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A faulty production line

How to compile a folder of evidence of competence

GP education experts Dr Andy Gooden and Dr Amar Rughani help make sense of the complex and daunting process of collating evidence to demonstrate a GP’s competence

GP education experts Dr Andy Gooden and Dr Amar Rughani help make sense of the complex and daunting process of collating evidence to demonstrate a GP's competence



GPs have been told that revalidation is imminent so frequently that – as with those who heard the boy crying wolf – there is a risk we might miss the call that counts.

But the system is now being piloted and it is clear that, like it or not, we are going to have to prove as never before our continuing fitness to practise as GPs. However, forewarned is forearmed.

Here, we plan to give you some practical tips on how to prepare a folder of evidence about your performance as a GP, building on the evidence you already collect for your annual appraisals.

Fortunately, much of it will already be available within your practice and just needs bringing together. Although the final rules of revalidation are not yet known, the advice here is based on the best available information.

Organising a folder of evidence

For appraisal and revalidation, evidence will be collected under the headings included in the GMC's Good Medical Practice (GMP) guidance. GMP is being streamlined and will have the following subsections:

• knowledge, skills and performance

• safety and quality

• communication, partnership and teamwork

• maintaining trust.

In this article, we list the evidence appraisers will be looking at in each area of GMP. We use the headings GPs are familiar with, as the evidence will be easily transferable to the new framework when the details are known.

Remember that although we work in teams, revalidation requires analysis and comment on our personal performance.

This might affect how you collect and present your practice data. For example, you may wish to show your personal referral profile and comment on how it compares with those of your colleagues.

Evidence GPs need to provide

Appraisers will expect a range of evidence under each section of GMP. We've produced lists here, which are not exhaustive, of some of the areas which should be covered – highlighting areas that are likely to become compulsory:

Good clinical care

• Evidence of participation in a significant event audit.

• Evidence of engagement in reflective practice:

– Revalidation emphasises the need for doctors to demonstrate insight, so get into the habit of critically appraising your work, comparing it with colleagues and identifying areas for both celebration and improvement.

– The QOF provides enormous amounts of audit data via the QMAS website (ask your practice manager for more information).

If you have practice meetings to discuss progress and your scores improve as a result, then you are doing an audit that demonstrates change – so record it.

• Case review – using structured reflective templates (see box, below):

– Suitable for use by all GPs, including sessional doctors.

• Prescribing/PACT data.

• Referral analysis – PCOs often provide this, so now's the chance to make some constructive use of it. What does it show, what have you learned and how (if at all) do you need to change?

Maintaining good medical practice

• Documentation of clinical learning over the preceding year and a completed personal development plan.

– Must demonstrate engagement in appraisal.

– Should include last year's form 4 and PDP in your folder, with reflection on learning. (Online CPD modules are often suitable for your PDP and many provide proof of satisfactory completion.)

• Accredited CPD

• Practice development plan (if available).

• Notes from support and learning groups attended.

• Records of clinical meetings and courses.

• A diary of patients' unmet needs (PUNS) and doctors' educational needs (DENS).

• Reading logs.

Try to bring scraps of paper together. Either keep a book, or better still a simple word document on your desktop (or memory stick if you move around).

For each learning group, meeting or conference you attend, try writing down three key learning points, to demonstrate you have reflected and learned. Some online resources, such as GPnotebook and Mentor, offer tracking facilities to record the pages you have viewed.

But this simply proves that you have accessed them – a summary of learning points or text highlighted with your own key points is better.

Relationship with patients

• Results of a patient survey:

– Done annually by most practices for the QOF. Individual clinician feedback every few years is useful (and likely to become mandatory).

– Inclusion of the Action Plan (PE5/6) can

be useful.

– For sessional GPs obtaining feedback

is harder, but not impossible.

• Practice complaints procedures.

• List of all complaints against you within the past five years and subsequent learning points – SRT available.

• Published material, such as patient information leaflets and practice websites. (But perhaps we can now drop the thank-you cards from patients that sometimes still find their way into appraisal folders!)

Relationship with colleagues

• Peer feedback: 360° and multisource feedback (MSF). An MSF tool is being developed, which will form a cornerstone

of the evidence we will eventually need to submit.

• Systems for delegation within the practice and to other teams.

• Lists, minutes of meetings and so on.

Teaching, appraisal, GPSI or other roles

(if appropriate)

• Evidence of performance review within other role – SRT available.

Research (if appropriate)

• Proof of adherence to local research governance procedures.

• Declaration of research involvement.

• Declaration of sponsorship.

Probity

• GMC self-declaration (and SRT).

Health

• GMC self-declaration of health (and SRT).

Future developments

It is likely we will all have to collate our evidence and paperwork electronically within a year or so (as GPs in Wales, Scotland and Northern Ireland already do).

Many English GPs also do this already via the NHS Appraisal Toolkit, available at www.appraisals.nhs.uk.

The appraisal paperwork is in the process of being rewritten in a format to be hosted online, with SRTs likely to be embedded within it.

Changes are happening quickly, but it is possible to keep up with them.

If you concentrate on the evidence highlighted here, you will be well on the way to having a folder that will not only improve your appraisal but will be ready to support your revalidation.

Dr Andy Godden is CPD tutor and Dr Amar Rughani is associate postgraduate dean at Yorkshire & the Humber deanery

Structured reflective templates

Demonstrating that we reflect on our work will be central to revalidation and structured reflective templates (SRTs) are useful tools for doing so.

They were developed at the National Appraisal Conference in 2007, providing a structure for our reflections on various aspects of our work, and helping to bridge the gap between information about a practice (audit data or survey results perhaps) and what individual doctors learn from it.

They are available as part of the Appraisal Toolkit or can be downloaded from www.appraisalsupport.nhs.uk (look for the Leicester Statement button on the right).

They also allow sessional doctors an opportunity to demonstrate reflection on aspects of their work.

Folder of evidence

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