ࡱ> mojkl @ bjbj ƙ( dzQQQNRlSz}U XL8Y(`Y`Y[6]g^T$UR"fk["[ff"`Y`Y 7lllf`Y`YlfllH`YU 5?"aQgȠ,tM0}7Rh*7Xzz7 ^(`lmb<c^^^""zz$LQ|l^zzQ  SHAPE \* MERGEFORMAT  REVALIDATION FOR GENERAL PRACTITIONERS CONSULTATION DOCUMENT Index of Contents  TOC \o "1-3" \h \z \u  HYPERLINK \l "_Toc215885925" Background  PAGEREF _Toc215885925 \h 2  HYPERLINK \l "_Toc215885926" This document  PAGEREF _Toc215885926 \h 3  HYPERLINK \l "_Toc215885927" SECTION 1: The standard process for the revalidation of general practitioners  PAGEREF _Toc215885927 \h 5  HYPERLINK \l "_Toc215885928" This part of the document  PAGEREF _Toc215885928 \h 5  HYPERLINK \l "_Toc215885929" Principles  PAGEREF _Toc215885929 \h 5  HYPERLINK \l "_Toc215885930" The evidence to be gathered  PAGEREF _Toc215885930 \h 6  HYPERLINK \l "_Toc215885931" The submission of the evidence  PAGEREF _Toc215885931 \h 9  HYPERLINK \l "_Toc215885932" Assessment of evidence for revalidation  PAGEREF _Toc215885932 \h 9  HYPERLINK \l "_Toc215885933" Quality assurance  PAGEREF _Toc215885933 \h 10  HYPERLINK \l "_Toc215885934" SECTION 2: Non-standard processes for the revalidation of general practitioners  PAGEREF _Toc215885934 \h 11  HYPERLINK \l "_Toc215885935" This part of the document  PAGEREF _Toc215885935 \h 11  HYPERLINK \l "_Toc215885936" Guidance in considering non-standard portfolios  PAGEREF _Toc215885936 \h 11  HYPERLINK \l "_Toc215885937" Issues to be considered  PAGEREF _Toc215885937 \h 12  HYPERLINK \l "_Toc215885938" Portfolios for revalidation for general practitioners  PAGEREF _Toc215885938 \h 14  HYPERLINK \l "_Toc215885939" APPENDIX 1: The map of the RCGPs Criteria to the Domains and Attributes in the General Medical Councils Framework  PAGEREF _Toc215885939 \h 17  HYPERLINK \l "_Toc215885940" This part of the document  PAGEREF _Toc215885940 \h 17  HYPERLINK \l "_Toc215885941" The map to the General Medical Councils Framework  PAGEREF _Toc215885941 \h 17  HYPERLINK \l "_Toc215885942" APPENDIX 2: Criteria, Standards and Evidence for the revalidation of general practitioners  PAGEREF _Toc215885942 \h 19  HYPERLINK \l "_Toc215885943" This part of the document  PAGEREF _Toc215885943 \h 19  HYPERLINK \l "_Toc215885944" The criteria, standards and evidence  PAGEREF _Toc215885944 \h 19  Background In 2009 the General Medical Council will introduce licensing. All doctors who are registered at the time that licensing is introduced will be entitled to a licence to practise. From its introduction next year, it will be the licence, rather than registration that signifies to patients that a doctor has the legal authority to write prescriptions, sign death certificates and exercise a wide range of other legal privileges. General practitioners will need a licence to practise if they work as a doctor, either in the NHS or in the independent sector on a permanent or locum basis. GPs will remain on both the general medical register and the GP register. Only licensed doctors will be subject to revalidation. In common with all doctors, GPs will need to be relicensed and recertified (for the GP register) periodically. These two outcomes will be achieved through one process revalidation which will require evidence that they keep up to date and continue to be fit to practise.  EMBED PowerPoint.Slide.8  The Royal College of General Practitioners (RCGP) has the responsibility, on behalf of members and non-members, to propose the standards and revalidation methods for the revalidation of general practitioners. The General Medical Council has to approve those standards and methods before introduction. The first practical step towards defining the standards for revalidation was the publication by the General Medical Council of a Framework for Appraisal and Revalidation based on Good Medical Practice. The criteria for the revalidation of all doctors are based on this document. Next the RCGP published its revision of Good Medical Practice for General Practitioners which sets out the expectations of an exemplary and an unacceptable general practitioner. The latter are the standards for revalidation. Finally the RCGP has been describing the evidence required for most general practitioners and for those who will find the normal process challenging; and the process for revalidation. The RCGP has been working with key partners the General Medical Council, the General Practitioners Committee of the British Medical Association, the Academy of Medical Royal Colleges, the Departments of Health and bodies such as the Revalidation Support Team in England to prepare for its roles. This document takes into account the views of these partners. This document This document sets out for all interested parties general practitioners, other doctors, the NHS, other Colleges, regulators and, importantly, the public the RCGPs draft proposals for the process for the revalidation of general practitioners. This includes the criteria that will be used, the standards that will apply and the evidence expected. This document has four elements: SECTION 1: A description of the process that the Royal College of General Practitioners proposes for the majority of general practitioners who are in clinical practice SECTION 2: A description of how revalidation might occur for those general practitioners who need a non-standard route APPENDIX 1: The mapping of the RCGP criteria for revalidation to the General Medical Councils framework APPENDIX 2: The criteria, standards and evidence that will be