RCGP’s new appraisal guide

The RCGP has responded to feedback from its 2015 revalidation survey by clarifying and simplifying its appraisal and revalidation guidance. Dr Sara Chambers, NASGP's appraisal and revalidation lead, highlights the main changes in the new RCGP appraisal guidance.

The six areas of supporting evidence are largely unchanged, but there have been some important clarifications, a couple of removals and a few additions.

On reflection

There is a back-to-basics (or back to GMC) definition on what it is to be a reflective professional as a habit of mind and behaviour, rather than having to “obsessively document” every new thing you learn or act on.

So for documentary evidence in your appraisal, you should be able to present a selection of representative examples of learning points with high quality notes on reflection. It’s going to be quality, not quantity.

AppraisalAid - Reflection

NASGP AppraisalAidDownload 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 provide you with 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).

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NASGP AppraisalAidPUNs are Patients’ Unmet Needs. They are discovered in consultations simply by asking ourselves at the end, when the patient has gone, ‘How could I have done better?’ During consultations we are commonly aware of gaps in our ability, gaps in the in house systems or attitudinal problems. You need to focus on the Patient’s Needs to identify these. The doctor, not the patient, will decide whether the patient’s needs have been met. Recognition of deficiencies lead to the discovery of Doctors' Educational Needs DENs. When you discover Patients’ Unmet Needs you have found your first PUN ! It simple really!

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NASGP AppraisalAidIn its confidentiality guidance, the GMC states that implied consent would be sufficient in cases where patient data is being used for the purposes of clinical audit, which would include following up a patient's progress with the aim of personal learning and improvement. This means that if a locum sees a patient and then subsequently wishes to access the records of that patient held by that patient’s regular GP, they can do so without breaching confidentiality.

 

How to safely follow up a patient

Continuing professional development - CPD

Not too much change here in the new RCGP appraisal guidance:

  • You still need to demonstrate that you keep up to date with an average of at least 50 CPD credits a year, irrespective of the number of sessions you work.
  • There is some leeway in the following cases, provided there is an explanation and justification that has been discussed with your appraiser and Responsible Officer:
    • For periods of work less than 12 months e.g. appraisal date moved forward, time out of work on maternity leave etc
    • If you no longer provide full range of usual, “undifferentiated” (i.e. 'normal') GP care.
  • One credit = one hour of learning activity demonstrated by a reflective record
    • “Impact”- the automatic doubling of credits by demonstrating impact - is being phased out from 1 April 2016.
    • If a learning point leads to a change in practise, or some other new learning, then obviously record all of that.
  • It is a new ‘best practice” recommendation - if you work in only one setting - to participate in CPD outside of your normal place of work to avoid professional isolation.

Quality improvement activities - QIA

Room for locums to be creative with meaningful QIAs:

  • The wide variety of types of acceptable quality improvement activities has been really emphasised so that “it may be understood by all.”
  • There are no specific examples, and no fixed numbers are recommended, as the type of activity will vary from the simple (e.g. a single case review) to the more complex (e.g. a condition-based review). So, there is definitely room for locums to be creative in thinking of meaningful QIAs.
  • But you should be showing some evidence of reviewing a representative slice of your work every year.
  • For some, the previous RCGP recommendation of two case reviews and/or significant event analyses every year, and one larger piece (e.g. audit) in every 5 year cycle, might still be appropriate.

AppraisalAid - QIA

NASGP AppraisalAidIdentify a condition or area of care you want to brush up on, then use this template to evaluate your current practise, review any evidence or guidance, identify any changes you need to make. Once that's done (step#7), re-evaluate your practise and record your reflection - all on the same template.

This is best suited to commonly occurring conditions where you can expect to see a reasonable number of cases for your data collection e.g.

  • Management of the menopause
  • Treating headaches
  • Dyspepsia
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NASGP AppraisalAidThe idea is to capture a slice of your usual working life by recording 10-20 consecutive consultations. Then review your work with a suitable colleague.

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NASGP AppraisalAidThis may have been a new condition, an unusual presentation of a common condition, something that went well or wrong. Basically anything that triggered you to identify a learning need.

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NASGP AppraisalAidDo your referral letters contain the necessary information in an accessible format that will allow for a smooth, timely referral experience for your patients?

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NASGP AppraisalAidDid you refer the patient to the right place at the right time?

As a locum it can be especially challenging to get feedback on our referrals. Nonetheless, this is a valuable area of learning in how to use local resources efficiently, and most importantly, doing our bit in helping our patients have the smoothest, safest journey possible.

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NASGP AppraisalAidMeeting complex patients with multi-morbidities, and a medication list stretching across two screens, is not uncommon in general practice. Some of this polypharmacy will be what the Kings Fund in their 2013 report called appropriate in improving quality and duration of life.

