DATE:

Impact of

CPD/Appraisal/Revalidation

on healthcare

Dr Andrew Long

Vice President, Education, RCPCH

Consultant Paediatrician, Great Ormond Street Hospital

Cost benefit

The Department of Health has published a long awaited

impact assessment for revalidation, revealing that the

scheme will cost doctors over £450 in ‘opportunity costs’ per

revalidation cycle and will only prevent 0.75% of cases of

death, severe harm and moderate harm per year.

The impact assessment reveals the scheme will cost a total

of £97m a year, the majority of which accounts for the added

pressures on doctors’ time.

The impact assessment said that there will be two main

costs for revalidation: those associated with undertaking

appraisals and making revalidation decisions.

Evidence that revalidation is delivering value include:

• a continued increase in appraisal rates (which increased from 63% to 91%

between March 2011 and March 2016)

• an increased focus on the quality of appraisers and the appraisal process

• indicative signs that concerns about a doctor’s practice are being identified at an

earlier stage

• strong support for the system among responsible officers and appraisers

• strong support from doctors, appraisers and responsible officers for medical

appraisal, a key element of revalidation.

However, the report also highlights a few areas where further work is needed:

• While doctors continue to value appraisals and continuing professional

development, some feel that revalidation is not yet relevant to their needs..

• Patients and the public need clearer and more powerful roles in revalidation in the

future.

The outcomes/effectiveness of revalidation in the United Kingdom:evaluating the regulatory impact of medical revalidation

Julian Archer, Niall Cameron, Katie Laugharne, Martin Marshall, Sam Regan de Bere, Kieran Walshe, Richard Wright

Purpose of the evaluation

• 30 research questions, addressing 6 core regulatory aims for medical revalidation:

– Is the GMC’s objective of bringing all doctors into a governed systemthat evaluates their fitness to practise on a regular basis being consistently achieved?

– How is the requirement for all doctors to collect and reflect upon supporting information (SI) about their whole practice through appraisal being experienced by revalidation stakeholders?

– Is engagement in revalidation promoting medical professionalism by increasing doctors’ awareness and adoption of the principles and values set out in Good Medical Practice?

– Are revalidation mechanisms facilitating the identification and remedy of potential concerns before they become safety issues or FTP referrals?

– How do ROs fulfil their statutory function of advising the GMC about doctors’ fitness to practise and what support do they have in this role?

– Are patients being effectively and meaningfully engaged in revalidation processes?

What is the impact of revalidation on clinicians_-HD.mp4

Patient involvementInstruments

Patient feedback questionnaires

Patient survey

Patient information from GMC and

patient groups

Patients, Public

Lay

representatives

Rules

Revalidation

processes/regulations

Fitness to Practice

Organisational Protocols

Organisational structures

Rules

Revalidation

processes/regulations

Fitness to Practice

Organisational Protocols

Organisational structures

Community

Medical Community

Patients/carers

Patient groups

Medical Institutions

DoH

NHS

Healthwatch

CCG’s

Non-medical communities

Division of Labour

Patients

Lay representatives

Doctors

Revalidation Representation

Outcome

“Up to date and fit to

practice”

Increased patient

safety and public

confidence

Current system inadequate

- further work in progress

Benefits to profession

Summary

• Revalidation has been implemented in the UK with numerical success

• CPD is an essential component of revalidation

– demonstrate knowledge and skills necessary

– show relationship to Good Medical Practice

• Revalidation portfolio should demonstrate professional attitude to working life

• Best outcome for patients is likely to relate to how seriously clinicians engage with the process

• Highlights the need for reflective practice

Questions….?