Outcomes/Effectiveness of revalidation in the UK
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Revalidation is a five-year process in the UK that aims to bring all doctors into a clinical governance system, help identify problems earlier, encourage self-reflection, and contribute to safer, higher quality patient care. So far, over 118,000 doctors have been revalidated. Early evidence suggests revalidation is increasing appraisal rates and identification of concerns, while 24,795 doctors have given up their licenses. Responsible Officers report revalidation is central to quality improvement and allows better understanding of doctors' practices. The future of revalidation may see it more integrated with team performance and use more objective data linked to specialist expectations.
Outcomes/Effectiveness of revalidation in the UK
- 1. Outcomes/Effectiveness of revalidation in the UK IAMRA Revalidation Symposium 29 October 2015 Una Lane Director Registration and Revalidation
- 2. The register tells you: Name Date of Qualification Date of entry to specialist register Holding registration with a licence to practise will move from being an historical record of educational achievement to a contemporary affirmation of competence What are we trying to achieve?
- 3. What are we trying to achieve? Bring all doctors into a clinical governed system Help to identify problems earlier Encourage self reflection Contribute to safer and higher quality care for patients
- 4. Revalidation – the process This is a five year process – NOT a fifth year process
- 5. Revalidation: requirements for doctors 4 domains of GMP
- 6. Where are we now? The numbers Doctors subject to revalidation in the UK: 228,609 GMC figures, as at 31 August 2015 recommendations received by the GMC: 144,777 number of doctors revalidated: 118,448 number of deferrals: 26,061 number of notifications of non- engagement: 268 Revalidate Deferral Non-engagement Not yet received recommendation
- 7. Early evidence of impact? 94% of licensed doctor in the UK now connected to a designated organisation/Responsible Officer Appraisal rates for all doctors have increased significantly e.g. from 64% (2011) to 87% (2015) for NHS consultants Anecdotal claims of earlier identification of concerns – strong support among Responsible Officers 24,795 doctors have chosen to give up their licence to practise Suspended approval of recommendations in three organisations Removed 1,890 licences due to failure to engage with the process as a whole (e.g. providing no information to GMC)
- 8. What Responsible Officers say “Revalidation for me is central to the quality agenda that I am pushing in this hospital” “….allowed me to develop a far better understanding of what my doctors are actually doing in the hospital and elsewhere - I feel more assured” “….there is clearly a move towards better sharing of information around doctors’ whole scope of practice …. this is a direct result of revalidation” “In short, fewer bolt holes for doctors with unaddressed concerns to disappear into.”
- 9. What Responsible Officers say
- 10. What others say 86% of doctors who had been revalidated believed they were treated fairly throughout the revalidation process 34% of doctors who had been revalidated indicated that they were reflecting more on their work than a year ago 73% of employers said they felt that doctors were reflecting more on their practice compared to 12 months ago and 59% of employers said they felt that doctors were more aware of how to apply the principles in Good medical practice compared to a year ago. Over 2 million patients have provided feedback to their doctors
- 11. How will we know it’s working? Bring all doctors into a clinical governed system Help to identify problems earlier Encourage self reflection Contribute to safer and higher quality care for patients Evaluation UK Medical Revalidation Evaluation Collaboration (UMbRELLA)
- 12. The future of revalidation Revalidation the next phase? More integrated with team performance More objective data More linked to specialist expectations Easier to complete Safety and quality increasingly recognised as critical everywhere Data drives patients, professionals and providers to different behaviours Various systems for re-certification, re-licensure around the world.
Editor's Notes
- #4: In the future, I’d expect to see revalidation letters up on practice noticeboards – further evidence that a doctor is up-to-date. Revalidation is fundamental to the clinical governance of safe systems – boards and appraisers need to know the quality of their staff.
- #5: Step 1: Revalidation timeline Step 2: 5 year cycle for each doctor This will become a five year process – it is NOT a fifth year process
- #7: Responsible officers can recommend a deferral for two reasons: insufficient evidence on which to base a recommendation or an on-going local process that needs to be concluded before a recommendation is made. Deferral rates across the 4 countries ranges from 5% to 8%. Deferral rates among doctors with different Primary Medical Qualification (PMQ) regions seem relatively consistent. There is a higher proportion of female doctors receiving a deferral, which could be down to differences in parental leave.
- #11: Survey commissioned by the GMC in 2014
- #12: We have commissioned UMbRELLA (UK Medical Revalidation Evaluation Collaboration) – a collaboration of regulatory academics and revalidation implementers from across the UK to undertake a long term evaluation of revalidation which is due to finish in 2018. The evaluation is based on the framework we commissioned from Plymouth University. We are confident it will make a significant contribution to the development of medical revalidation in the UK. How are GMC guidelines on appraisal being applied in practice and how might they be improved? Has the process of collecting the supporting information and the appraisal process increased doctors’ levels of reflection? Does revalidation help identify potential concerns earlier? What level of involvement do patients want in the revalidation process?
- #13: Various systems for re-certification, re-lincensure around the world