10 Key Changes to Appraisal and Revalidation
The RCGP have this year (September 2016) updated their advice on the evidence required for appraisal and revalidation, based on changes in the GMC guidance. Many GPs though seem to be unaware of these important changes , so to keep it simple for you we have listed some of the key changes below.
It is GOOD NEWS! The new guidance is aimed to SIMPLIFY the process for GPs and to make the task of collecting supporting information less onerous. The change in guidance reflects the current trend for GPs to do more sessional work and develop portfolio careers. The emphasis is on quality not quantity. Documentation and evidence should be 'reasonable and proportionate', and not detract from patient care.
Ten key changes that GPs need to know:
- Automatic 'doubling' impact credits have been discontinued. That does not mean impact is not important (it is), nor that time spent on activities which have impact cannot be claimed (it can). The old system of automatic doubling for impact has gone, and been replaced by a system whereby CPD credits can be claimed for time spent learning AND time spent on subsequent impact activities. For example, if you attend a Hot Topics course and learn about the new NICE End of life Guidelines (6 credits claimed for the whole course, if accompanied by a reflective note). You decide this is an important topic for your practice, so you spend an hour preparing a teaching session for the practice, another hour looking at some recent end of life case reviews and another discussing this as a group. All 3 subsequent hours of work can also be claimed as CPD credits, as long as they are accompanied by an appropriate reflective note.
- You still have to accrue 50 CPD credits per year (and one CPD credit = one hour of learning) across a broad range of learning activities, but to claim a CPD point you must record a reflective note. CPD can be claimed not just from traditional sources but also on learning from Significant Events, Multisource feedback, complaints & compliments etc. You have to reflect on all complaints in which you have been personally named, and this is recorded as CPD (unless a Serious Untoward Incident, see below)
- Reflection can be brief (it is quality not quantity that counts) e.g. what you learnt and how this may change your practice
- For a whole day learning event, you may claim 6 credits but only one reflective note per learning event is needed (i.e. you can claim 6 credits with one reflective note). If time is spent at a learning event but nothing new is learned, CPD credits can still be claimed with an appropriate reflective note. Reflection is only needed for up to 50 credits per year; many GPs do more than this, but further reflective notes beyond 50 are not essential.
- It is no longer required to complete an audit cycle every 5 years
- It is no longer required to include two significant events per year. However, we still need to have regular significant event meeting for CQC purposes, and furthermore significant events can provide an excellent opportunity for reflection and learning. So, ideally they should be continued but are now best recorded as part of your CPD with appropriate reflection and credits claimed.
- GPs should provide evidence of one Quality Improvement Activity per year, with reflection on how this has impacted on their practice. This is any activity which review the quality of practice and aim to improve it. It could be a formal audit as before or it could be a simple data search, local information collection and analysis, significant event analysis, case reviews, review of personal outcome data etc. It is expected that GPs will include QIAs over the 5 year cycle which will reflect all their roles
- Serious Untoward Incidents (SUIs) are significant events which cause actual harm to a patient or a significant risk of harm. These must be recorded, with appropriate reflection documented on a standard 'root cause analysis' pro forma. SUIs are the only ones that need putting in the significant events section of your appraisals toolkit. If you attend and record significant event meetings, these can be included as CPD as long as their is a reflective note. Personal significant events can still be recorded as case reviews but, again, this is now in the CPD section.
- Scope of practice. It is increasingly important to describe all of your roles beyond standard general practice, and to include evidence and CPD which relates to all of these roles. If an outside role (e.g. teaching, prison, out of hours, charity etc) is not being appraised elsewhere, a 'scope of work' letter from the outside organisation will be needed stating that you are fit to practise in that role. There is no national 'template' for this, and local area teams may have different forms they want you to use such as this East of England Scope of Work letter.
- Patient Survey and MSF, still needed one of each every 5 years. 35 patients is the recommended minimum number, but it has to be representative of your whole population so, for example, it is not recommended that they are all done by email. Collation by a practice manage will not be accepted, they have to independently assessed outside of the practice.
Busy GPs should welcome these changes. They will streamline the process, make it less onerous and hopefully provide more time for genuine learning and professional development. However, we must bear in mind that whilst the appraisal process may have been relaxed, we need to be aware that other bodies (e.g. CQC) have other performance criteria (e.g. Safeguarding) that needs to be demonstrated. In our next blog, Zoe will give some guidance on how to make the whole process easier, more formative and importantly enjoyable. For more information, see the links below. Highly recommended is the RCGP Myth Busters guide accessed via RCGP Revalidation Guidance
Thanks for reading, and many thanks for your feedback which has helped to shape it! Why not write a reflective note on what you have learnt, upload it and record a CPD credit for it? For Wales, Scotland and NI see below.
This article by Simon Curtis was first published on NB Medical on December 2016: http://www.nbmedical.com/the-hot-topics-blog/10-changes-to-appraisal-rev