used in revalidation for general practitioners This document will be re-drafted in the light of this consultation and the RCGP will undertake pilots in 2009 in preparation for the commencement of revalidation in 2010. SECTION 1: The standard process for the revalidation of general practitioners This part of the document This section gives an overview of revalidation. It describes the sort of evidence that will be expected from a general practitioner at revalidation and the way in which that evidence will be assessed. It is deliberately high level and clearly many details need to be agreed once the strategy has been settled. Principles The principles that underpin revalidation are: Local continuing clinical governance systems will detect and address performance issues throughout the revalidation five year cycle. Revalidation should act as confirmation that local processes have been effective, and the vast majority of doctors should be revalidated. Annual appraisal is central to revalidation, acting as a forum to promote the skills and attributes of the general practitioner and to check progress towards revalidation Recertification for the GP Register means that the doctor is considered fit to work as a general practitioner, including in clinical general practice. Revalidation should not be overly onerous on general practitioners but it must be sufficient to provide confidence to the public, the profession and employers that each doctor is fit to practise. The evidence required and the standards applied to that evidence must take account of the different working lives of general practitioners; the process must be objective, fair and equitable. The RCGP must judge that a general practitioners evidence is suitable for recertification before it can recommend recertification to the General Medical Council. The RCGP will retain discretion in making its assessment of an individuals evidence, but will act within agreed and published guidance and will need to provide a cogent explanation for its decision if challenged. If the RCGP is unable to make a recommendation for recertification, the General Medical Council will need to consider the doctors case. Only after due process can the doctors certification be jeopardised. There will be an appeals process for any adverse decision by the General Medical Council. Consultation question 1. Have you any comments on the principles identified? Are any unclear, or are there any that have been missed? The evidence to be gathered These proposals draw on the draft Criteria Standards and Evidence (Appendix 2 to this document) and these, in turn, are based on the General Medical Councils Framework for Appraisal and Revalidation (Appendix 1). Other sources used include the General Medical Councils Good Medical Practice, Good Medical Practice for General Practitioners, Essential Evidence to Support Appraisal from the Welsh Deanery, the Leicester 2007 Conference Statement on Essential Evidence for Appraisal and the RCGP Scotland Revalidation Toolkit. The Royal College of General Practitioners currently proposes that a revalidation portfolio will normally contain twelve items of evidence (with additional evidence from those with extra roles). A description of all the professional roles undertaken by the general practitioner and demographic data. In order to make judgments on whether there is sufficient supporting evidence for revalidation there must be clarity on the roles undertaken by the general practitioner. Exceptional Circumstances There may be exceptional circumstances which have occurred which both the appraiser and any portfolio assessor need to be aware of when making an assessment. Examples may include periods of prolonged sickness, career breaks, bereavement etc. Evidence of active and effective participation in a cycle of five annual appraisals over the five year revalidation cycle. This would normally be five forms signed by the GPs appraiser(s). A personal development plan (PDP) for each year agreed with the appraiser [presented annually year one to five]. The PDP should reflect educational needs identified by the GP including any needs identified during the appraisal discussion. A review of the previous years PDP, with reflection on whether educational needs identified have been met or reasons as to why they have not been or only partially been met [presented annually initially year two to five]. Impact of development should also be considered at appraisal and linked to the CPD credit system (see 6 below). This would normally be part of the appraisal discussion. It is anticipated that for a number of reasons not all the learning outcomes on the preceding years PDP will have necessarily been met. The key issue will be reflection on the reasons for this and a plan to move forward in the next year (which can include dismissing the learning need). Self-accreditation of a minimum of 250 learning credits over the 5 year revalidation cycle, normally at least 50 credits each year, discussed and agreed at annual appraisal [presented annually years 1-5] The credit system is an integral part of the RCGPs Revalidation proposals and a separate consultation and pilot process is underway Credits are not time based, but will be self-attributed on the basis of effort and impact on patient care. There may be reasons why the number of credits fall short over a particular year. This should be justified by the GP. It is anticipated that over the five year