28 th January 20 Aneurin Bevan University Health Board Professional Revalidation Purpose of the Report: The purpose of this paper is to provide the Board with an update in relation to the Nursing Revalidation Pilot and the medical professional appraisal and revalidation being undertaken with the Health Board. Recommendation: The Board are asked to note the considerable progress that has been made for medical staff revalidation and to note the work that will be required for ABUHB to implement in partnership with the NMC the nursing revalidation pilot. The Board is asked to: (please tick as appropriate) Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance Note the Report for Information Only Executive Sponsor: Denise Llewellyn, Director of Nursing/Dr Paul Buss, Medical Director Report Author: Nicola Ryley, Assistant Director of Nursing/ Lyn Middleton, Senior Nurse, Linda Coe, Head of Medical Education Report Received consideration and supported by : Executive Committee of the Board N/A Team [Committee Name] Date of the Report: 16 th January 20 Supplementary Papers Attached: 1 Introduction Appendix 1 NMC Revalidation Requirements Appendix 2 NMC Revalidation Pilot Overview Revalidation is the process by which the General Medical Council (GMC) will confirm the continuation of a doctors licence to practice in the UK. Its purpose is to assure patients and the public, employers and other healthcare professionals that licensed doctors are up to date and fit to practice. To date doctors are the only health professionals who undertake revalidation. The Nursing & Midwifery Council (NMC) have also now stipulated that revalidation for nursing will be required by the end of 20. 1
28 th January 20 ABUHB has been chosen as one of 6 organisations from the UK to pilot in partnership with the NMC the introduction of validation from nurses. 2 Background to Revalidation for Medical Staff Revalidation for doctors formally came into force in December 2012, it came out of recommendations in the Bristol enquiry and others In Wales, our Responsible Officers were the first to be revalidated and went through the process in March 2013. Since that time, we have been working hard in order to develop our own local processes to ensure that doctors with a connection to Aneurin Bevan University Health Board meet the criteria which allow them to be recommended for GMC revalidation. For doctors we also now have a formal process which has been adopted by the Medical Director (who is the Responsible Officer). This supports doctors in the months prior to their revalidation to enable them to gather the information required in order for a recommendation to be made. We have also rolled out the electronic Medical Appraisal and Revalidation System (MARS) which acts as an enhanced e-portfolio system to support annual appraisal and also allows individuals (and the Health Board) to monitor progress throughout the five year revalidation cycle. An Intranet site is updated with appropriate links which provides the required information. In addition, we have developed a comprehensive email list of all our doctors in both. This we believe will help the learning for the nursing pilot to be successful. It is imperative that annual appraisal continues for all medical staff however in the first five-year revalidation cycle, ROs are able to make a recommendation if the individual has had an appraisal within the last 12 months. However, future cycles will require evidence of regular appraisal for every doctor with a prescribed connection to ABUHB. There are currently 1032 doctors within Aneurin Bevan University Health Board, 452 in primary care and 580 in secondary care. 3 Medical Professional Appraisal Revalidation 3.1 Medical Appraisal Summary of current position situation (for consultants and GPs) 2
28 th January 20 96% of ABUHB doctors are now logged on to MARS. This figure is unlikely to reach 100% due to the transient nature of some of our medical staff, particularly clinical fellows which make up approximately 8% of our overall total in primary and secondary care. As of April 2014, paper based appraisals have been phased out and all appraisal information is now electronic. In secondary care over the past 18 months, 433 appraisals have been completed and 76 secondary care appraisers have been trained and actively engaged in appraising using MARS. This amounts to 74% of our secondary care doctors having had an electronic appraisal over the past 18 months. The evidence is that quality of the appraisals is also improving significantly as clinicians gain more understanding of the appraisal process. We have already received feedback from clinicians advocating the benefits of appraisal, particularly now that it is being carried out in a more structured manner. The Revalidation team in ABUHB is small but ongoing restructuring within the Department at other levels has allowed workloads to be redistributed to enable focus learning from appraisal and revalidation. A National Appraisers Network has proved to be successful in supporting and professionalising our Appraisers which in turn is resulting in a higher quality of appraisal. Feedback suggests that these sessions are seen as extremely useful, particularly in identifying and resolving issues. We focus on personal and team learning and quality improvement. We have identified 76 out of 102 trained Appraisers currently active on our MARS system, this is being addressed. Additionally in Surgery relatively low numbers of appraisers being identified. This is an ongoing issue that both the Clinical Director and Divisional Directors working on identifying a way forward. 3.2 Non Training Grade Doctors Clinical Fellows are employed usually for periods between 6 months to 2 years. Whilst they may not be with us during their revalidation period, we have a responsibility for their appraisal They are given access to MARS. Recognition of this group of staff is easier than shorter term locums and we are working closely with Medical Recruitment to ensure that we are able to 3
