Written evidence from the Royal College
of Paediatrics and Child Health (REV 13)
The Royal College of Paediatrics and Child Health
(RCPCH) represents paediatricians in career grade posts (consultants
and specialty, staff and associate specialist grade (SSASG) doctors)
and paediatricians in training.
We support the evidence presented to the Health
Select Committee by the Academy of Medical Royal Colleges but
have additional evidence to present.
The information presented draws from data formally
collected from the RCPCH membership between late 2008 and mid
2010 by means of surveys, focus groups and consultations, and
informally from discussions at paediatric meetings and conferences.
The RCPCH supports the recent GMC decision to simplify
the process of revalidation. We present evidence from paediatrics
to support the general principles that the first steps of the
process should be to ensure that all the workforce:
- Undertakes a process of strengthened appraisal;
- Undertakes peer multisource feedback (with a
validated tool selected by their organisation);
- Undertakes patient/carer feedback with a tool
validated/selected by the specialty (in the case of paediatricians
by the RCPCH);
- Should have the process of revalidation properly
audited (to seek out false positive and false negative results)
by a robust quality assurance process.
1. The RCPCH supports the introduction of medical
revalidation, and within the newly GMC announced timetable by
2. We believe that paediatricians are
generally in agreement with, and compliant with, current procedures
within their organisations and are not outliers in the current
process, which makes the evidence presented here more relevant
3. We support the introduction of a structured
review of a doctor's practice via a process of strengthened appraisal.
However a RCPCH survey suggests that approximately 70% of all
paediatricians have had appraisals and that availability of appraisal
systems and processes for paediatricians is not UK-wide. (More
than 30% of SSASG doctors have not had an appraisal).
4. There is a lack of clarity around how doctors
on the GMC register working outside the UK will be supported through
appraisal and ultimately revalidation. This is especially relevant
to a number of paediatricians. There is anecdotal evidence that
a significant number of these doctors wish to remain GMC registered
with a licence to practice. More work is needed.
5. Consistency of appraisal is essential to effect
robust revalidation outcomes, and there is a recognition of the
need for appraiser training, both to cover generic expectations
of GMC and Colleges. However there is currently no intention to
provide a national appraiser training scheme, supplemented by
speciality additions as needed.
GMC AND SPECIALTY
6. Even with clear guidance, an appraiser will
need to exercise judgement to determine whether the content of
supporting information demonstrates fulfilment of an attribute.
This can be reduced by discussion and interdisciplinary exchange
of concepts and ideas. Appraiser training nationally is essential
to ensure consistency of judgements made.
7. Paediatricians support a range of supporting
information types as part of revalidation including MSF, patient
feedback, CPD, audit, and case based discussion. But to ensure
revalidation is manageable, the types of supporting information
required at the outset may need to be restricted.
8. The level of assessment remains to be clarified
- assessment should be at the level of "fit to practise"
rather than expecting standards of excellence, however attractive
these standards may seem in terms of presentation.
(MSF) AND PATIENT
9. Paediatricians are generally supportive of
revalidation. However, fewer than 50% of paediatricians have undertaken
a peer-based MSF in their organisation. The majority of paediatricians
who have undertaken MSF indicated it was worthwhile. Implementing
this as a core component of revalidation is a priority.
10. NHS Trusts which have undertaken multisource
feedback for their consultants have usually chosen to run one
model which fits all specialties. Specialty-based models, though
attractive, are more expensive and potentially more complex to
process, understand and incorporate into the revalidation process
in a standard way.
11. Specialty patient feedback tools are required.
The RCPCH has developed a paediatric carers of children feedback
tool (PaedCCF) to cover this gap. Our current analysis shows that
25 parent/carer feedback forms per doctor are needed to provide
a reliable measure. While this may set a standard for patient
and carer feedback tools, there are also major resource implications.
12. Not all doctors will be able to obtain patient
feedback through questionnaires however e.g. those working in
safeguarding, and alternative methods should be allowed.
13. CPD as a core component of revalidation is
supported by paediatricians, but evidence shows that not all paediatricians
can meet current College CPD scheme requirements. Workplace restrictions
may currently affect doctors' abilities to access CPD e.g. lack
of time, funding or opportunities. In addition, GMC principles
for CPD include a focus on demonstrating reflection and learning
outcomes, which are challenging for many doctors to capture and
14. Careful consideration is needed for this.
A range of support is required (from self help to support by national
organisations) but the current focus as part of revalidation appears
to be on more in depth support. The aim must be to address issues
before they become serious concerns that will affect a revalidation
15. Quality assurance of revalidation must cover
both process and outcomes e.g. revalidation decisions. Quality
assurance of outcomes needs to include an audit of all those who
fail the revalidation process and a sampling of those who have
16. Paediatricians would expect to be involved
in quality assurance with the GMC to ensure decisions are made
fairly and equitably within the specialty.
17. The RCPCH agrees there is a need for a fully
functioning electronic revalidation system to support data storing,
content reflection, sharing and review by appraisees, appraisers,
Responsible Officers and quality assurance bodies. The system
must be secure and meet patient confidentiality protocols.
18. Central support is needed to avoid implementing
untested IT systems.
19. Paediatricians are clear that the cost and
time required to implement revalidation must not be to the detriment
of patient care and frontline services.
20. Systems and processes must be put in place
to ensure the system is effective, low in bureaucracy and not
just a tick-box exercise. Anecdotal evidence from pilot sites
suggests that information-gathering is time consuming, current
IT systems intended to simplify this process are instead prolonging
and complicating the process. Untested requirements e.g. MSF may
further increase time and cost factors. Ongoing funding to develop
and support revalidation is not as yet clear.