To demonstrate you are keeping up to date, you will need to collect 50 credits in each appraisal year, irrespective of the number of sessions worked, leading to 250 credits over a 5-year revalidation cycle. You award them to yourself and then they are verified by your appraiser.
Basically, one hour of education demonstrated by a “reflective record” on learning points and changes made is one learning credit.
What you learn will be individual to you, your interests and your working life but some tips that will keep your appraiser happy:
- Over your 5 year revalidation cycle, spread your learning credits across all areas of your work.
- Demonstrate that what you’ve learnt is needs-based and relevant to your working situation.
- “Close the loop” by showing how you applied some new learning e.g. write up a case review showing how you used your new learning to change your practise.
- You will be expected to demonstrate that you are up to date in child safeguarding and basic life support.
How you learn is also up to you.
- Aim for a mixture of different learning activities; anything from personal study, locum group learning, discussion with a colleague, organised courses.
- Don’t forget, you’ll also be clocking up learning credits from your quality improvement activities and your learning from feedback via significant event analysis. Just remember not to double count the credits (e.g. counting credits for the same piece of learning in your QIA and CPD area) as this is frowned upon.
Reflection, reflection, reflection
This is key when it comes to claiming your CPD credits. Recording that you read the BMJ for an hour a week – bingo 52 credits! – will not be sufficient. Similarly, just collecting attendance certificates at meetings will not do. The argument being that the untargeted and unreflected acquisition of knowledge does not necessarily translate to change that will benefit patients. You need to reflect and record why this learning is important to you; what you might need to do differently as a result of this learning and a plan for doing this; ideally, as a final flourish, you could demonstrate the outcome of your learning by showing how your practise has changed, perhaps handily leading to a QIA...
For many, the process of reflective learning feels like such a fundamental part of being a doctor that the act of having to record what seems obvious and natural can feel cumbersome and frustrating. But appraisal, now being the basis of revalidation, is here to stay and there is a way to turn the process to your advantage….and the NASGP CPD templates are here to help you capture learning from different settings and record those important features of reflection that your appraiser will want to see.
Download and adapt any of our four appraisal templates to quickly guide you through the process of recording and reflecting on your CPD
- From an interesting encounter with a patient
- From a meeting you've attended
- On having read and article, book or clinical blog.
We also include a structured clinical reflection template.
All are in both Word and Google docs, which can be synced to your hard drive, smartphone and cloud storage, allowing you to record evidence, and later access your learning , on-the-go (both online and offline).
NEW! Online structured learning template to record learning and reflections, and have a searchable PDF emailed to you immediately for you to upload to your favourite (!) online learning toolkit.
Many of our downloads are available as Google Docs or Microsoft Word documents. Both can be stored as single files that you can download on to a hard disk of a computer. However, if you want to access them at any time from any computer or other device (ideal for GP locums working in many practices) then look into cloud based storage options such as Google Drive.
- If you click on one of our Google Docs links, you'll notice that it's View only. So in order to make a copy of this, click on the Google Sign in link on the Google Doc screen (usually top right hand of the screen) and sign in with your Gmail account*.
- Then go to File >> Make a copy, which will then save your very own copy in your own Google Drive for you to access and customise.
*Don't have a Gmail account? You'll be prompted to signup for one if you try to sign in. Worth doing; it's quick, free and you get email and calendar along with the Google Drive (document storage).
There is no consistently set minimum number of sessions you should work per year across the UK.
To remain on the performers list in England, you must be performing at least one session a year.
Structured reflective template (SRT) for appraisal
But anyone in England/Wales working less than 40 sessions in the year of their appraisal will need to submit a ‘structured reflective template’ (SRT) with their appraisal to demonstrate their continued ability to provide safe care.
- See NHS guidance "Supporting doctors who undertake a low volume of NHS General Practice clinical work"
- AppraisalAid | Structured reflective template for doctors undertaking a low volume of NHS GP clinical work
Employers have a legal obligation to provide a working environment that enables their employees to work safely and to the best of their ability. Which should mean that they provide all the equipment you need, in working order.
The real world isn’t like that. It can be very hard to unearth the piece of equipment, and, when you find it, it may be broken or out of date. And even if it is working, it may be a model you aren’t familiar with. And nothing wastes time and reduces a patient’s confidence in you more than watching you hunt through drawers or fiddling with a device that you clearly don’t know how to use.
The solution is to take your own equipment. Then you you know where it is and you know it is working order (don’t you?).
But equipment can be expensive, and there is a limit to what you can carry, especially if you are on a bike. So here is a list of items contributed by locums. The nearer the top, the more people carry the item. Have a look and consider what, in your circumstances, you would not want to be without.
And if you have pet pieces of equipment you wouldn’t be without, let NASGP know and we will add them to the list.
- sphygmomanometer (serviced regularly)
- diagnostic set (with spare batteries)
- patella hammer
- tuning fork
- tongue depressors
- peak flow meter plus mouthpieces
- tape measure
- obstetric wheel
- lubricating jelly
- pulse oximeter
- dip sticks (in date)
- glucometer (plus in-date test strips)
- BNF (paper or electronic version)
- favourite reference books (paper or electronic version)
- pregnancy tests
- vaginal speculum
- Pinard stethoscope
- adrenaline and means of administering it
Practices vary widely, and the only sure way to know is to speak to each practice before you go or, better still, carry your own equipment with you.
