here you will find details of the consultation and how you can contribute. The current proposals for revalidation have been developed with the help of many organisations but we recognise there is more to be done. In order to shape revalidation before it is finalised we are keen to secure the views of doctors from across the profession as well as all those who will be involved or affected by the process. Four themes How revalidation will work the process and the basis on which decisions to revalidate will be made. What doctors and employers will need to do the standards to be met, the supporting information required, and the key role of local appraisal and clinical governance. Patient and public involvement the role that patient and colleague questionnaires will play in providing feedback on a doctor s performance. How and when revalidation will be introduced the proposed timetable and how revalidation will be rolled out for all doctors. The consultation runs from 1 March 2010 to 4 June 2010. You can find details on how to take part on the back page of this publication. Contents Revalidation at a glance...04 Making revalidation work for doctors... 05 Professor Malcolm Lewis explains how revalidation will support clinical practice and encourage professional development. CommentS... 06 Dr Andy Theobald, Buckinghamshire PCT. Professor Rajan Madhok, Chairman of BAPIO. Comment... 07 Dr Hamish Meldrum, Chairman of Council, BMA. Working together: doctors and employers... 08 Understanding the shared responsibility for all healthcare organisations to support revalidation. Comment... 09 Dr Anne Kilgallen, Medical Director, Western Health and Social Care Trust. How will it be for me?...10 How doctors who work in non-standard roles will revalidate. Patients and colleagues as part of the process...12 Obtaining feedback from patients and colleagues. Comment...12 Jeremy Taylor, Chief Executive, National Voices. Revalidation: your questions answered...13 The way ahead: what comes next?... 14 Steady progress, not a big bang approach, for the roll-out of revalidation. Comment...15 Dr Sarada Kodali, Locum Consultant Psychiatrist.
4 Revalidation at a glance 1 All doctors will need to have a Responsible Officer. 2 All doctors will need to have an annual appraisal. 3 All doctors will need to produce supporting information for their appraisal which demonstrates that they are competent and fit to practise. 4 All doctors will need to seek independent feedback from patients (where relevant) and colleagues at least once every five years. 5 The appraisal will include a set of standards set by the GMC based on Good Medical Practice. 6 The appraisal will also include the specialist and general practice standards set by the appropriate Medical Royal College or Faculty and agreed by the GMC. 7 Any areas for development or of concern identified during the appraisal process will be followed up in the normal way, usually with local support or action. 8 The Responsible Officer will review the outcome of the appraisals once every five years and, assuming the information does not show the doctor s fitness to practise is impaired, will recommend the doctor for revalidation. Doctor takes part in annual appraisal over a five-year period with local appraiser Supporting information gathered for appraisal including: l colleague and patient feedback l CPD records l clinical audit Responsible Officer receives feedback on appraisal Medical Royal College/Faculty input including: l defining standards for appraisal and supporting information l providing specialty guidance and advice for appraisers, appraisees and Responsible Officers Responsible Officer makes revalidation recommendation to GMC Doctor revalidated by GMC Quality assurance by: l Medical Royal Colleges and Faculties l Systems regulators (e.g. The Care Quality Commission) l GMC
5 Making revalidation work for doctors As well as promoting public confidence in the profession, writes Malcolm Lewis, a Wales-based GP and Chair of the GMC s Continued Practice Board, revalidation will support doctors practice and encourage professional development. Here he looks at how the new process will work. Revalidation will neither be a boxticking exercise nor a punitive process. What it will be is relevant to our day-to-day medical practice and built upon systems that should already exist in the workplace to support high-quality care. The GMC and other organisations are determined to make sure that it will be neither burdensome nor hamper us in any way in fulfilling our main duty: caring for our patients. Appraisals Revalidation will not be a single point-in-time assessment of a doctor s knowledge and skills. Instead, it will be based on a continuing evaluation of doctors actual performance in the workplace. It will be based on local systems of appraisal which will need to include an evaluation of the doctor s performance against the generic standards set by the GMC and the specialist or general practice standards set by the Medical Royal Colleges and Faculties and agreed by the GMC. This means surgeons will be evaluated in their work as surgeons, GPs will be evaluated in their work as GPs and so on. For most doctors, taking part in an annual appraisal will be nothing new. However, for the purposes of revalidation, it will be essential that these appraisals include an evaluation of performance against the relevant national standards. Doctors will need to maintain a folder or portfolio of information drawn from their practice to show how they are meeting the required standards. This will provide the basis for discussion at their annual appraisal. (For more information on the standards, see page 9.) Because each doctor s practice is different, the information collected will vary. After a period of usually five years, these appraisals will be used to inform the doctor s revalidation. By linking performance to national standards and identifying areas for action, any concerns should be addressed long before a doctor is required to revalidate. To that extent revalidation will be automatic; it should simply affirm periodically what has already been demonstrated through the appraisal process. Doctors will need to maintain a folder or portfolio of information drawn from their practice to show how they are meeting the required standards.