period a minimum of 250 credits will be included. The RCGP will provide a six monthly Essential Knowledge Update of new and changing knowledge that every UK GP should have assimilated. In addition the linked Essential Knowledge Challenge will be a voluntary assessment for the GP to provide evidence of keeping up to date. Results of at least two multi-source feedbacks from colleagues, with evidence of reflection, appropriate change and discussion in appraisal [normally one MSF in year one or two and one MSF in year four or five]. Results of at least two patient surveys of their consultations and care during the revalidation cycle, with evidence of reflection, appropriate change and discussion in appraisal [normally one patient survey in year one or two and one patient survey in year four or five]. The RCGP will, following completion of an independent review by an international expert, develop the criteria for assessing and approving MSF tools and patient surveys for general practice. Any tools approved by the RCGP as suitable for revalidation will also need to be approved by the General Medical Council. A description of any cause for concern raised about the doctor and a review of any formal complaint in which the doctor has been directly involved; with a description of the circumstances, lessons learnt, and appropriate actions taken, and evidence of discussion in appraisal [presented annually year 1-5]. In cases where there has been no cause for concern or complaints this should be recorded. It is recognised that complaints can be very stressful for the general practitioner (as well as for the patient). There is emerging evidence that many GPs have found it supportive and constructive to discuss complaints at appraisal and to include reflection. If the Primary Care Organisation has raised concerns, then the GP should describe their response to those concerns and, if appropriate, actions taken to address them. General Practitioners will need to clearly understand what is meant by a formal complaint and this will form part of the piloting work. A minimum of five significant event audits involving the GP that demonstrate reflection and change, with evidence of discussion in appraisal, over the five year cycle. Following the introduction of the new GMS Contract in 2004, all practices now participate in significant event analysis. The analyses presented for revalidation should include learning points for the GP. Audits of the care delivered by the GP in at least two significant clinical areas of their practice, with standards, re-audit and evidence of both appropriate improvement, compliance with best practice guidelines and discussion in appraisal. It is important that the audit presented reflects the care given by the individual doctor. A proforma for the recording of audits will be included in the e-portfolio. Statements of probity, health and use of health care, including registration with a GP in another practice; evidence of appropriate insurance or indemnity cover It is anticipated that the General Medical Council will develop a generic approach to this element. It should include Hepatitis B status. There will be additional evidence required from some general practitioners with extended roles. These include evidence and supporting statements for appraisers, trainers and teachers; standards of care and competency in any extended clinical role (such as GP with Special Interests) performed; and research governance sign off for researchers. Consultation question 2. Have you any comments on the areas of evidence to be gathered? Are any of the areas particularly challenging to gather, and if so, how? The submission of the evidence Each GP will be expected to submit a portfolio of evidence every five years. This portfolio can be on paper but it is expected that most GPs will chose to gather an electronic portfolio for their annual appraisals and revalidation. They will submit the relevant parts of that electronic portfolio for their revalidation. The RCGP will design and pilot an electronic portfolio that is suitable for appraisal and revalidation. Other electronic portfolios may also be approved as suitable for revalidation. The doctors portfolio will be considered alongside evidence from other local sources available to the Responsible Officer including clinical governance data. Consultation question 3. Have you any comments? Are there any particular areas that you think need to be considered when developing an electronic portfolio? Assessment of evidence for revalidation When a portfolio of evidence is submitted it will initially be sifted by the local Responsible Officer or their staff. This assessment will also be informed by the evidence from annual appraisals and clinical governance processes. The evidence will be initially assessed into three broad categories: appears satisfactory; needs discussion; or substantial issues are raised. A local group will be convened consisting of the Responsible Officer, an RCGP external assessor and a lay assessor. [If the Responsible Officer is not on the general practice register, the Responsible Officer will need to consider appointing an appropriate general practitioner as their adviser and to attend the meeting.] All three will need appropriate and adequate training and resourcing. The trio will allocate their time appropriately, sampling satisfactory portfolios and assessing fully other portfolios. They will notify the General Medical