Sceptics will not be surprised to find the words 'onerous' and 'challenging' in papers supporting the RCGP consultation on revalidation, which closes today.
Many GPs will no doubt look at the 12-point list of evidence they will need to include in revalidation portfolios with some trepidation (see below).
Building up evidence
Rounding up colleagues and patients to take part in feed-back exercises and surveys, significant event audits, personal development plans and further detailed audits of key clinical areas sounds work-intensive.
And that's before you get to the part about building up evidence to justify claiming the minimum of 50 'credits' a year required to demonstrate that you are up to scratch.
But RCGP chairman Professor Steve Field is urging GPs not to see it that way.
'The appraisal process has to be much more effective, but we have to make sure that accreditation disrupts practice as little as possible,' he says.
Asked how long he expects GPs to have to spend on revalidation, he replies that it's difficult to say. This is because, unlike the systems for most other clinical specialties, GP revalidation will not be based on hours.
The RCGP is keen to move away from a process that allows clinicians to pick up points by falling asleep at the back of a lecture theatre.
Instead, the credit-gathering process encourages GPs to record practical examples of how they improve their own knowledge and raise the standard of their clinical practice as a result.
This could involve anything from a major process such as becoming a training practice, to facing a complex clinical scenario, reassessing relevant literature and adjusting your work accordingly. It is also about identifying and plugging gaps in your knowledge.
This is where fears that the process will be onerous start to fall away. Professor Field says that most GPs will be practising in a way that gains them credits as a matter of course.
As long as they are aware of the need to record this information incrementally - the RCGP is designing an e-portfolio suitable for this - much of the data they need will be ready and waiting by the time appraisals, and revalidation, come around.
Accountability is the key. GPC member Dr Brian Keighley says: 'Part of this is to produce confirmation that the very high quality of GPs in this country is supported by educational activity that hasn't necessarily been recorded in the past.'
The aim is to adopt the best principles of adult education, he says, recognising that different people learn in different ways.
'Some find text books better, others find audits of events that have actually taken place or preparing to give a tutorial to a trainee the best way to learn.' All three of these activities could potentially generate credits.
How it will work
Although GPs back the principles of revalidation, concerns remain about the practicalities.
GPC member and Wessex LMCs chief executive Dr Nigel Watson says: 'No one's against continuing professional development but it has to be realistic. Multi-source feedback is the part I have most concerns about.'
He says that with two feedback exercises in each five-year period for every GP, in which 20 people take part, 'that's a huge number of people filling in forms on each other and you have to question how valid or in-depth it can remain'.
Dr Watson adds that it remains to be seen how variations in assessment can be avoided. 'It has to be consistent.'
GPs will need a huge programme of training to make sure they are aware of how to take part efficiently in the revalidation process, Dr Watson says.
Meanwhile, specific groups of practitioners, such as locums or retired GPs doing insurance medicals, have expressed concern about how they will fit in.
But Professor Field says that the RCGP has set up a committee that incorporates these groups and will aim to devise flexibilities to accommodate them.
The GMC will issue doctors with a licence to practise in autumn 2009, without which they will be unable to practise in the UK. Revalidation pilots will also start in 2009.
The RCGP has said it wants to avoid a 'big bang' approach to introducing the new system, by being methodical, using pilots and consulting fully.
The test will be how well the system can be integrated with everyday general practice, and whether GPs can be convinced that 'onerous' and 'challenging' are the wrong adjectives.
GPs must accumulate 250 credits in the five-year revalidation cycle, by demonstrating how they have improved their knowledge and applied this effectively in practice. The higher the impact of the work GPs can use in examples, the higher its credit value. Here are two examples GPs could give to claim credits:
- GP learns of new indication for antibiotics in a particular group of patients, examines records to ensure guidelines are being followed. Claims two credits.
- GP approved as trainer, allowing practice to take on training status. Provides documents setting out how the practice will need to change, and the process of convincing partners to make the change. Claims 50 credits.
Building a revalidation portfolio
Under RCGP proposals, a standard revalidation portfolio would contain 12 key elements.
1. Description of the GP's professional roles.
2. Exceptional circumstances (details of sickness, career breaks etc).
3. Evidence of active and effective participation in annual appraisals over the five-year revalidation cycle.
4. A personal development plan (PDP) for each year agreed with the appraiser.
5. Review of the previous year's PDP.
6. Self-accreditation of a minimum of 250 learning credits over the five-year revalidation cycle (see box, above right).
7. Results of at least two multi-source feedbacks from colleagues
8. Results of at least two patient surveys of GP's consultations and care
9. Description of any cause for concern raised about the doctor and a review of any formal complaint.
10. Minimum of five significant event audits involving the GP
11. Audits of care delivered by the GP in at least two significant clinical areas of their practice
12. Statements of probity, health and use of health care; evidence of insurance or indemnity cover.
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