Guidance

Introduction

Revalidation has started and Wessex LMCs are keen to offer support to GP locums with their preparation for revalidation. It has been acknowledged nationally that locum doctors may face additional practical challenges in obtaining their supporting information. We hope that this document will go some way to easing those challenges.

This document contains a range of practical suggestions that GP locums can use to add to their existing evidence for appraisal. It has been written by GP locums for GP locums.

The key message is that revalidation does not have to be difficult. If in doubt, ask early – your Appraiser and your LMC will be happy to help.

You can read this document from start to finish or dip in and dip out again. We hope that you find it helpful.

Back to Top

 

1.Where to Start

Important advice for locums about revalidation itself can be found on the website of the Revalidation Support Team. Click here.

There is ample general information on the Wessex LMCs website about revalidation.

Back to Top

 

2.The Six Areas for Revalidation

2.1 Continuing Professional Development 

Here is a summary of what you need to do:

CPD is the cornerstone of revalidation and will be discussed at each appraisal.

CPD should be specified and undertaken as part of your personal development. You should identify your professional needs and competencies and should take account of the needs of patients and the healthcare system when planning your CPD. With the wide-ranging breadth and depth that general practice covers there are several options to discover learning opportunities.

The RCGP does not specify the amount of CPD that you need to do each year any longer (having previously specified a 50 credit minimum per year). The vast majority of GPs will undertake significantly more than this in any case most years, but by removing the specific credit amount the RCGP has freed up GPs to consider their needs in discussion with their appraiser. The GMC does not define a specific number of hours or credits but does require you to engage, record and reflect on the activities you undertake, and do enough to demonstrate that you are up to date across the whole scope of your work.

You should complete a variety of learning events or actions, which could include:

  • Attending an external lecture or conference
  • Attending an internal practice based educational event g. significant event meeting, practice based education, try asking the Practice Manager at practices if you can link up with their activities
  • Attending a small group based learning g. an action learning set, Problem Based Small Group Learning (PBSGL) with a formal or informal origin or done through a locum support group or chambers
  • Reading a medical journal or book
  • E-learning modules, podcasts, apps or websites
  • Teaching and training
  • Case based discussion
  • Clinical audit
  • Data collection and analysis
  • Review of notes with a colleague

CPD is not only about filling gaps in knowledge but is also about maintaining your skills.

You will need to demonstrate you are keeping your skills and knowledge up to date in all aspects of your work especially where you have more than one role.

Keep a CPD log of what you have done during the year, why you have done it, how long you have spent doing it and recording brief reflections, focusing on the outcomes of your learning rather than providing vast sums of documents. It is the impact on your practice that matters. Your CPD can be recorded on many of the commercial toolkits, the RCGP portfolio, the MAG form or the Severn Deanery toolkit. There is also a free learning log at www.fourteenfish.com that can be exported as a PDF at the end of the year to any appraisal tool you wish. This is probably the most popular appraisal option for GPs in the Wessex area.

(Back to Top)

2.2 Significant Event Review

The GMC definition of a significant event is not the same as the one that has been used in general practice (essentially a significant untoward incident).

All practices discuss significant events and practitioners should use these as quality improvement activities. What appraisers are looking for is your reflection and then any action that has been taken which will improve the quality and safety of care in your practice.

As a locum you should try to ensure that the places you work let you know if you have been involved in a significant event so that you can share the learning by getting the minutes, even if you can’t always attend the meeting. You could stipulate this in your terms and conditions.

(Back to Top)

2.3 Feedback From Colleagues

There are a number of feedback tools that are available to do this for you. They come at a variety of prices. You are free to choose whichever you wish, check beforehand that they match the GMC requirements.

