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.
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.
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
- AppraisalAid | Can GP locums access patient records later?
- AppraisalAid Download | QIA – Audit process
- AppraisalAid Download | QIA – Audit referral letter outcome review
- AppraisalAid Download | QIA – Medication review template
- AppraisalAid Download | QIA – Condition-based case reviews
- AppraisalAid Download | QIA – Serial case reviews with a colleague
- AppraisalAid Download | QIA – Qualitative review of your antibiotic prescribing
- AppraisalAid Download | QIA – Referral outcome review
- AppraisalAid Download | QIA – Referral letter content review
- AppraisalAid Download | Individual case review
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!
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.