6 Comment: Dr Andy Theobald, Buckinghamshire PCT Our recent pilot project sought to understand the quantity and quality of information that GPs currently bring to their appraisals and how this could be improved. As a group of GPs who are appraisers we were keen to introduce more rigour into the quality assurance of the appraisals we undertake. What makes the appraisals work for us is the fact that they are peer led. As appraisers, we understand the job we are appraising. It is also important that revalidation will be based on taking five years as a whole rather than just a one-off assessment. That s why a five-year revalidation process is good for patients and good for doctors. For all but a minute proportion of doctors the new system should be nothing to worry about. And if a problem is identified by the process, hopefully it should be dealt with at an early stage. What makes the appraisals work for us is the fact that they are peer led. As appraisers, we understand the job we are appraising. Dr Andy Theobald Comment: Professor Rajan Madhok, Chairman BAPIO, GMC Council Member and Medical Director, Manchester PCT One of my central concerns as Chairman of the British Association of Physicians of Indian Origin is to ensure that there is no discrimination against Indian (and all international) doctors within the NHS. From the outset therefore it is essential that the principles of equality are built into the process of revalidation. I believe that black and minority ethnic doctors have everything to gain and nothing to lose through the successful implementation of revalidation, as it should act as the catalyst to resolve some of the long-standing problems faced by BME doctors. But this will only happen if we take the opportunity to help shape the process. That means responding to the GMC s consultation and pressing for local systems of appraisal and clinical governance that are not only free from discrimination but also support doctors when they face difficulties. If we achieve that, revalidation will not be something to fear but a long-overdue opportunity for change and improvement. Responsible Officers To revalidate a doctor, the GMC will require assurance that he or she is meeting the required standards and that there are no known concerns about their practice. In most cases, this revalidation recommendation will come to the GMC via the local Responsible Officer. This is a new role created under the provisions of the Health and Social Care Act 2008. Although there will be some differences between England, Scotland, Wales and Northern Ireland, the Responsible Officer will generally be a senior doctor in a healthcare organisation, such as the medical director. To make a revalidation recommendation to the GMC, the Responsible Officer will rely on the outcome of a doctor s annual appraisals over the course of five years, combined with information drawn from the clinical governance systems of the organisation in which the doctor works. In a large organisation, the Responsible Officer may cover several thousand doctors spread across a range of different specialties. It is not realistic to expect one Responsible Officer to be familiar with the practice of every doctor in that organisation, so the person conducting the appraisal (who will usually be from the doctor s own specialty) will therefore have a crucial role in informing the Responsible Officer s recommendation. The Responsible Officer will also be able to draw on advice from others and particularly have regard to the specialty standards developed by the Medical Royal Colleges and Faculties and approved by the GMC. Once the Responsible Officer makes a recommendation to the GMC about a doctor s revalidation (normally every five years), it will then be for the GMC to decide whether the doctor concerned should be revalidated. The GMC will itself need to be confident that the recommendations are robust, fair and consistently applied. Both the process leading to the recommendations, and the recommendations themselves, will therefore be subject to quality assurance and audit. I am confident that the vast majority of doctors will have no difficulty meeting the standards for revalidation. These doctors will retain their licence to practise until their next revalidation is due. This will generally be after a further five years.