The GMC states that all colleague and patient questionnaires must:

  • be consistent with the principles, values and responsibilities set out in the GMC’s core guidance, Good Medical Practice
  • be piloted on the appropriate population, and demonstrate that they are reliable and valid
  • reflect and measure the whole practice of the doctor
  • be evaluated and administered independently from the doctor and appraiser to ensure an objective review of the information.
  • provide appropriate and useful information to the doctor that can be used in discussions with a supervisor or mentor, or through appraisal
  • help the doctor reflect on his or her practice and identify opportunities for professional development and improvement.

https://www.fourteenfish.com/  is a tailored service for GPs set up in partnership with Wessex LMCs to reduce the stress around revalidation, colleague feedback and patient feedback as much as possible. There is clear guidance on how to undertake this feedback on the Fourteen Fish website. There are a number of alternatives on the market.

If you are a portfolio GP try to anticipate that most of the questions are clinical in nature. It would be helpful, if you can, to try to select most colleagues whom you know from working in a clinical setting. Do not limit yourself to doctors. A receptionist working with you regularly would also get valuable feedback about your interpersonal skills from patients; this is also true for GPs working in the Out of Hours service or as GPwSI in a secondary care setting.

If you work in a non-clinical role there are optional alternative Colleague feedback surveys also available on Fourteen Fish and other platforms.

(Back to Top)

2.4 Feedback From Patients

Patient feedback is intended to help doctors reflect on their practice by giving them the information about their work through the eyes of those they treat.

There are a number of organisations available to administrate this requirement for you. They can be found easily via search engines on the internet. They will vary in price. There may be an opportunity to purchase both a patient and colleague survey for a discount.

Whichever company you choose check that they will meet the GMC standards; the same principles as for the colleague feedback surveys.

This needs to be completed at least once in every Revalidation 5-year cycle. If you have completed on in the last 3 years bring this to your next appraisal as this will be valid.

You must reflect on the results and discuss them with your appraiser.

The survey needs to be administered, collected, and analysed independently of the GP.

The guidance is that you need to distribute 50 questionnaires (they do not have to be to consecutive patients) but they should not be given to selected patient (because you know they will give you positive feedback). You need 34 completed questionnaires to ensure the result is valid.

The diagram on the following page helps you avoid some of the pitfalls and make sure the process is as painless as possible.

The use of texting to patients has led to a significant simplification for GPs undertaking patient surveys. Work with your practice administrators to see how a simple link can be sent by SMS test to patients asking them to complete a survey about the care you have given them. A simple method is to set up your survey and then use SMS text survey request to your 50 previous patients. Please be aware that older patients are less likely to respond to these so consider a mixed approach with text and paper surveys.

(Back to Top)

2.5 Ensuring Collecting Your Feedback is Painless

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Back to Top)

2.6 Review of Compliments and Complaints

The GMC see complaints and compliments as a type of feedback.

Compliments: As important as complaints, we can always learn and share experiences. They can also help you to reflect on your strengths which are as important as your weaknesses.

Complaints: Each year at your appraisal you will be required to declare whether you have been named in a complaint and if so you will be expected to demonstrate that you have reflected on this, defined any lessons that have been learnt and most importantly discussed any outcomes in terms of change in clinical or managerial practice as a result of this.

This is not a second chance for the establishment to open up resolved complaints, but a chance for you to review them with the benefit of hindsight after it is all over. Unresolved complaints should be identified but would not be appropriate to discuss at any length until the appraisal after they have been resolved (although you may already have some lesson learned to discuss part way through an investigation).

Note: Do not provide patient identifiable information in any of your written supporting information, nor should you name colleagues or provide colleague identifiable information in your written supporting information.

Back to Top

 

3. Quality Improvement Activities

In the past GPs were told by the RCGP that once in every 5-year cycle they would need to complete a full clinical audit.  This is now not a requirement as defined by the GMC, although the RCGP suggests that GPs should use this as part of their quality improvement activity.

At each appraisal you need to demonstrate that you are engaged in quality improvement activities and provide supporting information for this.

