How To Collate and Present Your Supporting Information

Dr Deen Mirza
GP tutor, Health education england (former london deanery)
How To Collate and
Present Your
Supporting
Information
www.londondeanery.ac.uk
The Purpose of Revalidation
•To assure patients and public,
employers, and other health care
professionals, that licensed doctors
are up to date and fit to practise
www.revalidationsupport.nhs.uk
The importance of Supporting Information
•Proof that you adhere to the GMC
principles
•Covering different domains of your work
•Required components will be checked prerevalidation
Six Types of Supporting Information
1) Continuing professional
development
2) Quality improvement
activity
3) Significant events
4) Feedback from
colleagues
5) Feedback from patients
6) Review of complaints
and compliments
Six types of supporting information
organised under four headings
•
•
•
•
General information
Keeping up to date
– Continuing professional development
Review of your practice
– Quality improvement activity
– Significant events
Feedback on your practice
– Feedback from colleagues
– Feedback from patients (where applicable)
– Review of complaints and compliments
Supporting Information
- how often?
•CPD to be discussed at each appraisal (50 credits)
•Involvement in Quality Improvement is expected
at least once per revalidation cycle - e.g. Audit
once per cycle
•Significant Events /case reviews: 2 a year
•Colleague and patient feedback (where
applicable) - at least once per revalidation cycle
•Complaints and compliments yearly
CPD
www.londondeanery.ac.uk
How many CPD credits do you need?
• The GMC does not specify, just enough to
keep you up to date
•The RCGP recommends 50 CPD credits a
year
•The South London RO expects around 50
CPD credits yearly
- It needs to cover your full scope of work
Everything counts!
• Most types of supporting information accrue
CPD points
•This gets counted and tallied up by the
Clarity/RCGP toolkits
•Therefore you don’t have to have 50 hours of
lectures/online modules
What can you collect?
• Clinical
meeting minutes
•Emails when you have a query answered, or you get
some feedback
•Important discussions with colleagues
•(certificates from lectures/modules)
GMC Guidance on Continuing
Professional Development for
all doctors - June 2012
How do you record and store as you go along?
Evernote
How can you keep track of your learning needs/DENs?
• Many
clinical queries solved in real time or at the point of
patient contact
•These journeys are often lost
•Keep a physical or electronic note book
•Choose what is easy to use day to day
•Collect casually, review formally at the end of the year
Capturing what you look up
Online tracking
Some ways of identifying learning needs from General
Practice
1.
2.
3.
4.
5.
6.
7.
PUNs & DENs or similar (learning from patient contacts)
Log from GP Notebook and similar online resources - can be used to
analyse clinical behaviour (and can identify avoidance behaviours /
unknown unknowns)
Case discussions (use SRT to record http://www.appraisalsupport.nhs.uk/)
Audits of e.g. prescribing, referrals, clinical records etc...
Significant Event Analyses (SEAs) (use SRT to record)
Colleague & patient feedback (formal & informal)
RCGP e-learning Essential Knowledge updates & challenges
http://elearning.rcgp.org.uk/
8.
RCGP Scotland Online Self Assessment Learning Tool (nPEP)
http://www.rcgp.org.uk/college_locations/rcgp_scotland/professional_development/education_and_training/npep.aspx
Characteristics of PDP items
• PDP items should be SMART
(specific, measurable, achievable, relevant, time limited)
• PDP items must be “owned” by the Appraisee
• PDP items should address learning needs and not just learning
wants
• Some PDP items should ideally provide evidence which links
learning to (change in) practice
Stages in creating a “robust” PDP Item
• Identification of learning need
• Plan of action to:
– Address learning need (i.e. what to do)
– Provide evidence of learning (i.e. what was learned from what
happened or what was done - e.g. reflective diary entry, case
review, significant event analysis etc...)
– Provide evidence of application of learning in practice (e.g. full
audit cycle, follow-up case reviews / small group case discussion
write-up, development of clinical service etc...)
Deen Mirza
GP Tutor, London Deanery
Quality Improvement
Activity
www.londondeanery.ac.uk
What is Quality Improvement Activity?
Any activity that looks at current practice and makes
changes where these are necessary to bring about
improvement
→ Looking at the healthcare of an individual,
group of patients or population, to looking at a
teaching programme or evaluating an area of
management or policy.