7 The GMC s consultation is your opportunity to help to shape what the new system will look like and how it is implemented. Dr Outside standard practice Some doctors will be in wholly independent practice, or working in organisations that do not provide an appropriate appraisal system or a Responsible Officer. These doctors are strongly advised to make alternative arrangements to ensure they undergo an appropriate and regular appraisal and that they link up with a Responsible Officer once they are in place. This will make their revalidation more straightforward. In particular, it will help to ensure that they are meeting the requirements before the time comes for them to revalidate. There are a number of organisations that may be able to help with this. The Independent Doctors Federation, the Royal Society of Medicine, and some Medical Royal Colleges or Faculties are considering providing appraisal or Responsible Officer facilities for their members. Affirming good practice The proposals for revalidating doctors should not exist in isolation from other systems designed to assure the quality of care. Revalidation will focus on affirming good practice for the vast majority of doctors but will complement other systems for detecting concerns about practice. The key is to enable this assurance to be achieved, as far as practicable, from existing professional activities that are worthwhile in themselves rather than new activities devised specifically for revalidation. This is important, both to ensure that, as doctors, we engage in and support the process, but also to minimise Hamish Meldrum additional costs on the healthcare service and the time we have to spend away from our patients. Comment: Dr Hamish Meldrum, Chairman of Council, BMA Dr Hamish Meldrum Revalidation will impact on every single licensed doctor, regardless of their branch of practice or stage in career. Progress is being made in firming up how revalidation may work in practice, and the GMC s consultation, and the opportunity for stakeholders and members of the profession to feed into this process is an important milestone. Challenges abound in trying to construct a system of revalidation that is fair, transparent, and avoids excessive bureaucracy, and many questions remain to be answered. One thing that is clear to me, however, is that the confidence of the profession is crucial to the success of any system that is introduced. The GMC s consultation is your opportunity to help to shape what the new system will look like and how it is implemented. Revalidation will have to contend with the everyday pressures of the working lives of doctors, and so I urge you to read the consultation document and feed in your views in order to help us achieve a system that is fair, practical and achievable.
8 Working together: doctors and employers Revalidation will be a shared responsibility apart from the GMC, the health departments, the Royal Colleges and Faculties, and individual doctors, it will depend on healthcare organisations throughout the UK. They will have a key role in helping doctors to maintain and improve their practice and raise the quality of care. Organisations that employ or contract with doctors will need to ensure that doctors who work for them are able to revalidate. They will also have a statutory duty to appoint a Responsible Officer who will support doctors in meeting the requirements of revalidation and then make recommendations to the GMC. The proposals are based on strengthening existing systems for appraisal and clinical governance. Revalidation is about how doctors perform in practice, which is why it is vital that systems of clinical governance and appraisal are effective and can enable doctors to collect the information they need for their revalidation and for that data to be properly evaluated. Healthcare organisations will be responsible for: l A robust system of clinical governance (including appraisal). l Arrangements to enable doctors continuing professional development. l Systems that enable doctors to monitor their practice: through performance information, including clinical indicators relating to patient outcomes; through feedback from patients and colleagues; and in other ways. l Annual appraisals that include an evaluation of the doctor s performance against the professional standards set by the GMC and those of the relevant Medical Royal College or Faculty.
9 We recognise that a single approach to appraisal will not be suitable for all doctors in all settings. The proposed arrangements reflect differences in practice settings and organisations. Appraisal standards The GMC was required by the UK government to develop a means by which doctors practice could be appraised and objectively assessed based on Good Medical Practice. We produced a framework in 2008, which set out how such a system might work and the standards that should be incorporated into all appraisal systems to enable doctors to reflect and identify areas of practice where they could make improvements. We recognise that a single approach to appraisal will not be suitable for all doctors in all settings. The proposed arrangements reflect differences in practice settings and organisations. However, the key principles and generic standards, set out in Good Medical Practice, are broadly relevant to all doctors. There are three types of generic standard: a. Those that will apply to the overwhelming majority of doctors, irrespective of the nature of their practice such as keeping knowledge and skills up to date. b. Those that apply only where doctors work with patients, act as managers or work in research. c. Those that depend on particular circumstances or events. A number of pilots and projects have been running to test this approach and to seek to understand the resource implications of a strengthened appraisal system in supporting revalidation. You can view the framework online at www.gmc-uk.org/ doctors/licensing/revalidation _gmp_framework.asp. Comment: Dr Anne Kilgallen, Medical Director, Western Health and Social Care Trust As a group, the Medical Directors in Northern Ireland tested the standards that need to be incorporated into appraisal. I acted as liaison for the GMC within the Western Trust and my role was to ensure clinicians were aware of the testing phase. We had two teams of doctors taking part ensuring quite a diverse range of feedback and with geographical spread across the organisation. The main concern was whether we have adequate routine information sources and that is what the pilot was designed to test. I think it is a very rational framework. It does not require us to develop new information sources apart from the introduction of a validated multi-source feedback tool. We recognise we will need to improve the administrative infrastructure to support our doctors more proactively. It is not a large leap although some development work needs to be done. If revalidation is to be of benefit then it must provide a means by which doctors can record evidence that they are maintaining high professional standards. I believe the pilots have demonstrated that we are better prepared than we anticipated.