Council of the names of those GPs that they are able to recommend for revalidation. Where the local trio are unable to recommend revalidation to the General Medical Council, the portfolio will be shared with the RCGP centrally. The precise processes by which the decision will then be moderated have to be decided, but they are likely to involve the GMC Affiliate, the RCGP and the General Medical Council. At this stage some doctors will be recommended for revalidation, but others may need to be considered further by the General Medical Council. Consultation question 4. Have you any comments about the local arrangements described and those at the national level? Quality assurance Ultimately the responsibility for revalidation lies with the General Medical Council. In the process described in this document the RCGP is acting on the General Medical Councils behalf. Whatever the RCGP proposes must be subject to General Medical Council approval. One key role for the RCGP is in quality assurance and to do this it will need to oversee the training and processes of the assessors; review all portfolios where a recommendation cannot be made; and review a sample of recommended portfolios. The RCGP will need to satisfy the General Medical Council that the process of revalidation is as fair, equitable and objective as possible. Consultation question 5. Have you any suggestions about how the RCGP should satisfy the GMC that the process is fair, equitable and objective? SECTION 2: Non-standard processes for the revalidation of general practitioners This part of the document This section of the document describes possible non-standard ways in which evidence might be submitted by those who would find a standard portfolio of evidence for revalidation impractical. This group encompasses those in clinical general practice but who may find elements of a conventional portfolio difficult to accumulate; those who were not in work for all years in the five year cycle or who are on extended career breaks; and those whose only or predominant work as doctors is not as a clinical general practitioner. The latter group includes a small number of GPs in NHS management, educational management, political roles (RCGP, BMA, Department of Health etc), health informatics or academia. Guidance in considering non-standard portfolios In considering whether to recommend a doctor for re-certification for the general practice register, it is suggested that the local panel and, if appropriate, the RCGP centrally will take into account the following guidance: If, at revalidation, a general practitioner has not been in clinical practice for the past five years or more the RCGP will not normally recommend that doctor for recertification to the GP register If, at revalidation, a general practitioner has been in clinical practice during the past five years the RCGP will wish to consider the following: The environment in which the GP has worked and whether the evidence of clinical governance and annual appraisal from that environment can be relied on The GPs learning credits over the five years and in each year The evidence of annual appraisal, annual PDP and PDP review The evidence of feedback from colleagues (MSF) and patients (patient surveys) Any assessment of clinical skills or knowledge Any outcome from a re-entry programme The RCGP will normally expect evidence that the general practitioner satisfies the requirements for recertification for each year in which the GP was substantially clinically active, provided that the evidence covers at least three years in the five year revalidation cycle. If the general practitioner was in clinical practice for fewer than three years in the five years in the revalidation cycle, the RCGP would normally accept evidence that the general practitioner was keeping up to date (50 learning credits per year) and being effectively appraised annually (including PDP and PDP review) for at least three of the five years. The doctors Responsible Officer and the RCGP will need to be satisfied that the evidence is sufficient to demonstrate that the doctor is up-to-date and fit to practise at the time of revalidation. It should be noted that Committee of General Practice Education Directors (COGPED) recommend a re-entry course in an approved setting after a GP has had an absence of a period of two years with no learning credits or appraisal during that time. If the general practitioner has not been clinically active at all in the five year period the RCGP would not normally recommend recertification. For those with intermittent absences or who can demonstrate that they keep up to date, the RCGP will consider the evidence put before them. Consultation question 6. Are there any other areas that could be considered non-standard? If so, what are they and do they fall within the guidance defined in the paper? Issues to be considered The minimum clinical commitment required to establish eligibility for a recommendation for recertification The RCGP will need to consult on this issue and to evolve its guidance with experience of the pilots and the early years of revalidation. However, it might formulate guidance such as: The RCGP would expect a clinical general practitioner to have a commitment of at least 200 clinical half-day sessions (equivalent to one day a week over a period of at least two years) in the five year cycle. Consultation question 7. Bearing in mind that the RCGP will need to consult