UK Revalidation System: for whose benefit? Dr Andrew Long Vice President, Education, RCPCH DATE: Consultant Paediatrician, Great Ormond Street Hospital
Overview What is value for money? How do professionals equate benefit? Who are the beneficiaries? the regulator the employer the public the individual
Cost benefit Evidence that revalidation is delivering value include: a continued increase in appraisal rates (which increased from 63% to 76% between March 2011 and March 2013) The Department of Health has published a long awaited impact assessment earlier for stage revalidation, revealing that the scheme will cost doctors over 450 in opportunity costs per revalidation cycle and will only prevent 0.75% of cases of appraisal, a key element of revalidation. death, severe harm and moderate harm per year. an increased focus on the quality of appraisers and the appraisal process indicative signs that concerns about a doctor s practice are being identified at an strong support for the system among responsible officers and appraisers strong support from doctors, appraisers and responsible officers for medical However, the report also highlights a few areas where further work is needed: While doctors continue to value appraisals and continuing professional development, some feel that revalidation is not yet relevant to their needs. The impact assessment reveals the scheme will cost a total of 97m a year, the majority of which accounts for the added pressures on doctors time. Doctors, appraisers and responsible officers are, on average, taking slightly longer than expected in this first year, to participate in appraisal and revalidation. Patients and the public need clearer and more powerful roles in revalidation in the future. The impact assessment said that there will be two main costs for revalidation: those associated with undertaking appraisals and making revalidation decisions.
The outcomes/effectiveness of revalidation in the United Kingdom: evaluating the regulatory impact of medical revalidation Julian Archer, Niall Cameron, Katie Laugharne, Martin Marshall, Sam Regan de Bere, Kieran Walshe, Richard Wright
Purpose of the evaluation 30 research questions, addressing 6 core regulatory aims for medical revalidation: Is the GMC s objective of bringing all doctors into a governed system that evaluates their fitness to practise on a regular basis being consistently achieved? How is the requirement for all doctors to collect and reflect upon supporting information (SI) about their whole practice through appraisal being experienced by revalidation stakeholders? Is engagement in revalidation promoting medical professionalism by increasing doctors awareness and adoption of the principles and values set out in Good Medical Practice? Are revalidation mechanisms facilitating the identification and remedy of potential concerns before they become safety issues or FTP referrals? How do ROs fulfil their statutory function of advising the GMC about doctors fitness to practise and what support do they have in this role? Are patients being effectively and meaningfully engaged in revalidation processes?
Life-long learning/continuing Professional Development Evaluation of effectiveness of CPD intervention and the benefit to patient care Assessment of individual needs Implementation Planning personal development plans PDPs A First Class Service DoH 1998 TRAINING AND DEVELOPMENT PLANS IN PLACE FOR THE MAJORITY OF HEALTH PROFESSIONALS BY APRIL 2000 CPD follows a circular pathway through assessment, planning of personal development, implementation and evaluation
Revalidation: requirements for doctors 4 domains of GMP Dr Una Lane, Director, Registration and Revalidation, GMC
Where are we now? The numbers Doctors subject to revalidation in the UK: 228,609 recommendations received by the GMC: 144,777 Revalidate Deferral number of doctors revalidated: 118,448 number of deferrals: 26,061 number of notifications of nonengagement: 268 Non-engagement Not yet received recommendation GMC figures, as at 31 August 2015 Dr Una Lane, Director, Registration and Revalidation, GMC
Early evidence of impact? 94% of licensed doctor in the UK now connected to a designated organisation/responsible Officer Appraisal rates for all doctors have increased significantly e.g. from 64% (2011) to 87% (2015) for NHS consultants Anecdotal claims of earlier identification of concerns strong support among Responsible Officers 24,795 doctors have chosen to give up their licence to practise Suspended approval of recommendations in three organisations Removed 1,890 licences due to failure to engage with the process as a whole (e.g. providing no information to GMC) Dr Una Lane, Director, Registration and Revalidation, GMC
Success vs benefit
Patient Involvement
Patient involvement Instruments Patient feedback questionnaires Patient survey Patient information from GMC and patient groups Outcome Up to date and fit to practice Increased patient safety and public confidence Patients, Public Lay representatives Revalidation Representation Rules Rules Revalidation Revalidation processes/regulations processes/regulations Fitness to Practice Fitness to Practice Organisational Protocols Organisational Protocols Organisational structures Organisational structures Community Medical Community Patients/carers Patient groups Medical Institutions DoH NHS Healthwatch CCG s Non-medical communities Division of Labour Patients Lay representatives Doctors Current system inadequate - further work in progress
Benefits to profession
Summary Revalidation has been implemented in the UK with numerical success CPD is an essential component of revalidation demonstrate knowledge and skills necessary show relationship to Good Medical Practice Revalidation portfolio should demonstrate professional attitude to working life Best outcome for patients is likely to relate to how seriously clinicians engage with the process Highlights the need for reflective practice
Questions.?