10 How will it be for me? For doctors who are having a career break or who are not in standard roles revalidation should not be any more difficult. Here we look at how doctors in various situations will find the revalidation experience. Independent practice A doctor works wholly in independent private practice and has no contact with the NHS. Will this make it harder to revalidate? Regardless of the setting for their clinical practice, doctors will need to participate in annual appraisal and link to a Responsible Officer in order to revalidate. Once the health departments in England, Northern Ireland, Scotland and Wales have finalised the legislation and guidance for Responsible Officers, we expect a number of non-nhs organisations to be able to appoint Responsible Officers. These are likely to include the Independent Doctors Federation, the Faculty of Occupational Medicine, the Faculty of Pharmaceutical Medicine and the Faculty of Public Health Medicine. Doctors working outside the NHS should be able to revalidate using the services of these organisations. EU locum doctor A doctor who qualified as a radiologist in a European Union member state works once a month in the UK as a locum consultant. How will she be revalidated? As a locum consultant the doctor will be required to demonstrate that she is practising to the specialty standards agreed by the Royal College of Radiologists. Whether she is on the specialist register or not, the specialty standards that she needs to meet will be the same. EU doctors will need to revalidate in the same way as doctors who are based in the UK, i.e. by participating in a quality assured annual appraisal (relying on supporting information from their pratice in the UK) based on GMC and College standards and by linking to a Responsible Officer who will make a recommendation to the GMC on their revalidation. Breaks in service A doctor has been working as a full-time GP in England for approximately five years and is shortly about to take 12-18 months maternity leave. However, she is worried about the impact this will have on her revalidation, particularly because her name may lapse from the PCT s performers list during this time. There will be many doctors in this situation. Taking maternity leave will not impact on her revalidation when she returns to work, even though she may miss an appraisal and CPD activity while away. If she has no medical practice or CPD to draw on over a 12-18 month period, then the evidence from her previous appraisals should provide sufficient information on which a Responsible Officer can make a positive recommendation to revalidate to the GMC. Alternatively, the doctor s Responsible Officer may ask the GMC to defer revalidation for another year until the doctor has had an opportunity to accumulate more recent supporting information and have a further appraisal. In these circumstances, the doctor s licence to practise would simply continue during this interim period.
