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.

GOK why MSF and PSQ are being used for SGPs

NASGP member John Pike has written a comprehensive document on the problems relating to Multi Source Feedback and Patient Satisfaction Questionnaires with specific reference to their use with Sessional GPs.

We’re inviting our members to contribute to this evolving document which cab be downloaded from our main website. Here’s the executive summary:

• A patient satisfaction survey giving timely feedback to the doctor should be helpful for his personal reflection and for discussion at appraisal, but
• Patient-satisfaction surveys and MSF tools are not sufficiently robust for revalidation
• Neither of the two patient satisfaction tools currently used for the Quality and Outcomes Framework (QOF) has been formally assessed for reliability and their validation has been sub-optimal
• Currently used Patient Satisfaction Surveys and MSF are subjective and subject to huge elements of bias and to many variables outside the doctor’s control
• They are therefore unethical
• Some studies have shown no benefit, and even adverse results, from the use of MSFs
• A large study of a patient satisfaction survey used in Australia showed that it did not help GPs to improve patient-satisfaction over a nine year period
• Any tool used must be useful to GPs, helping GPs to improve their practice
• Any tool used must be acceptable to all GPs using it and GPs must have confidence in it
• Qualitative feedback is an essential part of any survey but commercial companies are not qualified to interpret it
• Qualitative feedback should be given to the GP at the end of each day for his own personal reflection and for later discussion at appraisal
• The GP concerned (perhaps with help from an appraisal discussion) is the only person qualified to interpret, and to reflect on, the results of Patient-Satisfaction Surveys and of MSF regarding himself.
• Different tools may be needed for regular members of a practice and for locum GPs

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!