Sadly, problematic polypharmacy is also out there, putting patients at risk of adverse drug reactions (ADRs), drug interactions (common causes of unplanned hospital admissions), as well as poor compliance and is a huge waste of resources.

As locums, coming across patients on long lists of medications can be a challenge, but as a fresh pair of eyes you might spot a risky drug combination or ADs that could be making a patient’s life miserable.

In their excellent March 2015 Polypharmacy Guidance, NHS Scotland developed a “7- steps approach to medication review”. We’ve referenced it in developing an easy reference template for those “Where do I start?” moments. You could take it a step further by recording and reflecting on a series of medication reviews as a QIA for your appraisal.

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NASGP AppraisalAidWe all know antibiotics are a finite resource; with primary care generating 80% of NHS antibiotic prescriptions, use this qualitative review to identify what factors drive your prescribing and if there are any changes you can make to help tackle antimicrobial resistance.

 

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NASGP AppraisalAidReferral letter outcome review for audit ideas for your referrals.

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NASGP AppraisalAidTemplate for a run through of the audit process.

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NASGP AppraisalAidIn its confidentiality guidance, the GMC states that implied consent would be sufficient in cases where patient data is being used for the purposes of clinical audit, which would include following up a patient's progress with the aim of personal learning and improvement. This means that if a locum sees a patient and then subsequently wishes to access the records of that patient held by that patient’s regular GP, they can do so without breaching confidentiality.

 

How to safely follow up a patient

Significant events - SEs

There is clarification of the GMC definition of SEs as critical incidents or serious untoward events vs the 'GP' definition of significant event analysis (SEA), which can refer to any event - whether good or bad - that enabled you to review your practice.

  • GMC level significant events are what are referred to as 'significant events' in the appraisal portfolio. If you have not been involved in an SE, you should sign the statement confirming this.
  • 'GP' SEA should be included under quality improvement activities (QIA) in your appraisal portfolio.

This clarification should put an end to the urge that many seem to have to sign up to two “significant events” a year!

AppraisalAid - SEs

NASGP AppraisalAid

If you have been involved in a serious significant event that caused, or had the potential to cause harm, you may find the process of enhanced significant event analysis helpful.

Apologies for using the term 'significant event analysis' having only just clarified that significant event analysis is different from a Significant event for the purposes of appraisal and revalidation, but this is the name given to this very enlightened and useful form of incident analysis by its developers at NHS Education for Scotland and the Health Foundation.

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If you have been involved in a serious significant event that caused, or had the potential to cause harm, consider also looking at Recording significant events - enhanced - it may save your sanity.

 

 

 

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Feedback from colleagues and patients

There’s still the requirement for one formal GMC-compliant colleague feedback and patient feedback survey in a five year cycle, but patients want more of a voice...

  • Patient groups have had input into this guidance, and for “most” GPs seeing “many patients every day”, a 5-yearly patient survey was not thought to provide adequate feedback.
  • RCGP now recommends that GPs reflect on all the other forms of patient feedback annually at appraisal e.g. reflective notes on comments to you or about incidents, letters, cards etc
  • There is no expectation that you should have to carry out any additional surveys; this is just about reflecting on feedback sources that should already be available to you.
  • If you have non-clinical roles, you may choose to use the GMC-compliant survey for all your colleagues.
  • Or, for your non-clinical colleagues, if more specific tools are available, you could use these alternatives. Clinical colleagues will need the GMC compliant survey.

Listen to our podcast on the latest changes to the RCGP's appraisal and revalidation guide

Sara was a salaried GP for 4 years, and has worked as a locum GP since 2001 in over sixty different GP practices. As well as NASGP’s appraisal and revalidation lead, and mother to twins, she is also the brains behind NASGP’s Practeus platform.

Sara’s an avid reader, especially fiction, history and trains (yes, trains); loves walking, pilates and beans on toast with cheese.

3 Responses

  1. Dr Tiwari
    I am puzzled by Dr Chambers' comment "There is no expectation that you should have to carry out any additional surveys; this is just about reflecting on feedback sources that should already be available to you". The Clarity GP Appraisal Toolkit will not allow appraisal documents to be submitted without adding documentary evidence of patient and colleague feedback. The BMA when contacted has confirmed today that this must be GMC approved feedback documentation. So it appears that colleague and patient feedback must now be submitted annually instead of every 5 years, thereby considerably adding to the appraisal burden.
    • Richard Fieldhouse
      Hi David, I think this is more a case of the cart leading the horse, in terms of Clarity having a user interface that suggests you need to provide both colleague and patient feedback every year. I use Clarity too to upload and present all my completed AppraisalAid templates, and in the years where I haven't completed one of the required quinquennial GMC-approved feedback surveys, I just upload my most recent one to show that it's been done.
      • Vimal Tiwari
        Dear Richard Thank you for your suggestion, this is very helpful. Vimal PS I think I know the David you mean but I am not he!

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