11 Clinical academics A professor in paediatrics works in both research and teaching but does not see any patients or prescribe. Will she be able to revalidate if she is not able to obtain any patient feedback? Even though the professor is not involved in clinical work she will still be able to revalidate. If she holds a licence to practise, her revalidation will be based on the work that she actually does. Although she does not see patients, she should still be able to obtain feedback on her work from colleagues and take part in annual appraisals. We are working with the Academy of Medical Royal Colleges and others to develop the standards for doctors in a range of non-clinical roles, and the types of information they might bring to appraisal showing how they are meeting those standards. Practising overseas A specialist on sabbatical from full-time work in the NHS is currently working for an aid agency overseas. What should he do if there are no appraisal facilities available overseas? First, the doctor should check with the agency to see whether they will contractually require him to hold a licence to practise while he is working for them. If not, and he intends to be away from UK practice for a number of years, it may make sense for him to relinquish his licence for the duration of his time overseas. He can apply for his licence to be restored when he returns to the UK, at no cost. Restoring his licence will usually be straightforward. In general, it will be easier for him to do this than to maintain his licence while working overseas. Once he returns to practise in the UK he will need to link to a Responsible Officer and participate in annual appraisal in the same way as all other UK-based doctors. If he decides to maintain his licence to practise while working abroad he will need to participate in revalidation. Revalidation is being designed to ensure that doctors practising in the UK are doing so to the appropriate professional standards. Systems (such as enhanced appraisal and multi-source feedback) are being put in place to support this and because those systems, or equivalent systems, may not exist in other countries, revalidation will be less straightforward for those who are overseas. Medical management A doctor is an associate medical director/senior manager in an NHS trust but still undertakes a limited amount of clinical work. How will he prepare for revalidation? The doctor s revalidation will be based on the whole of his medical practice, both clinical and non-clinical. Although he is only undertaking a limited amount of clinical work, he will need to be able to show that he is meeting the standards appropriate for his specialty across the breadth of the clinical work he undertakes. The relevant College/Faculty will be able to provide him with guidance on the information he will need to collect. His annual appraisal will need to cover the nonclinical and clinical aspects of his work. The doctor will need to look at the standards that the College or Faculty has developed for his specialty and at the supporting information which it recommends as necessary to demonstrate that he is continuing to meet the standards. The doctor should also link with a Responsible Officer in the UK if at all possible. The Responsible Officer will help to ensure that the doctor is meeting the requirements for revalidation and will make recommendations to the GMC about whether the doctor should be revalidated. If the doctor is unable to link to a Responsible Officer in the UK, the only option is likely to be for the GMC to evaluate the information he can provide in support of his revalidation. The GMC will also require confirmation of his continued good standing with the medical regulator in the jurisdiction where he is working.
12 Patients and colleagues as part of the process One of the most important ways in which doctors can understand the impact of their practice is by gathering feedback from both patients and colleagues. This will also help build public confidence in the revalidation process. An important part of the supporting information doctors will need to collect to demonstrate that they meet the standards for revalidation will be feedback from colleagues and patients. The feedback will usually be gathered by asking colleagues and patients to complete questionnaires on the doctor s practice and performance. This feedback is sometimes known as 360-degree or multi-source feedback (MSF). Many doctors already use such methods to obtain feedback from patients and colleagues. For revalidation, the feedback will be fed into the appraisal process. Further information on how patient and colleague questionnaires might be used is provided in section 3 of the consultation. The feedback from patients and colleagues will be organised through the doctor s workplace, usually by independent organisations. We do not envisage that doctors will need to submit completed questionnaires every year. Our current view is that every doctor should have gathered independent feedback from patients and colleagues at least once every five years. It is important that this process is robust and independently administered. We are currently developing colleague and patient questionnaires for use in the revalidation process. Early research by Peninsula Medical School into the validity, reliability and practicality of these questionnaires has been encouraging. The results of a pilot study were published in June 2008 and are available online in the Quality and Safety in Health Care Journal. We have now commissioned more in-depth testing across whole organisations and in different clinical settings. This independent research suggests that these patient and colleague questionnaires do have the potential to be a reliable means of collecting information about doctors performance. Comment: Jeremy Taylor, Chief Executive, National Voices From a patient perspective, revalidation is good