Points-based recertification plan

The RCGP is looking overseas to help develop UK-wide continuing professional development, says Julie Griffiths.

There are different systems for continuing professional development (CPD) across the four different countries in the UK.

More than that, it varies from deanery to deanery in England.

Delegates at the annual RCGP conference, in Edinburgh last month, heard that this should not continue.

Dr John Howard, associate director in postgraduate general practice at the University of Liverpool said: 'I have been a GP for 20 years and we've always been talking about "re-something". Now is the time to get on with it.'

He believed that the debate around recertification - which involves CPD and is specific to each specialty as opposed to the five-yearly relicensure required of all doctors via appraisal - provided the profession with an opportunity to select the right direction for the whole of the UK.

Dr Howard, provost at the RCGP's Mersey faculty, said looking at how other countries handled CPD and recertification could be useful in helping UK deliberation.

Points-based system
Primary care provision across the world can be divided into those systems that are publicly funded and those provided commercially.

A points-based approach to recertification, which the UK plans to follow, is popular in both types of country.

Dr Howard said that revalidation began in private healthcare systems before spreading to the public domain.

In the US, primary care is implementing a system that has been rolling out since 2004. By 2010, all family doctors will be taking part in the 10-year cycle, which comprises four components. They are: professionalism; self-assessed lifelong learning; cognitive expertise; and performance in practice.

Dr Howard said: 'There are two web-based modules in lifelong learning which involve a clinical scenario that you have to work through. You can take the test as many times as you need to pass.'

Every 10 years, US doctors will complete a multiple-choice question exam if all the other components have been met.

Of the statutory schemes set up for primary care provided in a mostly public setting, Dr Howard deemed New Zealand the best.

'This became compulsory in 2003 and requires 150 credits over three years,' he said.

There are four categories: continuous quality improvement; continuing medical education; peer review activities; and additional professional development activities.

Dr Howard said it was important to collect evidence that doctors were reflecting upon their practice, and that recertification should not be a worrying procedure.

Professor Nigel Sparrow, vice chairman of the RCGP Council, said the college had devised a strategy for recertification in the UK which was in line with other countries.

He said the challenge was to ensure quality assurance rather than a tick-box approach.

'The postgraduate education allowance (PGEA) was really measuring attendance. It needs to be thought of in terms of educational outcomes to provide better patient care,' he said.

Recertification must also take into account the fact that people learn in different ways, he added: 'Whatever CPD scheme we have should be based on your learning needs.'

Four pillars
The four pillars of the UK recertification system will be: essential general practice; managed CPD which involves reflection and learning; modern professional practice in the specialism which looks at performance; and GP relicensure, which is the generic standards required of all medics.

The idea is that appraisal will bind all four elements together.

The learning aspect of the process will be a credit-based system, likely to involve 50 points.

'One credit equals one hour of learning but it has to be varied,' said Professor Sparrow. 'So you can't just read the BMJ 50 times and log 50 points. It will be private study, e-learning, conferences, small groups. It's keeping a reflective note of career-long learning.'

Dr Mairi Scott, chairwoman of RCGP Scotland, said that for CPD to be effective it had to meet certain criteria: 'It has to be holistic. It should be structured, but not segmented, and flexible but planned. Most importantly, it has to be work related and work located.'

Unless it was embedded in what GPs did on a day-to-day basis, it would not work, said Dr Scott: 'People are so busy that it needs to be based in work, otherwise we won't do it.'

In any case, she said, this was the best way to learn: 'Learning and work are the same thing and we should not separate them.'

Recertification is currently being discussed by a committee chaired by England's CMO Sir Liam Donaldson looking at the regulation White Paper.

UK revalidation

  • 2009: Relicensing pilots.
  • 2010: Relicensing rolled out.
  • No date suggested for recertification, which is the second part of relicensing.

Source: GMC.


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