Examples of quality improvement are:

  • Case based discussion.
  • Significant event reviews (as defined in QoF)
  • A review of clinical outcome
  • Audit and monitor / data collection and analysis
  • Clinical audit
  • PUNs and DENs
  • Review of notes, referrals or prescribing with a colleague or small group

With the above headings in mind, you find below a list of suggested options to use as quality improvement activities, like a menu card you can choose from. Please do not think you are expected to do them all, instead you are expected to keep your recording proportionate and reasonable.

The difference between CPD and QI           

In the purest sense one might argue that any education leads to Quality Improvement. Being more pragmatic, CPD is education but may involve revision of an area and therefore could be argued that this is not always improving quality.  The RCGP Revalidation Guidance suggests that the main two ways to demonstrate Quality Improvement (QI) is Significant Event Analysis (SEA) (‘At least two for the 12-month period prior to your last appraisal before your revalidation date; any serious incident must be included’) and also a cycle of clinical audit (‘Evidence of regular participation in quality improvement activity relevant to your scope of work and discussed at your last appraisal before your revalidation recommendation’ at least one full cycle per year’).  There is a caveat though which says ‘The RCGP has defined the significant event audit and clinical audit as the core information to be included under Review of Practice. However, a broader range of activities can be submitted including case discussions and briefer reviews of clinical and other work if SEA or clinical audit information is not appropriate given your circumstances’.

Within the RCGP revalidation guidance is a paragraph specifically aimed at addressing QI if you are a locum or OOH GP which contains one notable statement ‘A locum or out-of-hours doctor may undertake an ‘action audit’ in which the care of presenting cases of a defined nature is continually reviewed against pre-set criteria and standards with continuous reflection and improvement recorded. One example might be keeping a log of all referrals and patients causing concern, and then following up the patient on return to the practice or clinic and learning lessons from the outcomes’.

The last part of this statement implies that regularly reviewing the outcomes of your patients that you have concerns about, reflecting on it and learning lessons from it, is a form of QI.

(Back to Top)

3.1 Case Based Review or Discussion

A documented account of interesting or challenging cases that a doctor has discussed with a peer, another specialist or within a multi-disciplinary team. You must record an outcome ­ you only need one line, but will this discussion change your clinical practice for the better?

  1. Consider getting together regularly with two colleagues (or more) for case-based reviews. Some groups even enhance their learning by acting out scenarios which can be an educationally rich experience and fun, especially without CSA related stress.

How to do a group scenario

  1. Write out a case scenario: one with patient information for the doctor to act out, one for the observer with additional background information about why this case proved to be an interesting or challenging scenario.
  2. Act the case.
  3. Discuss the case together.
  4. Link the discussed topic to national guidance.
  5. Next time you see a similar or related patient – write down how the case-based discussion influenced your clinical assessment and decision making.
  6. Write the above process up as a quality improvement activity.
    • Another form to discuss topics in a more structured format is the use of Practice Based Small Group Learning (PBSGL). Groups of 5-12 GPs/ practice nurses come together come together every 6-8 weeks for facilitated group work focussing on pre-prepared evidence-based modules integrating recent guidelines reducing the gap between current and best practice.

(Back to Top)

3.2 Review of Clinical Outcomes

Where robust, attributable and validated data is available. This could include morbidity and mortality statistics or complication rates where these are routinely recorded for local or national reports. Again, ensure you record the reflections and actions taken.

  1. Retrospective reflection of your past clinic: in a practice where you have worked some months ago take a look at the outcome of the consultations you have had in one clinical session.
    1. Diagnosis: Did the patient come back? Was your diagnosis reviewed and changed? What do you learn from this? Did you request the right investigations?
    2. Referral: If you have referred a patient to secondary care – was the outcome what you expected? Does this change your decision in the future? Does this identify your learning need?
    3. Quality of record keeping: Was the patient followed up according to your expectation? Did your notes indicate clearly a suggested plan of action for the patient and the next GP?
    4. Safety-netting: Did you safety net patients at risk of significant disease safely? Is this clear from your notes? If your answer is no to these questions, how are you going to improve this? How did you communicate with the patient’s own GP – paper based, intra-net based, via other staff?