If you need the practice to provide it for you, make sure it's agreed in your Terms and Conditions.
Here's just a few of the usual publications that seem to stop arriving when you're a sessional GP, although to be fair a lot more are going online anyway.
British National Formulary
- NASGP work with NHS England to help as many NASGP locum members in England receive one every September (not April), so please make sure that you've updated your NASGP membership with your country, GMC number and GP status. Salaried GPs should organise distribution through their practice; if you're a locum and salaried/partner, you'll receive a BNF via your practice - NHS England will only send you one if you're not otherwise listed as a partner or salaried GP. We can't guarantee that NHS England will provide one, as they have ultimate control over distribution and distribution is dependent on available supplies.
- In Scotland, the Local Health Boards (or equivalent) distribute the BNF so please contact them.
- If you live in Wales or Northern Ireland, your local Health Authority still has responsibility so you need to send your contact details to the chief executive of your Health Authority.
There is the online eBNF, or the BNF smartphone/tablet apps.
If I didn't receive my BNF?
- NASGP acts as a third party by sending your details to the DH once a year, and they then cross-check our list against their own. If they see you on a different list e.g. on a previous practice (partner or salaried) they'll send it to that practice instead. If Binleys run out of BNFs, then they won't send any at all. We suggest check with your old practice (if you had one within the last 18 months), or if not contact Binleys direct.
- NASGP submits its list in July ready for the September BNF mailing of that year. If you join the NASGP between those dates that we won't be able to submit your information until the following year.
- NASGP can not supply BNFs if Binleys have run out, and does not guarantee that you will receive a copy. Please direct all queries about non-supply to Binleys.
Drug and Therapeutics Bulletin (DTB)
- No longer free - bought by BMJ Publishing from Which
- Call 0207 383 6270
Sessional GPs can access MIMS (quarterly print issues + full online access) at special rates.
The simple advice here is to try not to get involved in repeat prescribing. This is an area fraught with risk for locums. If you don’t know the patients or their medical histories, this could compromise their care. The last thing you want is a batch of 100 prescriptions to sign off under the pressures of time and record-checking.
Nevertheless, you may be unable to avoid this task if your services are required long-term or in a single-handed practice. In this case, you should agree what will be expected of you regarding repeat prescribing in your terms with the practice in advance.
It is important to clarify
Will you be expected to sign repeat prescriptions?
Does the practice have a protocol for safe repeat prescribing? (Some locums ask for the practice to state in writing that this system is robust and checked regularly.)
What extra time you will need and any supplementary fee for carrying out repeat prescribing work.
When using an unfamiliar electronic prescribing system:
Specific review period or dates should be entered and observed.
Don’t ignore computer warnings of over- or under-use of medication.
Prescriptions should be issued with caution if a review with the patient is overdue. Make sure appropriate arrangements for timely follow up are in place.
Add appropriate computer messages, eg ‘No more methodone until seen’, with the date and your initials.
From a patient safety and risk management perspective, the suggestions below may help.
Familiarise yourself with the practice’s repeat prescribing protocols.
Some medication is unsuitable for repeat prescribing, so a face-to-face consultation would be essential in cases such as night sedation, antidepressants in the suicidal and NSAIDs in the elderly.
Don’t issue a prescription for an item you feel uncomfortable with, eg hypnotics, strong analgesics or anti-depressants.
Refresh your memory on the National Prescribing Centre’s guide – saving time, helping patients: A good practice guide to quality repeat prescribing.
Although all GPs should have an annual Basic Life Support update, it is not mandatory.
In its framework for appraisal and data to Responsible Officers, NHS England says that evidence of annual BLS training should be expected from GPs. This is apparently a nationally agreed item that will be flagged to the responsible officer if it is absent, but confusingly, is “not necessarily directly relevant to the doctor’s revalidation recommendation.” Which goes with our interpretation is that it's good to get BLS training annually, but it's not mandatory.
So can you skip BLS training in your appraisal? Arguably yes, but since you can't skip the mandatory 50 hours of CPD, you may as well include an hour of BLS, and allay any pre-appraisal anxiety about having any argument with your appraiser.
Here at NASGP we've tried a few accredited online training modules, and our favourite is the one from Blue Stream Academy. We've got an exclusive offer for NASGP members for a 20% discount of not just this, but over 60 other online practice-based modules, including BLS, child and adult safeguarding too.
This is something that more of us are being asked to provide proof of by practice managers. It's generally not something that's expected as part of our NHS appraisal evidence, but is something that the CQC are asking practices for proof of.
In 2011 the Dept of Health and the Information Commissioner's Office wrote to all NHS staff:
All NHS organisations (and others with access to NHS patient information) should:
ensure all staff undertake appropriate information governance training annually as identified in the NHS Information Governance Toolkit.