news. It will strengthen the assurance that doctors are safe, effective and up to date in their practice. Patient feedback will be central to the process and we need to find ways of ensuring that people can praise what is good as well as voice concerns so that a balanced picture emerges. Revalidation needs to reinforce standards of good practice that are meaningful to patients. Doctors need to be excellent technicians, but also people people and team workers. They need to be able to share information, and involve people fully in medical decisions, particularly the growing number of people with long-term conditions, who account for the largest part of NHS spending. Overall, there are high levels of satisfaction with doctors. The extra public accountability may feel scary for some, but there is no reason for the profession to be defensive. In other walks of life, regular appraisal of performance is routine. Besides, the NHS needs to get better at learning from patient experience and opinion, not only to stamp out poor practice but to reward, recognise and spread good practice. Revalidation could prove to be an exemplar in how this is done. If you would like further information on this research, please see our website at www.gmc-uk.org/doctors/licensing/ revalidation_multi_source_feedback_for_doctors.asp
13 Revalidation: Your questions answered It is unreasonable for me to have to prove every year that I am competent so that I can have my licence renewed. Revalidation will not be an annual event. Doctors will need to take part in annual appraisal within the workplace, but most doctors already do this. Successful completion of annual appraisals over the course of five years will provide the basis for doctors revalidation. Revalidation will simply affirm what has already been demonstrated through the appraisal process. If the appraisal process does throw up any issues, they should be dealt with in the normal way. By the point of the fifth appraisal, revalidation should be a formality, based on what has happened over the previous five years. Revalidation will be expensive, and all the costs will have to be borne by the profession. Revalidation is based on strengthening local systems of clinical governance and appraisal in the NHS and independent sector organisations. These systems are not an optional extra; they are a prerequisite for safe and effective care and should form part of any good healthcare system. The requirements of revalidation should therefore already be in place as part of current appraisal processes. Where local systems require strengthening, the cost should not fall on individual doctors. Revalidation is yet another example of bureaucracy overtaking doctors professional lives, rather than caring for patients. It is important that revalidation does not create unnecessary burdens that will hamper doctors in fulfilling their main concern of caring for patients. For most doctors, revalidation should not mean having to do new things or change the way they work. The key is to enable greater assurance to be derived, as far as practicable, from existing professional activities that are worthwhile in themselves rather than new activities devised for revalidation. We will do everything we can to ensure that it does not involve wasted time, but we do believe that effective appraisal systems are important and can encourage more reflective practice and ultimately better care for patients. Revalidation seems to be just about catching bad apples not about supporting doctors. Revalidation is not about tackling poor practice, although it does rely on robust clinical governance arrangements which should identify underperforming practitioners. Revalidation is about providing a positive assurance for the public, employers and the profession that doctors are practising to the appropriate professional standards. It should help doctors maintain and improve their practice and ensure that the organisations in which doctors work support them in keeping their practice up to date. The vast majority of doctors do an excellent job, often in difficult circumstances. In the small number of cases where local clinical governance and appraisal identify problems, it is in everyone s interests that these are identified early and appropriate support is given. This should minimise the chances of the problems becoming serious enough to affect the doctor s subsequent revalidation or of having to involve the GMC. Revalidation is being introduced without being comprehensively tested. We are committed to piloting all aspects of revalidation thoroughly before the process is launched and we are working closely with the four departments of health who are funding pilots in each of the four countries of the UK. Piloting is already underway and will increase in scope and intensity over the next 18 months. For more information on the pilots that are running up and down the country, visit www.gmc-uk.org/doctors/ licensing/revalidation_projects_and_pilots.asp. Revalidation will only be introduced once we are satisfied that the local systems necessary to support doctors in meeting the requirements of revalidation have been properly tested and are sufficiently mature. Isn t revalidation really all about catching the next Harold Shipman? This is a common misconception whatever revalidation is about it is not about catching serial killers. Instead, it is one of several mechanisms intended to improve the quality of care by focusing on doctors efforts to keep up to date and improve their practice. It is true though that better appraisal and clinical governance should help to identify some doctors whose practice is not meeting the required standards they will need support to improve their practice through local remediation in their own healthcare organisations, with the support of the deanery, college or faculty, or with advice or assessment from the National Clinical Assessment Service.
