10 ways to lift the burden of revalidation
Dr Sirfraz Hussain explains how GPs can reduce the stress and workload associated with revalidation
It’s been branded ‘incredibly burdensome’ and ‘a waste of time’ by GP leaders since its introduction in 2012, while the GMC insists it is having a positive effect on professional standards. But wherever you stand on revalidation, you can’t avoid it if you want to practise as a GP.
Different doctors respond differently to preparing for revalidation. It is easy to see it as a time-consuming and anxiety-provoking process – from spending excessive time trying to do CPD that has little impact on actual clinical practice, to fretting about perfecting your e-portfolio. Alternatively, you may be the type that refuses to get bogged down in revalidation and does the bare minimum.
But in essence, the key to being successfully revalidated is ensuring you meet the requirements of your annual appraisal. Your responsible officer will only recommend you to the GMC for revalidation if they can prove that you have participated in annual appraisals during the five-year cycle that covered your full scope of work, that you collected and reflected on the appropriate supporting information during that process, and that there are no unresolved concerns about your performance.
This article lists 10 tips to help you sail through your annual appraisals so when you reach the end of the five-year cycle, revalidation is a smooth and easy process.
Whether you’re writing your personal development plans, seeking patient feedback or recording significant events, ensuring you collect and record the necessary material every year will work wonders in easing the revalidation burden.
1 Target PDPs early
Appraisers are encouraged to help you write up personal development plans (PDP) that are specific, manageable, achievable, realistic, timely (SMART). PDPs represent gaps in knowledge or skills that you have identified yourself, so are very important.
These gaps become evident during consultations as patients’ unmet needs (PUNs), which, following some reflection, can be converted into your own. They should be specific: for example, ‘diagnosing pigmented skin lesions’ rather than ‘learning about dermatology’.
If a year elapses and you have not managed to complete a PDP that you identified as important enough to write down, it does not look good. So target your PDP goals early – failure to meet a PDP that you have identified as necessary learning can be viewed as fitness-to-practise concern.
If you need help generating a PDP for your appraisal, pulse-learning.co.uk can generate one for you by analysing your responses to 100 multiple-choice questions on a series of clinical topics.
2 Write PUNs and DENs throughout the year
Keep a small diary with something that refers to your patients’ identifiable numbers, alongside reflective thoughts so that you can follow up patients and devise doctors’ educational needs (DENs). Common examples of PUNs and DENs include:
• Finding what local weight loss schemes (PUN) or what services are available to patients and what the criteria for referral to them are (DEN).
• Identifying the phone number for the child safeguarding crisis team (DEN).
• Learning when to prescribe the newer oral anticoagulants, and when to undertake checks and monitoring (DEN).
Ideally add PUNs and DENs as you go along. This can be done by keeping
a notebook or a file on your PC of PUNs and writing up interesting cases and learning. You could choose to send a task to yourself on the computer (EMIS is good for this) for patients you want to review, and at a later date to review these to formulate DENs or simply to keep track of interesting patients.
3 Ask to be appointed the lead for significant events at your practice
Recording significant events earns you CPD points and shows insight and safe practice. A minimum of two per year is expected.
A significant event involving a colleague or somebody else can also earn you CPD points if you report that you have discussed and reflected on it in a practice meeting, perhaps. You will need to record details of the event, how it made you feel and what actions you will take to prevent recurrence.
Every minor ‘near miss’ is a significant event. Research into medical errors suggests that these occur in most weeks if not on most days, so it is uncommon to have just two at the end of year. Common examples include a mix-up between same-name patients, referrals that get lost between dictation and hospital, and test results or letters that don’t get looked at in a timely manner.
4 Use minutes of meetings as evidence
Meetings occur in practices all the time,usually with a minute-taker.
Attending and reflecting on minutes shows teamworking and CPD can be claimed if learning has occurred. When writing up CPD, the minutes can be submitted as evidence. But ensure no patients or their data are identifiable from any minutes if they are submitted.
5 Request a certificate after any course
Request course certificates or attendance certificates via email, then store them in an email folder so that when you start filling in your appraisal, they are easy to locate. Where paper certificates are available, ask reception staff to scan and email them to you. You can also write learning points on paper certificates before scanning.