on this in the future, do you feel that the example is about right? The acceptability of evidence from GPs not working in approved settings Normally a general practitioner will be required to demonstrate that they have worked in an organisation with a Responsible Officer who is prepared to certify that there are no concerns about that general practitioner. If a doctor has not been working in such an environment (working abroad for example) the RCGP would not normally recommend the doctor for recertification unless, exceptionally, the doctor can provide acceptable evidence of an equivalent environment. Consultation question 8. Do you feel this is the correct level for acceptability of evidence? The extent to which GPs in active clinical practice can choose what evidence to provide The RCGP will be recommending to the General Medical Council that there is some choice available to GPs. In particular, those who wish to undertake and pass an approved knowledge assessment in their fifth year might not be required to submit evidence of 250 learning credits; and those who undertake and pass an approved clinical skills assessment might not be required to provide evidence of undertaking significant event and conventional audits. The reasoning for this is that some general practitioners, for example those in very part-time sessional work, might find the accumulation of a conventional portfolio of evidence onerous. It should be noted such general practitioners must still participate in appraisals and clinical governance. Consultation question 9. Do you feel that this provision is flexible enough? The revalidation of GPs who wish to return to clinical practice If a general practitioner is on the General Medical Council GP Register but does not meet the minimum criteria set out in this document, then they should undertake and achieve satisfactory outcomes from a re-entry programme, and should demonstrate their fitness to practise through passing an approved knowledge assessment and an approved clinical skills assessment. The same will apply to GPs whose certification on the GP Register has lapsed. The General Medical Council will need to consider the arrangements whereby such a doctor can be licensed or certified to allow them to participate in a re-entry programme, but a mechanism such as conditional certification will be required. Consultation question 10. Have you any comments on the process put forward for those returning to clinical practice? The revalidation of GPs working as doctors but not in clinical general practice This is a small but important group. These doctors must be in good standing with the General Medical Council in order to undertake the work they do, but they may not be in active clinical practice for significant periods of time. The RCGP recommends that they should submit evidence for revalidation under the principles in this document. If they have not been in active clinical practice in the five years of the revalidation cycle or have not met the minimum criteria agreed by the RCGP, they will not normally be recommended for recertification. The General Medical Council will need to consider whether they are eligible for relicensure, and a licence may be all they require to undertake their non-clinical role. For this they will still need to relate to a Responsible Officer and if re-licensed would need to undergo re-entry before re-starting clinical practice. Consultation question 11. Have you any comments? Portfolios for revalidation for general practitioners The RCGP will want to consider each portfolio of evidence submitted by a general practitioner for recertification on its merits. This analysis suggests however that there will be four main types of portfolios of evidence: Standard portfolio The expectation is that the vast majority of general practitioners will submit a standard portfolio of evidence to be assessed in a standard way. Non-standard portfolio Some general practitioners will find a standard portfolio challenging and may opt to use success in an approved knowledge assessment to replace evidence of learning credits and success in an approved clinical skills assessment to replace evidence of significant event and conventional audits. Partial portfolio If a general practitioner has not been in active clinical practice for all of the five years in the revalidation cycle, they can submit evidence that they meet the minimum requirement for clinical activity in the five years and that they have kept up to date and been appraised in at least three of the past five years. Re-entry portfolio If a general practitioner cannot meet the requirements for a partial portfolio, they will need to provide evidence of successful re-entry to clinical general practice and success in an approved knowledge assessment and success in an approved clinical skills assessment. Consultation question 12. Do you think that these definitions capture all the possible permutations? EvidenceConventional portfolioNon- standard portfolioA partial portfolioRe-entry portfolioDescription of roles ((((Exceptional circumstances((((Evidence of 5 appraisals((At least threeFive PDPs((At least threeFour reviews of PDPs((At least two250 Learning Credits(At least 150Two MSFs from Colleagues((Either one or twoTwo Patient Surveys((Either one or twoReview of Complaints(((Five significant event audits(One for each year in practice in the fiveTwo conventional audits(Either one or twoStatement of probity