28 th January 20 obtain the required information. Our teams currently are developing minimum standards for our clinical fellows. 3.3 Completed Revalidations ABUHB have to date made recommendations on 550 doctors since 2013. 450 have been recommended for revalidation with 60 doctors deferred. The majority of deferrals have been as a result of sickness and/or maternity leave. All doctors for revalidation require reflection from other colleagues and patients as part of a 360 appraisal. This process is working very well. Importantly we almost always see increasingly primary care doctors and nursing staff participating in our consultants 360 appraisal process and vice versa. There are challenges for the medical team relating to locum and remediation which are being addressed at an All Wales basis. The medical revalidation team are keen to lend their knowledge, expertise and lessons learnt to help facilitate the nursing pilot. 4 Nursing Revalidation details of pilot The Nursing and Midwifery Council (NMC) is the largest Health Care Regulator in the World with circa 680,000 Registered Nurses and Midwifes on it register. The NMC sets standards for education, professional conduct and performance of Nurses and Midwifes across the United Kingdom. The primary function is patient and public protection. The process (Appendix 1) of maintaining registration is changing and will be replaced by revalidation requiring: 4
28 th January 20 An increase in continuous professional development activity from existing 35 hours to 40 hours. A move from self declaration of fitness to practice, to 3 rd party validation, building a portfolio showing how nurses continuous professional development and feedback from patients and others confirms or improves their practice in relation to the NMC Code of Practice. Reflection and discussion with a third party confirmer as verification will be a key part of revalidation. This can be done as part of the Performance Appraisal Development Review (PADR) process or it can be done separately. Nurses will need to demonstrate indemnity insurance this will be key within General Practice, Nursing Homes and Private Providers of Health Care. Aneurin Bevan University Health Board (ABUHB) is a partner of the Nursing and Midwifery Council (NMC) in piloting the revalidation process for nurses and midwives. The proposed model of revalidation and supporting policy that will be tested was agreed by the NMC in December 2014, and ABUHB will be a key partner in piloting the approach, being the largest organisation participating and the only one in Wales. Any system of revalidation can only be robust and fit for purpose provided it is tested in different settings and scopes of practice as well as being appropriately supported by employers and the wider sector. To aid this, the NMC has established partnerships with a variety of employers and professional networks. The focus of the pilot for ABUHB will be acute secondary care and will be the only pilot site for primary including practice nursing. The purpose of the pilot is to allow for the processes and tools for implementation of the agreed revalidation model to be tested with registrants during January 20 to June 20 (Appendix 2) The initial scoping of ABUHB has identified that approximately 1060 registrants from an overall total of 4500 registrants within ABUHB will be required to revalidate between January and September 20. Additionally as ABUHB are also piloting revalidation with primary care these figures will increase slightly. ABUHB Pilot Site Progress to date Jan Sept re-registration cohort data extracted from ESR as a baseline.. 1060 registrants final numbers TBC Division Continuing Health & Funded Nursing Care Director of Public Health Family & Therapies Division Jan Feb Mar Apr May Jun Jul Aug 5 Sep Grand Total 2 4 1 1 2 5 1 1 13 51 19 13 11 19 16 85 242
28 th January 20 Locality Community Care 8 14 36 18 14 24 13 63 205 Medical Director 1 2 3 Mental Health & Learning Disabilities Division 5 11 21 7 14 4 14 10 57 143 Nurse Director 1 2 1 2 2 3 11 Planning Director 1 1 Primary Care & Networks 1 1 1 1 1 1 6 Scheduled Care14 14 18 56 23 10 27 14 69 246 Unscheduled Care 2 20 37 12 7 25 8 58 184 Workforce & Organisational Development 2 1 3 Grand Total 44 81 206 81 61 74 106 65 342 1060 The outcomes of the pilots will help ensure the practicality of the guidance, process and forms before going live at the end of 20. An action plan has been produced to structure the UHB s approach to the pilot, and is based on a number of themes, from governance, pilot cohort, to communication. The pilot will be managed by a programme board that has been established Chaired by the Executive Nurse Director and supported by Planning, Finance, Workforce, Training & Development, Information Department, Medical Leads for Revalidation, Corporate Communications and Divisional Nurses. It has been recognised by the Executive Team that in order for this pilot to be successful a dedicated Project Manager will be funded and existing mechanisms will be adapted to achieve the overall outcomes. It is clear that whilst nursing numbers are much higher much can be learnt from the challenges and solutions experienced by medical staff. 4.1 Reporting Mechanisms Throughout the pilot phase progress will be reported through the All Wales Steering Group, Chaired by the Chief Nursing Officer and to the NMC Working Group in London. Within ABUHB progress will be reported to the Quality and Patient Safety Committee on a 3 monthly basis. 4.2 Research and Development In addition to the pilot, the NMC will undertake a mixed method research with all pilot sites to capture the benefits realisation of nursing revalidation and also cost estimations moving forward. 5 Recommendations 6
28 th January 20 The Board is asked to note the considerable progress that has been made for medical staff revalidation and to note the work that will be required for ABUHB to implement in partnership with the NMC the nursing revalidation pilot. Assessment of the Impact of the Report: Financial Assessment Link to Three Year Plan Risk Assessment Quality, Safety and Patient Experience Assessment Standards for Health Services Wales Equality and Diversity Impact Assessment (including child impact assessment) To be undertaken Nursing and Midwifery Validation is identified within the 3 year plan Risk will be managed the Programme Group and progress reported to Board Revalidation will provide further Patient and Public Protection Standard 24 Workforce Planning having effective workforce plans that ensure effective revalidation of the Medical, Nursing and Midwifery workforce. The Plan is underpinned by the Standards for Health Services Wales and sets out priorities to ensure that the organisation is maximising its contribution towards the delivery of these standards. No assessment has been undertaken but will be subject to EqIA screening and full EqIA assessment where appropriate. 7