Be careful, though. A certificate shows only evidence of attendance; reflection is needed to demonstrate learning.
6 Attend a CPD group
I attend a CPD group every month with a peer group of people with whom I studied, trained or graduated. We meet locally, present a topic, then eat together.
A lot of appraisees have set up CPD groups that meet on a regular basis, if possible in a place where food is available. All members take turns to do a presentation on a topic. This is a great way to meet colleagues in an environment free of drug reps, and to be re-energised and stay up to date. If there isn’t a group at practice level, with colleagues, old course mates, a locum chambers or your LMC, decide what would suit you and set one up yourself. You could even do it online or via Skype.
7 Upload your thank-you cards and complaints
It is important to declare complaints in your appraisal. A complaint is a form of feedback, which allows you to review and improve on your practice. Transparency is important and the appraisal folder should include any complaints and your responses. It is also important to include information about whether or not the complaint has been resolved. Responsible officers receive streams of information from many sources, appraisals being only one source, so be careful to declare all formal complaints.
But as well as the bad stuff, include the good. If you receive a thank-you card, get it scanned and upload it. Sometimes patients give small items such as sweets, fruit or flowers. Take a picture and record the circumstances as a caption.
Remove patient identifiable data from cards and complaints. This often simply means scrubbing out the patient’s name.
8 Do more CPD than you need to
The minimum amount of CPD you need is 50 credits per year, but if you only do the minimum and your appraiser discounts some of it, you may be left short.
Appraisers discount CPD points if too many are claimed for a single event. An example is the foundation course to train registrars. These are intensive (20-30 hours) but you don’t need to be a trainer to be a GP so not all the course is relevant and some credits can be discounted.
Likewise, if the CPD isn’t relevant to general practice but is a hobby or interest, it is liable to be discounted. But if you can justify CPD points from business or management experience, you can claim them. For example, leading a multidisciplinary team would be relevant.
GPs can double their CPD credits by demonstrating their learning has had an impact on care, for example if a one-hour meeting led to your introducing a new clinical guideline, or monitoring or prescribing a new drug. You can also double credits by demonstrating your learning has had an impact on your personal development (a new skill), on the NHS (a new service) or on others (teaching or training), according to RCGP guidance.
Most doctors do a lot more than 50 hours of CPD, but have difficulty capturing and recording their learning. We’ve covered several ways to increase and diversify the CPD points you record, but if you struggle to capture them, try creating an email folder marked ‘Appraisal’ and move anything to reflect on or record (such as minutes) there.
You could also carry a notebook or use a secure app on a phone or tablet to record interesting learning points.
9 Submit in good time
Rearranging meetings with appraisers is difficult so make the most of the meeting that has been organised by submitting your data early.
This will enable you to get feedback and make timely changes and additions. Most appraisers need two weeks or more.
10 Plan in which year you will do patient questionnaires, multisource feedback and audit
These three things need to be done once in every five-year revalidation cycle, so decide which year you want to do them. The criteria for acceptance of questionnaires are exacting so it is worth reviewing them. Sessional doctors can find this part of revalidation difficult because they move around. Doing audits is also challenging if you locum at many practices. I have noticed, however, that locums usually have regular practices; use this relationship to facilitate patient questionnaires and audits. This might also allow you to benefit from in-house mandatory training in areas such as getting equipment tested and certified.
Dr Sirfraz Hussain is a GP in Manchester and a GP appraiser
What do you need to be revalidated?
• Evidence of at least 50 credits of CPD completed a year, covering all aspects of your work
• Evidence of regular participation in quality improvement activity, which has been presented at each appraisal. This could be at least one full clinical audit, case reviews or a quality improvement project
• Details of at least two significant events a year
• At least one account of colleague feedback with reflection relevant to your current scope of practice
• At least one account of patient feedback with reflection relevant to your current scope of practice
• Evidence that you have reviewed formal complaints and compliments with reflection and discussed these at every appraisal
Source: NHS England guidance on Supporting Information for GP Appraisal 2013-2014. tinyurl.com/revalidation-support
As well as a PDP generator, Pulse Learning offers 350 clinical and practice business modules to help you through appraisal and revalidation.