and health((((Approved knowledge assessment((Approved clinical skills assessment((Satisfactory completion of re-entry programme( APPENDIX 1: The map of the RCGPs Criteria to the Domains and Attributes in the General Medical Councils Framework This part of the document To ensure that revalidation for all disciplines is set on an equivalent basic and is clearly tied to the General Medical Councils Good Medical Practice, the General Medical Council has published a framework. This Framework for Appraisal and Assessment was the starting point for the RCGPs work on criteria, standards and evidence for revalidation. This appendix maps the RCGPs proposed criteria to the General Medical Councils Framework, showing how the criteria were derived. The map to the General Medical Councils Framework The following table demonstrates the map between the RCGP criteria and the General Medical Councils Framework. Consultation question 13. Have you any comments about the mapping to the GMCs Framework shown in the table below? GMC Framework DomainGMC AttributeRCGP CriterionDomain 1: Knowledge, Skills and PerformanceMaintain your professional performanceA general practitioner must maintain their knowledge and skills, and keep up to date Apply knowledge and experience to practiceA general practitioner must have the appropriate clinical and communication skills and apply those skills for the doctor-patient partnership, including respect for patients dignity, privacy and confidentiality, and support for self-care A general practitioner who teaches, appraises or researches must do so properly, ethically and fairlyKeep clear, accurate and legible recordsA general practitioner must keep good records Domain 2: Safety and QualityPut into effect systems to protect patients and improve careA general practitioner must demonstrate commitment to reflective practice, quality assurance and improvement; and that the standards of care and patient safety achieved are appropriateRespond to risks to safetyA general practitioner must be suitably trained, skilled and insured or indemnified for the roles that they undertakeProtect patients and colleagues from any risk posed by your healthA general practitioners fitness to practise must not be compromised by health issues Domain 3: Communication, Partnership and TeamworkCommunicate effectivelyA general practitioner must communicate with and relate appropriately to colleaguesWork constructively with colleagues and delegate effectivelyA general practitioner must ensure that all staff, including locums and students, are properly trained and supervisedEstablish and maintain partnership with patientsA general practitioner must have the appropriate clinical and communication skills and apply those skills for the doctor-patient partnership, including respect for patients dignity, privacy and confidentiality, and support for self-careDomain 4: Maintaining TrustShow respect for patientsA general practitioner must have the appropriate clinical and communication skills and apply those skills for the doctor-patient partnership, including respect for patients dignity, privacy and confidentiality, and support for self-careTreat patients and colleagues fairly and without discriminationA general practitioner must have the appropriate clinical and communication skills and apply those skills for the doctor-patient partnership, including respect for patients dignity, privacy and confidentiality, and support for self-careAct with honesty and integrityA general practitioner must act with probity and honesty  APPENDIX 2: Criteria, Standards and Evidence for the revalidation of general practitioners This part of the document In the first part of this document the twelve areas of evidence that, it is proposed, will comprise a standard portfolio of evidence for a general practitioners revalidation, were described. This appendix maps out the criteria that the RCGP have derived, the standards (from Good Medical Practice for General Practitioners) which will be used, and the evidence expected. This shows how the evidence list in the first section has been drawn up. The criteria, standards and evidence The following table sets out the RCGPs current view of the criteria, standards and evidence for the revalidation of general practitioners. Consultation question 14. We would welcome your comments on the criteria, standards and evidence set out in the table below. In particular, we welcome your views on: The overall proposals Their balance and fitness for purpose Comments on the specific sections of the document (appendix 2) RCGP CriteriaRCGP StandardsRCGP Evidence for Recertification1. A general practitioner must have the appropriate clinical and communication skills and apply those skills for the doctor-patient partnership, including respect for patients dignity, privacy and confidentiality, and support for self-careSee Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 1: Good clinical care, pages 5 to 17 And Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 4: Relationships with patients, pages 27 to 34 Results of at least two patient surveys of their consultations and care during the revalidation cycle, with evidence of reflection, appropriate change and discussion in appraisal Results of relevant questions in at least two multi-source feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal A review of all formal complaints directly involving the GP, with description of the circumstances, lessons