Professor Malcolm Lewis Chair of Continued Practice, Revalidation ...

Professor Malcolm Lewis
Chair of Continued Practice, Revalidation and
Registration Board, GMC

Why revalidation matters
• The state of the medical workforce is
critical to safe, high quality care
• Effective clinical governance is a
prerequisite for safety and quality
• Revalidation will be built on and can be a
catalyst for effective clinical governance

Governance of Revalidation
•GMC
•Council
•Continued Practice Revalidation
and Registration Board
•UK Revalidation Programme
Board (oversight, consistency)
•National Delivery Boards
•RST (England);
Implementation Group (Wales

Responsibilities
• Designated Organisations
- Must appoint Responsible Officers
- Support ROs in delivering revalidation
• Responsible Officers
- Ensure robust system of clinical
governance
- Ensure doctors have annual appraisal
• The 4 Health Departments
- Commitment via Statement of Intent to
deliver revalidation in late 2012

Support for Revalidation
• Responsible Officers need the support of
NHS leaders
• GMC Employer Liaison advisers – to
support and advise ROs

The prize
• Earlier identification of problems
• Better support for critical human resource
• Patient safety will come first
• UK will lead the world

1999 – 2004 - GMC develops proposals and runs
pilots
2004 – Shipman Inquiry Fifth report
2006 – CMO report Good Doctors Safer Patients
2007 – Whitepaper Trust Assurance and Safety
2008 – CMO report Revalidation: principles and
next steps
2009 – First Stage Pilots
2010 – GMC revalidation consultation and
response
– Pathfinder Pilots
2011 – Simplification and Streamlining
– Additional Year of Testing
2012 – SoS sign off

Key Milestones for Readiness
• Responsible Officers in place in the Designated
Bodies
• All doctors participating in an annual appraisal
process
• Good Medical Practice Framework embedded in
appraisal
• Agreed core information for the doctors’ appraisal
• Process in place for delivery of Responsible Officer
recommendations to the GMC
• Agreed strategy for remediation where
performance concerns are identified

Expected Implementation Timetable
2011-12:
• Additional year of testing, piloting and preparation
• Organisation Readiness Self-Assessment (ORSA)
2012-13:
• Mid 2012: Secretary of State assessment of readiness
• Late 2012: ‘Go live’ decision
• End 2012/Early 2013: First RO recommendations (for
the Designated Bodies which are ready)
2013-14:
• First full year
2014-15, 2015-16, etc:
• Rollout, phased implementation

Responsible Officer recommendations
• ROs are required to make recommendations
about the fitness to practise of doctors to the
GMC.
• This duty is described in the Medical
Professional (Responsible Officer) 2010
regulations and equivalent regulations in
Northern Ireland.
• The GMC will determine the categories of
recommendation and the information that will
be required in recommendations.

Four routes for communication
• Positive affirmation
• Deferral request
• Non-engagement with revalidation
• Fitness to practise concerns

Categories of RO recommendations
• Positive affirmation Refers to a doctor’s
participation in components of revalidation. Highlights
GMC guidance on supporting information for
revalidation and the GMP Framework for appraisal
and revalidation.
• Deferral request Allows ROs to request a deferral
period for example due to prolonged absence from
practice. Does not prevent the GMC from deferring a
doctor’s revalidation at any point for example due to
ongoing fitness to practise proceedings.

Non-engagement with revalidation
• Should be managed through local clinical
governance systems.
• A separate channel will be established for
ROs to notify the GMC of non-engagement
when local procedures have been exhausted.
• This should happen as soon as practicable
and not be left unaddressed to the end of the
revalidation cycle.

Fitness to practise concerns
• ROs presently make ‘recommendations’ to
the GMC through referral to fitness to practise
procedures.
• ROs should use existing mechanisms to refer
fitness to practise concerns to the GMC when
they emerge, not at the point of revalidation.
• Where existing GMC procedures are
underway, the GMC will defer the revalidation
date if appropriate through its own systems.

The Responsible Officer
Regulations and Guidance came into force throughout the
UK on 1.1.2011
The RO is:
Licensed Medical Practitioner for 5 years
For NHS - usually MD
Accountable to Board
The RO role covers:
Contracts of employment or for provision of services
Communicating with the GMC
Monitoring conduct and performance
Appraisal
Responding to concerns

Timelines for trainees
•Full registration after FY1
•Clock starts for revalidation after five
years
•Achievement of CCT confers revalidation
regardless of timing
•Clock starts again for revalidation after
five years

The GMC Consultation
• Doctors in training should revalidate
• Already doing ‘enough’
• Highly supervised and relatively safe
aspect of the profession
• Clinical and educational governance
• Postgraduate dean to be the
Responsible Officer for doctors in
training

How will it work?
• English Deans Pilot supported by RST
England
• Information flows
– Clinical governance
– Educational governance
• The ARCP-CCT link

Questions and discussion