Andy Tomlinson Member Revalidation Delivery Committee Royal College of Anaesthetists

1. Update on revalidation and remediation Andy Tomlinson Member Revalidation Delivery Committee Royal College of Anaesthetists CDs meeting April 2012

2. Revalidation and remediation • Anticipated timetable • RST, GMC and Academy updates • RCoA update: Supporting Information • Remediation

3. Revalidation: anticipated timetable

4. Revalidation: anticipated timetable “In the light of the importance of this process to the quality of services delivered to patients, and of the status of the GMC as an independent regulator, the Committee looks to the GMC to give early and public notice if it concludes that delivery of this timetable is at risk.” Health Select Committee , March 2012

5. Updates

6. Updates: RST www.revalidationsupport.nhs.uk/CubeCore/.uploads/RSTMAGforReval0312.pdf www.revalidationsupport.nhs.uk

7. Updates: RST www.revalidationsupport.nhs.uk

8. Updates: GMC • All doctors: confirmation of designated body • Make your connection campaign • 4,000 – 40,000; estimate of possible problems! • All locum agencies should be designated bodies • Colleague and patient feedback • Instructions for administering GMC colleague and patient questionnaires • www.gmc-uk.org/Instructions_for_questionnairesfinal.pdf_48334410.pdf

9. Updates: Academy • Specialty Guidance • Helpful in pilots • Greater awareness needed • To be finalised end of May 2012 www.aomrc.org.uk/revalidation/item/speciality-frameworks-and-speciality-guidance.html • Specialty advice for ROs, doctors and appraisers by Royal Colleges and Faculties • Formal generic training agreed

10. Updates: Academy • RCoA, FPM and FICM Specialty Advice • Demand uncertain • Uncomplicated queries dealt with by College staff • Commence with a small (15-20) team of advisors • Membership to include representation from: • FPM & FICM • All home nations • All major sub-specialties • SAS grade • Retired/ independent practice • Training packages currently being developed

11. RCoA Update: Specialty specific supporting information www.rcoa.ac.uk/docs/Revalidation_doh_pilots.pdf

12. RCoA update: Specialty specific supporting information • More guidance required for:

13. RCoA update: Specialty specific supporting information • More guidance required for: • Outcomes • Target departments • Appoint LARCs • Survey all departments re outcome measurements • RCoA audit recipe book may be key • Join laparotomy and ♯NOF networks • Patient and Colleague feedback

14. Specialty feedback on professional practice www.rcoa.ac.uk/docs/peer_patFeedback2011.pdf

15. Update: Specialty feedback on professional practice www.rcoa.ac.uk/docs/REV-Statement-03.02.12.pdf

16. Specialty feedback on professional practice • GMC commissioned survey for feedback showed • Colleague feedback straightforward • 75% >14 questionnaires • Patient feedback much more difficult • 51% >21 questionnaires • Further work by RCoA with PLG to consider • Communication skills • Quality of care

17. Remediation

18. Remediation • Revalidation likely to identify increased numbers of doctors with fitness to practice issues • ~ 1000 remediation cases in progress in England • 2,800 (~2%) of all doctors in England subjected to investigation annually • Remediation provision will need to be enhanced & increased • DH report on remediation published Dec 2011

19. Remediation: what is meant? • The overall process agreed with the practitioner to redress identified aspects of underperformance. Remediation is a broad concept varying from informal agreements to carrying out some reskilling, to more formal programmes including supervised remediation and/or rehabilitation.

20. Remediation: DH report • Highlights lack of: • consistency in how organisations tackle doctors with performance issues • clarity about where a PDP stops and remediation starts • clarity as to who has responsibility for the remediation process • clarity on what constitutes acceptable clinical competence and capability • clarity about when the remediation process is complete and successful • clarity about when the doctor’s clinical capability is not remediable • capacity to deal with the remediation process

21. Remediation: DH report • Key recommendations: • Wherever possible, performance problems including clinical competence and capability issues, should be managed locally • Local processes need to be strengthened to try and avoid performance problems occurring and reduce their severity at the point of identification • The capacity of staff within organisations to deal with performance concerns needs to be increased with access to external expertise as required • A single organisation is required to advise and, when necessary, to co-ordinate the remediation process and case management so as to improve consistency across the service 

22. Remediation: DH report • Key recommendations (cont’d): • The medical royal colleges should produce guidance and also provide assessment and specialist input into remediation programmes • Postgraduate deaneries and all those involved in training and assessment need to assure their assessment processes so that any problems arising during training are fully addressed

23. Remediation: CDs view • Survey Monkey survey: • 240 individuals emailed (all four nations) • 54 responses (22.5%) • General consensus that: • Much should be managed locally • College should be involved • ‘A supportive rather than driving role’ • Setting standards - consistency • Providing advice on assessment and processes • Help make it happen • Concerns about funding

24. Remediation: RAs view • From breakout session March 2012: • General consensus that: • College should be involved in • Setting standards and establishing framework • Assessment: both advice and doing • Helping make it happen – organise external placements • Training for specialty needs

25. Remediation: NCAS view • Response to Remediation report • With 10 yrs of experience the organisation best placed to manage process locally • Has an “industry standard” in supporting the management of performance concerns and can provide external expertise to local organisations • Expertise in working in conjunction with many other bodies during case management, including trainees • Understands funding problems

26. Remediation: General consensus • Preferable to identify early • Ensure robust local appraisal and clinical governance processes are in place • Act on information obtained • Majority should be manageable locally

27. Comments or questions to: revalidation@rcoa.ac.uk