14 The way ahead: what comes next? Revalidation will be rolled out once local healthcare organisations are ready and local systems of appraisal and governance are in place and sufficiently robust. The successful introduction of revalidation is a shared responsibility involving the GMC, the health departments in England, Northern Ireland, Scotland and Wales, the Medical Royal Colleges, the NHS and other employers and the medical profession. There are currently around 218,000 doctors who hold full registration and a licence to practise in the UK. Introducing a system of revalidation which will apply to each and every one will be a major challenge for all the organisations involved. Our proposals are based on the assumption that revalidation should be implemented only when local systems are ready. It is important that where it is introduced there are the systems and structures to support doctors in providing the necessary information for revalidation. However, we know that there are organisations whose clinical governance and appraisal systems are not yet fully developed as well as others where improvement is needed. For this reason, we are proposing that revalidation should be rolled out on an incremental basis from 2011. Next steps for doctors For doctors, there is nothing that needs to be done immediately. Of course, you will want to consider the proposals on the supporting information you will need to bring to appraisal in the future. Many of you will already be maintaining folders of such information and participating in annual appraisal and we would encourage all doctors to continue to do this. We would also encourage you to find out as much as you can about local plans between now and the roll-out of revalidation from 2011. We will keep you informed about progress and there will be more information from other organisations involved in making revalidation work. We will shortly be launching an e-bulletin which will provide regular updates on the steps towards implementing revalidation if you would like We are proposing that revalidation should be rolled out on an incremental basis from 2011. to receive it, simply email us at revalidation@gmc-uk.org. And, of course, there is the consultation itself. We would like as many doctors as possible to respond by visiting www.gmc-uk.org/ thewayahead. We have also produced a toolkit with information on the whole process to help doctors wanting to organise meetings with colleagues to share their views on revalidation and feed this back to the GMC. You can download the toolkit from www.gmc-uk.org/ thewayahead.
15 Next steps for employers For employers, the time has come to bring revalidation preparation to the top of the agenda. As a matter of priority, healthcare organisations need to examine their current procedures and how they can be adapted. The GMC will decide when and where the first doctors will go through the revalidation process once the various parts of the system have been tested and embedded in local organisations. We will also need assurance that these organisations are ready to support revalidation. Piloting and early adopters Over the last few years, we have been testing how revalidation will work in practice. Pilots are currently underway across the UK involving thousands of doctors working in different specialties and sectors. In England, for example, the NHS Revalidation Support Team (RST) is coordinating a series of multi-organisational pilots during 2010. These will include more than 3,000 doctors in a variety of specialties and settings. These pathfinder pilots will test key components of revalidation, including: l the enhanced annual appraisal l the specialty standards and supporting information l the quality of information available to support a revalidation recommendation l the role of the Responsible Officer. Similar pilots are planned in Wales, Scotland and Northern Ireland through 2010 and 2011. Feedback, analysis and external evaluation of the pilots will begin later this year. The GMC s UK Revalidation Programme Board which oversees the practical delivery of medical revalidation across the four parts of the UK will oversee the various pilots across the UK. Following the consultation and the current pilots, the plan is for a number of organisations to be designated as early adopters who have been through a piloting process and have been assessed as ready to deliver revalidation for their doctors. Get involved In the meantime, we very much hope that both doctors and employers will take part in the consultation itself at www. gmc-uk.org/thewayahead or by emailing thewayahead@ gmc-uk.org. Comment: Dr Sarada Kodali, Locum Consultant Psychiatrist My involvement in revalidation has been to take part in a pilot held in Sheffield to assist NHS Professionals in preparing its doctors for revalidation. We also wanted to develop an appraisal system for locum doctors. Our focus was on the appraisee and how revalidation would work for locum doctors, looking at what time, training, supervision, support and guidance would be needed. We looked at the timescales involved and the practicalities of both parties appraisee and appraiser within the same specialty getting together for the appraisal. The pilot showed that it will be crucial to build in flexibility for locum doctors and that patience, understanding and communication will be key to making it a success. I would advise that if you are not clear about anything to seek advice and make sure you know what information you need to collect or acquire for your annual appraisal. The pilot showed that it will be crucial to build in flexibility to the process for locum doctors and that patience, understanding and communication will be key to making it a success. Dr Sarada Kodali
Take part in the consultation how to contribute We are keen to hear from doctors, employers and others who may be affected by the proposals for revalidation. The closing date is 4 June 2010 after which we will publish the GMC s response and any changes to the proposals as a result of your comments. To respond to the consultation online via our website go to: www.gmc-uk.org/thewayahead If you would like a hard copy of the full consultation document, including details of the suggested requirement for each specialty, email: thewayahead@gmc-uk.org For copies of the consultation toolkit go to: www.gmc-uk.org/thewayahead Email or call for further information: thewayahead@gmc-uk.org or 020 7189 5280 and you can sign up for the revalidation e-bulletin by emaling revalidation@gmc-uk.org