GMC Quality Improvement Activities
•Clinical audit – evidence of effective participation in clinical audit or an
equivalent quality improvement exercise that measures the care with which an
individual doctor has been directly involved
•Review of clinical outcomes –could include morbidity and mortality statistics
or complication rates
•Case review or SEA – a documented account of interesting or challenging cases
that a doctor has discussed with a peer, another specialist or within a multi-disciplinary
team
•Audit and monitor the effectiveness of a teaching programme
•Evaluate the impact and effectiveness of a piece of health policy or management
practice
The RCGP guidance primarily recommends doing audit
and case reviews
Case Review/ SEA
SEA Template
Definition of clinical audit
‘Clinical audit is a quality improvement
cycle that involves measurement of
the effectiveness of healthcare against
agreed and proven standards for high
quality, and taking action to bring
practice in line with these standards so
as to improve the quality of care and
health outcomes.’
Points about Audit for Revalidation
•ONLY one required every 5 years
•Specific details of what is involved in an audit cycle have not
been included in the guidance
•QOF topics acceptable
Sessional GPs- Equivalent Portfolio
•Collecting supporting evidence does not need to be
any more challenging for sessional GPs than for GPs
who are based in one practice.
‘The key is to perform a study examining your own
individual work rather than the work of the practice
where you are working’
Action Audit: Prescription Review
•One locum GP noted 50 consecutive prescriptions that
they initiated (not just repeat prescriptions)
• They identified the most frequently prescribed items
and checked the cost effectiveness, evidence base and
local prescribing guidelines for the top 4.
•The locum discovered that the antihistamine that they
had been prescribing was no longer the most cost
effective and that local guidelines now recommended
another.
•This led to a change in prescribing habit.
RCGP Guide: Quality Improvement Project
•“The RCGP believes that GPs should be able, if they wish and they have the expertise,
to include a quality improvement project as their audit. A quality improvement project
can be designed to review and improve systems of care and may include a review of
pathways of care experienced by a specific group of patients. A description of a quality
improvement programme) should
•Include the:
• title of the quality improvement programme
• reason for the choice of topic and statement of the problem
• process under consideration (process mapping)
• priorities for improvement and the measurements adopted
• techniques used to improve the processes
• baseline data collection, analysis and presentation
• quality improvement objectives
• intervention and the maintenance of successful changes
• quality improvement achieved and reflections
Colleague and Patient
Feedback
www.londondeanery.ac.uk
Colleague MSF
•Easiest to use the Clarity/ RCGP toolkit
•Email addresses
•Use non-clinical colleagues
•Wide net
Patient Survey
•Can be done via Clarity/RCGP toolkit
•Mixture of paper based vs electronic data
•Collection and electronic transcription has to be done independently
•The Toolkit provides the summary
•GMC requirements
Complaints and compliments
•Any compliments from patients should be recorded (anonymised) and
submitted together with reflection.
•Written complaints should be anonymised and the response submitted for
discussion during appraisal .
•It is important to identify your learning from the complaint and what changes
you will make.
Supporting Information Summary
•CPD to be discussed at each appraisal (50 credits)
•Involvement in Quality Improvement is expected
at least once per revalidation cycle - e.g. Audit
once per cycle
•Significant Events /case reviews: 2 a year
•Colleague and patient feedback (where
applicable) - at least once per revalidation cycle
•Complaints and compliments yearly
Thank you
www.londondeanery.ac.uk
Action Audit: Locum GP running late
• ’In the primary care setting, I worry that I run later than other locums?.
•She could audit her time keeping compared to other people in the practice or other
sessional GPs .
•As a result she might identify that missing equipment in the locum room is a factor or
that the first patient arrived late, every patient brought 4 problems or actually that her
time management is better than the partner next door or your locum peers.
•Outcomes of this type of review might be that;
- you request “catch up” slots within your surgery,
- you clarify the practices policy regarding late patients,
- you ask patients to prioritise their problems and book a further appointment,
- you carry more equipment or ask the practices to equip the rooms better ,
- or you worry less about your time management
Locum GP Physiotherapy referral review
•A review of 10 consecutive referrals for example led one locum GP to
discover that many of their physiotherapy referrals were never actually seen;
either the patient got better or appointments were missed.
•The locum was relieved to discover that this was also true for physiotherapy
referrals by peers in their sessional GP group.
•Looking into this revealed some cases where the waiting list was long and
others where patient addresses had changed.
•This led to the doctor changing their threshold for referral .Increasingly they
gave more leaflets and online resources for self help for musculoskeletal
problems only referring for physiotherapy if patients returned with no
improvement.
•They also developed the habit of double checking patients contact details
when making any referral to reduce miscommunication and missed
appointments.