learnt and appropriate actions taken, and evidence of discussion in appraisal 2. A general practitioner must maintain their knowledge and skills, and keep up to dateSee Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 2: Maintaining good medical practice, pages 19 to 21 Self-accreditation of a minimum of 250 learning credits over the 5 year revalidation cycle, normally at least 50 credits each year, discussed and agreed at annual appraisal Results of relevant questions in at least two multi-source feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal3. A general practitioner must demonstrate commitment to reflective practice, quality assurance and improvement; and that the standards of care and patient safety achieved are appropriateSee Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 2: Maintaining good medical practice, pages 19 to 21 Evidence of active and effective participation in a cycle of five annual appraisals over the five year recertification cycle A personal development plan for each year agreed in appraisal A review of the previous years personal development plan with reflection on whether educational needs identified have been met and agreed in appraisal A minimum of five significant event audits involving the GP that demonstrate reflection and change, with evidence of discussion in appraisal A review of any concerns raised and all formal complaints directly involving the GP, with description of the circumstances, lessons learnt and appropriate actions taken, and evidence of discussion in appraisal Audits of the care delivered by the GP in at least two significant clinical areas of their practice, with standards, re-audit and evidence of both appropriate improvement, compliance with best practice guidelines and discussion in appraisal4. A general practitioner must communicate with and relate appropriately to colleaguesSee Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 3: Teaching and training, appraising and assessing, pages 23 to 25 And Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 5: Working with colleagues, pages 35 to 43Results of relevant questions in at least two multi-source feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal5. A general practitioner must keep good recordsSee Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 1: Good clinical care, pages 5 to18 (particularly pages 9 and 10)Results of relevant questions in at least two multi-source feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal 6. A general practitioner must be suitably trained, skilled and insured or indemnified for the roles that they undertakeSee Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 1: Good clinical care, pages 5 to 18 (particularly pages 6 to 8)Evidence and supporting statements for their training, standards of care and competency in any extended clinical role (such as GP with Special Interests) performed Results of relevant questions in at least two multi-source feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal Evidence of appropriate insurance or indemnity cover7. A general practitioner must ensure that all staff, including locums and students, are properly trained and supervisedSee Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 3: Teaching and training, appraising and assessing, pages 23 to 25 And Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 5: Working with colleagues, pages 35 to 43Results of relevant questions in at least two multi-source feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal8. A general practitioner who teaches, appraises or researches must do so properly, ethically and fairly.See Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 3: Teaching and training, appraising and assessing, pages 23 to 25 And Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 6: Probity, pages 45 to 52 (particularly Research on pages 49 and 50)Evaluations of teaching and appraisals by students and appraisees Results of relevant questions in at least two multi-source feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal Research governance sign off9. A general practitioner must act with probity and honestySee Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 6: Probity, pages 45 to 52Statement of probity Results of relevant questions in at least two multi-source feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal10. A general practitioners fitness to practise must not be compromised by health issuesSee Good Medical Practice for General Practitioners Second Edition (RCGP and GPC. London: RCGP 2008) Section 7: Health, pages 53 and 54 Statement of health and use of health care, including registration with a GP in another practice Results of relevant questions in at least two multi-source feedback surveys from colleagues, with evidence of reflection, appropriate change and discussion in appraisal   HYPERLINK "http://www.gmc-uk.org/about/reform/gmp_framework.asp" http://www.gmc-uk.org/about/reform/gmp_framework.asp  RCGP and GPC. Good Medical Practice for General Practitioners: 2nd Edition. London: RCGP, 2008  HYPERLINK "http://www.rcgp.org.uk/PDF/GMP_web.pdf" http://www.rcgp.org.uk/PDF/GMP_web.pdf  There is a current consultation on the new post of Responsible Officer. The RCGPs proposals will need to take account of the outcome of that consultation.  RCGP and GPC. Good Medical Practice for General Practitioners: 2nd Edition. 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