Revalidation
Appraisal and revalidation are important, separate, but related issues. Appraisal is at the core of revalidation cycle and the two processes are mandatory. If a practitioner decides that she/he does not wish to participate, then they will not be able to receive a license to practice at the end of their current revalidation cycle. This article is intended to summarise the topic and focus on the forthcoming revalidation process.
Appraisal has been an annual requirement for many years and is now well established in medical practice. It is intended to assess the practitioner against a number of parameters in a number of areas, or “domains”, so as to provide a basis for personal development and ensure governance and quality assurance. It is intended to provide an ongoing mechanism of improving quality and safety.
Appraisal is designed to encompass the doctor’s whole practice and as such our Governance team here at St. John & St. Elizabeth will be providing data to support an individual’s practice e.g. Procedures undertaken, complication rates etc so that this can be added to other sites where they may work (including the NHS) thereby contributing to whole practice appraisal. The following is a summary of the “Domains” and supporting information required to underpin them.
Domains:
- Knowledge, Skills and Performance.
- Safety & Quality.
- Communication, partnership & teamwork.
- Maintaining trust.
Supporting information:
- Continuing CPD.
- Quality improvement activity.
- Significant events.
- Feedback from colleagues.
- Feedback from patients.
- Review of compliments and complaints.
I would recommend the following two references for more information: Good Medical Practice, Medical Appraisal Guide. Both the BMA and Independent Healthcare Advisory Services (IHAS) also provide useful guides to appraisal. I circulated details of the free IHAS pilot scheme earlier in the year and some may have taken up this opportunity.
The GMC provided all practicing doctors with a license to practice in November 2009. Revalidation builds on that process and is designed to assure patients and the public, employers and other healthcare professionals that licensed doctors are up to date and practicing to the appropriate professional standards (v). The system works as follows. The individual doctor has a five yearly revalidation cycle containing five annual appraisals. The individual should have at least one 3600, or multisource feedback session within the revalidation cycle. It is recommended that this should take place within the first three years of the cycle to enable sufficient time for any corrective measures to be implemented and reassessed before the five years have elapsed.
The Responsible Officer (RO) is a new role which came into force on 1st January 2011. An R.O. is a licensed medical practitioner of at least 5 years standing, usually, but not invariably the Medical Director and is accountable to the Board. I am the R.O. for the Hospital of St. John & St. Elizabeth and as such I have a statutory duty to make recommendations as to revalidation to the GMC. My performance as an R.O. is in turn assessed by the Medical Director of NHS London. At the end of the revalidation cycle the R.O. has three options. To recommend that the doctor is fit for revalidation as a practitioner with a license to practice (the vast majority of cases), to state that the information at his/her disposal is insufficient to make that recommendation and that more time is required to complete the assessment, or to express sufficient concern not to be able to recommend revalidation. The latter will automatically trigger a fitness to practice enquiry by the GMC.
Timetable for Revalidation
- 2011-2012 Additional year of testing, piloting and preparation.
- Mid 2012 Secretary of State assessment of readiness.
- Late/End 2012 “Go-live” decision.
- 2013-2014 First full year.
Who Is My Responsible Officer?
It is the duty of every doctor with a license to practice to establish who their R.O. is. In most cases this is very simple.
| Description | Responsible Officer |
|---|---|
| Practitioners with a substantive NHS contract | Your NHS Medical Director. |
| Whole time private practitioners | Depends on relative proportion of time at each hospital./ organisation. R.O. is where you spend the most time. If equal, then you may approach the individual R.Os and ask if they will be your responsible officer. |
| Post graduate Trainee | R.O. is the Deanery |
| I am a GP | If an NHS GP, then currently the PCT holding the Performers List on which the individual is named. If a private GP employed by a Hospital, then that employer. Further advice can also be obtained from the RCGP. |
| I am a locum | Either the PCT, PASA or the locum agency |
In summary, what appears to be daunting is not that difficult. The key is to engage with the process, ask any questions early and to maintain an individual appraisal portfolio so that the process is not more onerous than necessary.
I am always happy to help so please do not hesitate to contact david.mitchell@hje.org.uk or practicing.privaledges@hje.org.uk if you have any concerns.