If you're a partner or a salaried GP, or work with a hospital or CCG etc, it's likely that you already undertake annual online training with Health and Social Care Information Centre HSCIC, and can just provide evidence of that.
If you're a locum, and are being asked for this
- speak to a friendly local practice, or insist* on your CCG adding you to their IG training account with HSCIC.
- and work for an agency, they will probably organise this for you.
- and in a chambers or sessional GP group, you may be able to organise this as a talk (from your CCG's IG lead?).
If you're not being asked for this
- If you personally feel it's a learning requirement, discuss it with your appraiser at your next appraisal.
*seriously, if it's so important that you're being required to do it, your CCG needs to put its money where its mouth is and support its GPs.
Whilst the CQC will certainly be interested to ensure that practices and staff know how to recognise and respond to vulnerable adults, the safeguarding adults training requirements for GPs in this area, and for now, the appraisal requirements, are less clearly defined than they currently are for safeguarding children and young people.
So what adult safeguarding training should I be doing?
In the absence of current clear guidance, you could consider translating the level 3 competencies required for child safeguarding across to safeguarding adults:
Translation of level 3 competencies to safeguarding adults
- Aware of national guidance, professional duties of care
- Aware of local adult safeguarding board arrangements
- e.g. make it one of your appraisal supporting evidence items to study and reflect on local pathways and document this for your appraisal.
- Importance of information sharing and confidentiality
- Of different forms of abuse and neglect and how these can manifest
- Know how to share information appropriately, taking into consideration confidentiality and data-protection issues
- Able to contribute to, and make considered judgements about how to act to safeguard/protect a vulnerable adult.
- Able to present safeguarding concerns verbally and in writing for professional and legal purposes as required (and as appropriate to role, including case conferences, court proceedings etc)
Other learning options
- Document learning from significant events or case reviews involving vulnerable adults
- Toolkits and e-learning
- e.g. BMA’s Safeguarding vulnerable adults - a toolkit for general practitioners looks useful
- e-Learning for Healthcare has a Safeguarding Adults area
- Training organised by CCGs and other local organisations
- There will probably be more locally organised training as the Care Act 2014 requires Safeguarding Adults Boards to work with CCGs (and others) to provide this.
- These are useful as they are often multi-agency and can give you a greater insight into how agencies such as social care, health care workers and police interact.
We all know why childhood safeguarding training is so necessary for safeguarding children: after every high profile case of child neglect and abuse over recent years, the same failures and lapses emerge; poor communication and information-sharing between professionals and agencies, inadequate training and support for staff, and a failure to listen to children. So no-one begrudges getting skilled up in this key area.
How should we get safeguarding children training, and what evidence will appraisers and practices want to see?
Thankfully, there is clear guidance in Safeguarding children and young people: roles and competences for health care staff, an Intercollegiate document from March 2014. GPs require level 3 competence. Highlighted quotes relevant to GPs from its 102 pages include:
- Over a three-year period, professionals should receive refresher safeguarding children training equivalent to a minimum of 6 hours (for those at Level 3 core this equates to a minimum of 2 hours per annum).
- Training in safeguarding children at level 3 will include the training required at level 1 and 2 and will negate the need to undertake refresher training at levels 1 and 2 in addition to level 3.
- Training, education and learning opportunities should be multi-disciplinary and inter-agency, and delivered internally and externally. It should include personal reflection and scenario-based discussion, drawing on case studies, serious case reviews, lessons from research and audit, as well as communicating with children about what is happening.
- Educational sessions could be a combination of e-learning, personal reflection and discussion in clinical meetings or attendance at internal or external outside training courses.
- Safeguarding children training can be tailored by organisations to be delivered annually or once every 3 years and encompass a blended learning approach.
In addition to appraisal requirements, the CQC also take a view on this:
- The CQC reference the statutory guidance ‘Working Together to Safeguard Children’ which helps professionals understand what they need to do, and what they can expect of one another, to safeguard children. It focuses on core legal requirements and makes it clear what individuals and organisations should do to keep children safe.
- "GPs in particular have a responsibility to ensure that all staff across their organisations have the knowledge and skills to be able to meet this requirement."
Appraisal and revalidation requirements
Note that this intercollegiate guidance is talking about minimum requirements, and there may well be variation in how appraisers in different areas apply this. Indeed, it seems that some local area teams are piloting adding Safeguarding as an item in supporting information for appraisal, which may one day become nationally agreed.
Take home messages for GPs from this guidance
- Aim for minimum of 6 hours of refresher level 3 training over 3 years (or minimum 2 hours per year).
- Training and education can be a combination of various forms e.g. training courses, e-learning, personal reflections on cases or having read guidelines.
- Submit this evidence to your appraiser every year, and if working across different practices who ask for evidence from you that you satisfy the CQC's requirements, provide a signed letter from you stating that you submit this and any other relevant evidence in your annual NHS appraisal.
- Ensure that the employing practice undertakes its responsibilities too by ensuring you have access to all its safeguarding information, ideally by giving you access to its Standardised Practice Information Portal.
So check with your appraiser. This guidance may be a useful reference if your appraiser’s requirements seem overly onerous or prescriptive.