You may want to use the template appendix A to record your findings.

(Back to Top)

3.3 Audit and Quality Monitoring

As we have stated there is no requirement for audits, but you may choose to do this as one aspect of your quality improvement activity. Doing the measurement once could be seen as quality monitoring. In the following examples if the suggested areas are measured, reflected on and then repeated these would be audits that you could do as a locum.

Here as a refresher is the audit cycle:

  1. Equipment: Do you have with you that you may need? Appendix B has a list of suggested equipment.
  2. Emergency drugs
    1. Do you have what is needed? Further information on emergency drugs can be found on the LMC website page ‘The Emergency Doctors Bag’
    2. Do you keep your medication in date? Further information about how to look after your doctor’s bag can be found here
  3. Tracking expiry dates:
    1. Do you have a system that tracks your expiry dates of your emergency drugs?
    2. Drug name, formulation, dose, number held, manufacturer, LOT number, expiry date in spreadsheet.
    3. Copy and paste onto word document when needing to re-order.
  4. How to get your medication:
    1. Issue a private prescription to yourself with your name, title, GMC number. This is a business expense hence tax deductible.
    2. Consider carefully which drugs you have and any attached consequences. Do you store your drugs appropriately?
  5. If you work for the Out of Hours consider checking availability and working order (if appropriate) of the items listed. Do give feedback to the service about any missing items and record that you have done so. Can you make positive suggestions for improvement?
    1. Emergency equipment
    2. Emergency drugs – if stored in a cupboard, are they ‘in date’?
    3. Referral forms & envelopes
    4. Prescription pads
    5. Working order of laptop & phone
    6. Ensuring patient ID and MSU specimen bottles are systematically written correctly (not on a loose piece of paper, but on the specimen bottle itself)

(Back to Top)

3.4 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”.

There are many examples of audits currently undertaken in most practices including:

  • Minor surgery,
  • Cervical smears,
  • Monitoring of DMARDs,
  • End of life care
  • Cancer diagnosis
  • Referrals and admissions
  • Hypertension management
  • Leg ulcer care
  • Investigations and imaging

Practices may welcome their locum to attend their audit practice meeting or for a locum to get involved in one of their audits. You don’t know if they are unless you ask. Use practice audits to review your own work as part of personal quality improvement within the work place.

(Back to Top)

3.5 PUNs and DENs

Patient Unmet Needs (PUNs) and Doctor’s Educational Needs (DENs) are a way of identifying areas of learning during a surgery.

If you are using GPnotebook during your consultations, you could use their GPTracker system to identify your PUNs and DENs. At any time, you can have decide to review your learning needs of a chosen period e.g. Feb-Oct last year. The pages that you have read on GPnotebook can be compared with the rate of use of the same pages by other GPs in your Personal Knowledge Graph (PKG). In this way you can identify a topic or specialty you may wish to update your knowledge in further via e-learning modules or other sources.  E-learning modules can be found via BMJLearning, RCGP eLearning, GPnotebook Educational Modules, Doctors.net eCME  (Continuous Medical Education) modules to name a few.

(Back to Top)

3.6 The Benefit of Working in Small Groups

Working as a locum can be professionally isolating. The feedback loops about your clinical actions are not the same as GPs who work in the same setting over a long period of time. However, there is no reason why this cannot be different. Working in small groups, two or more GPs or other health care professionals if you wish, coming together (bi) monthly creates a wide range of options to choose from:

  1. All the activities as mentioned above can be shared with your colleague(s). Remember working together can double your CPD credits by demonstrating the impact of your shared learning on what you and/or your colleagues do.
  2. Share guidelines you have read. Consider sharing the workload by each summarising guidelines from 1 sources such as
    1. NICE
    2. SIGN
    3. Essential Knowledge Updates from the RCGP
    4. Guidelines’ or on-line eGuidelines (with free downloadable app)
  • Share information about change of local services. Contact your local ICB and ask whether they produce a Newsletter or have a GP mailing list. Ask to be added to the GP mailing list. Share this information together. Many ICBs have GP locums working for them, you’ll never know what this information may lead to.
  1. Share medical news you have seen and discuss clinical implications.
    1. BMJ
    2. BJGP
    3. For those registered with Doctors.net there is access to ‘Journal Watch’ (a round-up of relevant published research in different clinical areas. It is written by experts in the following specialties: diabetes, general internal medicine, general practice, haematology, HIV, oncology, psychiatry, respiratory medicine and rheumatology.) It provides quick and easy access to recently published topics.
    4. Recent LMC news. Wessex LMCs send out very regular news to all GPs with both clinical and managerial information, especially from national sources. Ensure you have access to the same information as other GPs by putting your name on their mailing list.
  2. Share the learning of educational events you have attended (doubling your CPD credits).
  3. If you see a patient after your meeting with a condition that you have discussed before, bring it to the next meeting. It is this kind of reflection and learning that is valuable for your appraisal.
  • Share new services or other information (indication for referral, referral form, telephone numbers) you have picked up from the locum pack of the surgery you have worked with your colleagues.
  • Discuss ‘How to approach this scenario’…. with your colleagues. GP locums work in a wide variety of circumstances and are exposed to at times challenging situations. Ask colleagues what they would if done if they were in your shoes in what proved to be a challenging situation for you. This reflection shows you are open for feedback and learning.

Do make sure you make a short report or minutes of your meeting, otherwise you cannot show your appraiser the great work you have done. You could add a summary of personal learning points for each meeting.

Here are suggestions how to become part of a small group:

  1. Contact the GP-tutors in your area. They may run a sessional GP group already or know of other locums who want to set up a group. Their details are known by your local deanery.
  2. The National Association of Sessional GPs may have contact details of a locum group in your area.
  3. Contact your LMC and ask for local locum groups in your area.
  4. Network via local educational events and meet other locums and ask them.
  5. If you are within the first 5 years of qualifying, consider the RCGP initiative First5.
  6. Small groups working together in the ‘Practice-Based Small Group Learning’ format can be found via pbsgl.co.uk

Back to Top

 

Appendix A Template for Retrospective Reflection on a Clinical Session

Back to Top

 

Appendix B  Your Equipment for General Consulting

Items to consider depending on work being undertaken:

  • stethoscope
  • appropriate IT to record consultations, make requests for investigations etc
  • ophthalmoscope/otoscope
  • blood pressure machine or manual sphygmomanometer
  • tape measure
  • thermometer
  • glucometer
  • pulse oximeter
  • disposable ear probes for thermometer and otoscope
  • pregnancy urine test kit (e.g., Clear Blue)
  • British National Formulary access (book or remote BNF app/online)
  • access to portable textbook via apps, on-line or paperback (e.g., Oxford Handbook of General Practice, GP notebook)
  • desk aids – peak flow chart, Snellen chart, pregnancy calculator, BMI chart
  • latex gloves
  • urine dipsticks
  • urine specimen bottle
  • peak flow meter; adult and child range
  • peak flow tubes
  • Maglite AA torch with spare batteries/or use mobile phone torch
  • lubricating jelly
  • fluorescein eye drops
  • A4 paper, envelopes, blood forms, X-ray forms
  • swabs
  • forms for biochemistry/haematology and microbiology
  • If taking blood test specimens:
    • Tourniquet
    • Blood tubes
  • needles and syringes
  • butterfly needles
  • sharp box (in date according to local IPC policies)
  • gauze swabs, plasters and alcohol wipes
  • vomit bowl
  • clinical waste bags
  • alcohol hand gel

From: Locum Doctor Survival Guide by R.Coull, locum123.com,2005.

Back to Top

Bookmark
ClosePlease loginn

Last Reviewed Date
08/12/2023