General Practitioner CPD – Making an Impact
It was hardly surprising that with a topic which looks at changes affecting GP CPD that the PM Society meeting on the 17th March 2010 was a complete sell out, with many senior people working in the pharmaceutical industry keen to understand how they can support GPs as part of their individual Continuing Professional Development. Hosts for the evening, were Haymarket Publishing and we would like to acknowledge their generous support of this event.
The evening began with a brief welcome by Peter Welland of Haymarket, followed by Chair of the PM Society’s Education and Annual Events sub-committee, MGP’s Ivor Eisenstadt, who introduced the event’s speaker Professor Nigel Sparrow FRCGP, Chair of the Professional Development Board at the RCGP.
From Left – Peter Welland, Haymarket, Professor Nigel Sparrow and Ivor Eisenstadt, PM Society and MGP Ltd
Professor Sparrow started by setting the scene: GP revalidation has been in development for 10 years and because of the nature of general practice will continue to evolve. But the overarching aim of the RCGP is to introduce a system that ensures that GPs are fit for practice and can continue to offer their patients the very best medical care.
What is GP revalidation?
From November 2009 all practising doctors are required to have a licence to practise and a certificate to be on the general practice register. They will have to renew their licence and certification every 5 years in a revalidation process. As part of the process they will be subject to a more rigorous annual appraisal which will include reflection and proof of learning.
A system of ‘credits’ will be introduced for GPs as evidence of continued learning and its impact. Under this system GPs will need to gain 50 credits each year through various forms of learning (a total of 250 credits in each 5 year revalidation period).
Background - In Preparation
To support revalidation, the Royal College of General Practitioners (RCGP) has introduced a credit-based system for demonstrating continuing professional development (CPD).
Crucially the system needs to be fair to the GP and fair to the patient. It has to be straight-forward and not become intrusive in daily life. It also needs to be flexible and accommodate the different types of General Practice.
Who’s Involved?
The initiative is being led by the RCGP but in addition:
- The ultimate responsibility lies with the GMC who will approve and sign it off.
- The DoH will initiate the legislation for the Responsible Officer and the HM Treasury will approve the resources (the anticipated timing is Summer/Autumn 2010 irrespective of the general election)
- Trusts will be responsible for appointing Responsible Officers, strengthening appraisals and improving Clinicial Governance
- Colleges (the AoMRC) will set the standards
- The BMA will secure the resources, especially for remediation
Setting the Standards
The RCGP has been working with key partners to map out key criteria and define the standards against which the revalidation will be assessed
In July 2008 the Good Medical Practice for General Practitioners was published. This clearly set out what was expected of GPs – what they should and shouldn’t do (available online). In addition a Consultation Document was produced which defined the specific criteria, standards and evidence to be used in revalidation. This was put out to consultation in December 2008 and prompted 300 positive responses which was regarded as extremely good for a document of such complexity. This document is also available on the RCGP website.
In April 2009 the RCGP produced the first version of the Guide to the Revalidation of General Practitioners. The third version was produced in January 2010 and is currently available on line (printed versions are not available because of the changing nature of the document).
Supporting Information
The RCGP has defined thirteen items of supporting information that GPs will need to present in order to get revalidated:
- Description of role (type of practice, specialist interest etc)
- Exceptional Circumstances statement (which will allow for flexibility in annual credit accrual for sabbaticals, maternity leave, illness etc)
- Participation in five annual appraisals (important for the GP and the appraiser. If GP is not producing their portfolio correctly it is the role of the appraiser to flag this up).
- Personal Development Plans (PDP)for each year as agreed with the appraiser
- Review of each previous year’s PDP
- Self-accreditation of a minimum of 250 learning credits over the five years
- Two multi-source feedbacks from colleagues
- Two patient surveys (currently seeking GMC approval for revalidation use)
- Review of any formal complaint
- 10ive significant event audits
- Audits of care in at least two significant clinical areas
- Statements of probity, health and appropriate use of health care
- Additional evidence of other roles held – teacher, trainer, extended clinical role (e.g. GPwSI), appraiser, researcher etc.
Revalidation – The System
One of the key tasks of the RCGP has been to define the system for revalidation including setting out how in practice this will work and who needs to be involved.
For each GP revalidation there will be an appointed Responsible Officer (RO) whose primary role will be to conduct the initial assessment and sort all the submitted information into three categories
Green light – all the evidence has been received
Amber light – most of the evidence is available
Red light – there are a few issues with the submission (anticipated to be less than 1%)
The RO will be able to recommend all Green light applications direct to the GMC for revalidation. However, because it is such an important task a panel comprising the RO, an RCGP Adviser and a Lay Adviser* will work together to review the evidence for all Amber and Red light applications. If the evidence is not recommended by the Panel it will be passed to the GMC to process.
*The Lay Adviser cannot be a PCT employee or a representative from a single issue group. Generalist lay people/patient representative will be sought.
RCGP CPD
The RCGP supports the consensus view of the Academy of Medical Royal Colleges that all doctors should collect a minimum of 50 credits per year (250 over a five year revalidation cycle) from a learning based credit system, to support their appraisal and revalidation needs.
Since the end of the previous Post Graduate Education Accreditation (PGEA) scheme GPs have not had a system for demonstrating CPD and the RCGP wanted to move away from a purely time based system of recognition. In particular the RCGP wanted GPs to be able to demonstrate how CPD makes a difference to patient care. The new scheme will require GPs to demonstrate that their CPD reflects their role and that it has made a difference to the services they offer in practice. It will no longer be acceptable for GPs to ‘just’ attend meetings as their learning will need to be relevant and the end result will need to deliver ‘impact’.
The new CPD Credits Scheme aims to:
- Support all GPs in updating and applying their knowledge and skills
- Promote patient confidence
- Demonstrate improved patient care
- Be appropriate and available to all practising GPs throughout the UK
- Be easy to use
How it works?
The RCGP CPD Credits Scheme is a simple to use mechanism for GPs to collect and demonstrate their CPD. Time and impact are the key elements in the new system. For example:
- Each hour spent on a learning activity, which can include planning and reflection, counts as one credit
- Additional credits can be earned by demonstrating the impact of the learning on practice and patient care. GPs can effectively double their credits.
This new measure of CPD fits exactly with the requirements of the CMO as outlined below:
"The more that credits can encompass the value of learning and not simply the time spent engaged in CPD, the more it will be valued by doctors and the better a measure it will be of their CPD activities."
From Medical revalidation – principles and next steps, section 6.3, Report of the CMO for England's Working Group
Collecting Credits
- CPD credits should be earned through undertaking a range of learning methods and be appropriate to the needs of the individual GP. GPs will need to collect credits through a mix of meetings, peer group learning, on line learning and private study.
- Credits can be collected using the RCGP Revalidation ePortfolio and web-based support tools
- The Essential Knowledge Updates and Challenge Programme, and other RCGP eLearning and educational products, will also provide good ways of collecting credits. Completion of one six monthly Updates Programme could be worth 10-15 Credits.
How Can the Industry Help?
The Pharmaceutical Industry plays an important role in funding key educational meetings and learning resources. Moving forward the key will be to extend these programmes to help GPs:
- Identify knowledge gaps
- Work together in peer group learning sessions
- Translate the outputs - the learnings into achieving 'Impact'
- Develop practical solutions that help put 'learnings' into practice and demonstrably improve patient care
Whilst not all initiatives have to go through the College, the RCGP is very happy to work with industry to develop high quality education for GPs.
Held on: 17/03/2010