Revalidation – where next for Sessional GPs?

The final report on “Revalidation processes for Sessional GPs – A feasibility study to pilot current proposals” is now available to read here. The study set out to explore the potential problems locum, salaried and remote GPs might have with the proposed supporting information required for appraisal as part of the revalidation process. GPs who experienced the most difficulty tended to be peripatetic locums and out of hours GPs with no permanent practice base.

The findings will come as no surprise to these GPs and will make worrying reading for those tasked with implementing a revalidation process that is fair to all doctors. Concerns raised in the report included:

• lack of support by practices and locum isolation.
• There were significant problems with the key revalidation requirements of Clinical Audit, Significant Event Audits.
• Patient Satisfaction Surveys and Multi-Source Feedback.

Possible solutions suggested included peer groups for reflective discussions, locum Chambers, greater support from Deaneries, LMCs, practices, OOH organisations and PCOs, alternatives to audit and other requirements, mentoring schemes, and locum prescribing numbers.

The RCGP has already gone some way to find alternative evidence that it would be acceptable for Sessional GPs to collate, and Version 4 of the Guide to Revalidation of GPs describes “equivalent portfolios” that GPs in Special Groups can present. However, substantial problems persist, and it remains to be seen how much support for locums will actually materialise. Past experience would suggest that there is a steep uphill path.
The BMA, in its evidence to the GMC consultation, had a number of criticisms of the current proposals, and opposition has come from several other quarters.

According to “Pulse” today, the “Department of Health is planning to substantially scale back revalidation in light of concerns over cost and anger among GP leaders about the level of bureaucracy to be heaped on practices”, and the article suggests areas where cuts may be made. With so many concerns about the cost, process, and fairness of the current proposals, it is surely time for the GMC to go back to the drawing board.

Only 45% locum GPs appraised in Scotland last year

Back now from the 9th meeting of the RCGP’s Revalidation Steering Group, with for some reason twice as many attendees as normal, probably reflecting the growing proximity of Revalidation itself. Some interesting stats from Scotland – 45% of locum GPs have been appraised in the last year compared to 75% of principals, and in the area where locums were paid for their appraisal the rate increased to 100%! Interesting too that 30% of GPs on a performers list are on it for less than a year.

On MSF and the only recognised tool being the GMC’s, there is a dawning recognition that more work needs to be done (soon) to create alternatives. A new version of the “RCGP’s Guide to Revalidation” should be published in the first week of December – we’ll remind you when it’s released and will as always be encouraging sessional GPs to feed back their thought s and comments.

Of growing concern is how remediation will take place and how it will be paid for, with quite a bizarre scenario emerging that the answer may well be in the form of a long “lost” piece of information from the DoH residing on the NASGP website stating that PCTs will indeed provide funding in such cases. All it requires now is to find out the document’s original provenance and make sure the advice is adhered to!

How much is it actually going to cost?

There’s no doubt that sessional GPs are being listened too; updated documents are now beginning to show the fruits of our labours. This week’s Revalidation Stakeholder Group was shown the latest in a long line of incarnations of its forthcoming guidance, being formally published by the RCGP in a few weeks. It’s interesting too how the dialogue on revalidating locums seems to be changing – not so much ‘How?’ but more ‘How much?’ A sure sign of progress, but actually a question that I feel is going to be even tougher to answer.

The next stage now is to await the outcomes of the Revalidation pilots, as this should actually highlight the main areas where work needs to be done to hone down the details of how we can actually collect ‘evidence’ for locum appraisal.

closer inspection reveals a more depressing picture

Returning home now from today’s RCGP Focus Group on Revalidation for Sessional GPs. On the one hand, a very exciting meeting. The college has done excellent job in assembling an eclectic mixture of Sessional GPs, and the 3-hour workshop certainly raised a lot of specific issues. But on the other hand, somewhat depressing! That’s not a criticism at all; in fact, so effective was the format – a progress report on where the college is at with revalidation, an excellent overview by the GPC Subcommittee on issues faced by Sessional GPs and my own overview of the NASGP’s aFGP Scheme and locum support teams – that the subsequent break-out groups were able to dig very deep into specific issues that locums may be facing over the next few years. The deeper one digs, however, the more complicated the solution seems to appear – at least to me. I have no doubt that a solution is deliverable, but suspect it’s going involve a lot more development than we’d hoped.

Preparing for next Thursday’s revalidation meeting

Now gearing up for next Thursday’s meeting at the RCGP to discuss revalidation for locum GPs. last month I emailed all our groups seeking 6 delegates to join me, and received 10 very enthusiastic replies. For those that are unable to attend, we’ve ‘buddied up’ online in a collaborative file-share area to discuss papers, ideas etc. I think we’re knocking on an open door here, but need to define a simple strategy that will actually deliver tangible support. The solution is going to cost, but who is going to pay for it…

No to revalidation ‘Plan B’

I’m becoming increasingly disheartened that Plan B for revalidation will simply be, for those who haven’t got enough support to get through the ‘conventional’ route, to sit the MRCGP. And considering that it’s the RCGP delivering revalidation, it’s a somewhat disingenuous situation whereby we’re potentially ending up lining the pockets of those who’ve left us in the lurch. I’ve written to the RCGP pointing this out, and have already had an acknowledgment that they will meet.

Revalidation – complaints being overlooked

I’ve just returned from the bi-monthly meeting of the RCGP’s Revalidation Stakeholder Group, so I thought I’d give you a brief update. Please bear in mind that a lot of what goes on in these meetings is still “under development” so I’m talking mostly in general terms.

When I’ve got my revalidation hat on, I talk mostly in terms of locums as, generally, salaried GPs will be covered by practice based systems:

• Audit – probably looking like every GP – locums of course included – will have to do a clinical audit cycle twice every 5 years. In my opinion, locums who are spread among many practices and/or who are isolated from other locums could find this really tough. What I’d really appreciate here is your help – please, I’d love to hear from any of your locum members who’ve done some audit on their locum practise so that I can further develop the Audit For Locums section on the NASGP website at http://www.nasgp.org.uk/cpd/auditaudit so that we’ve all got a central resource for ideas over the coming months and years.
• MSF – I thought this was something to do with DIY before I realised it stands for Multi-Source Feedback or 360 feedback. Again – a couple of times possibly (I did say it was all still vague, didn’t I?) over the course of the 5 year revalidation cycle. As locums, we’re going to have to apply to colleagues –either other GP locums or GPs in practices where we’re “well known” – to formally provide us with feedback on our clinical ability and professional behaviour from up to 5 clinicians and/or other non-clinical staff. Again, any experiences from you in doing this as a locum would be really helpful.
• I did get a tadge irritated today as yet again I felt we (all 15,000 of us!!) were being overlooked on the issue of complaints – not so much how locums are involved in the process, more the fact we’re often entirely overlooked and simply aren’t told about them – just not booked again! The solution, I fear, warrants a tidal shift in the attitude of many practices (which is why we so need the NASGP).

RCGP Revalidation Steering Group Meeting

• The RCGP has assured locums that we will be involved in the piloting wave coming up over this winter. If it’s something you would particularly like to be involved with, we will be happy to pass on your details to the RCGP.
• All GPs will be required to submit at least five significant events a year as evidence for their revalidation – see our website for suggestions about this.
• You will no doubt already know that we’ll have to provide evidence of having achieved 50 credits a year for participating in CPD – if you haven’t already done so, make sure your Sessional GP Group, and any informal journal clubs you belong to, applies to its local Deanery for approval to ensure that your participation is being counted!