Tales from the Panels Y&H GP School – Summer 2013.

This summary brings together all the feedback and learning from the three localities for GP School summer ARCP 2013.

There are some common themes together with specific issues encountered in each locality – relating to context, admin support and individual GPSTR challenges.

Common Themes across all localities

Form R

This was the first year of revalidation and Form R being part of the annual ARCP season. This certainly brought additional work to almost everybody whether ES, Deanery administrator or panel member. Trainees are required to complete form R and this is part of the evidence that panels use to identify unresolved concerns relating to revalidation. Completion rates for Form R in the summer 2013 ARCP panels were excellent after all the extra work people did.

The main ‘mistakes’ that trainees made in completing their Form Rs were:

·  To check the box saying they would be applying for a CEGPR (Certificate of Equivalent GP Registration) as well as a CCT (Certificate of Completion of Training). They should be applying for a CCT in nearly all instances, not a CEGPR.

·  Not accurately filling the date of expected revalidation.

The GP School is currently looking at adapting some of the guidance offered earlier in the year to help trainees with the process of completing the form. By the time this is circulated a new guidance document should be on the GP school website to help trainees.

If the Form R is not present for annual ARCP then a GPStR cannot be recommended for Revalidation so an Outcome 5 missing evidence is given and of course this could lead to a delay in CCT since an Outcome 6 is required to proceed to CCT.

ESR and validation of entries

Areas which, whilst they continue to improve we still could do better, include:

·  Evidence for competency ratings. Trainees and ESs often provide a commentary about why they have given the rating they have, rather than refer to the evidence in the trainee’s ePF. The new ESR in the latest version of the ePF should go some way to compelling trainees to do this as intended.

·  Some ES may be unaware that a GPStR should not be recommended for CCT unless the final ESR rates them competent for licensing in all competences. The default assumption would be that if the ESR does not rate all competencies as competent for licencing then an extension based on WPBA needs would be needed. However the final ARCP will make a detailed review to see if there is for instance clear evidence of competence outside of the learning log for example then they may make a recommendation for CCT and provide a write up explaining how they arrived at their decision. Otherwise the certification unit at the RCGP could reject the recommendation for CCT.

·  Validating competences. This is a supervisor responsibility and when done well it really helps panels find the evidence of competency where there are questions. But there is considerable variable in how much, competency validation is done.

  1. The expectation is that GP clinical supervisors/trainers will do the validation, because they see the trainees in their workplace
  2. Trainees are responsible for their evidence and should be encouraged to ask their trainers to validate appropriate competencies for their learning log entries when in Primary Care
  3. Ideally this should happen in Secondary Care as well, but the reality is that this is the exception rather than the rule. When it does not happen the ES is the person in the best place to validate competencies on log entries and is expected to do this so that they can provide an accurate and useful ESR. .

Short Posts

Short posts of 2 months (w.t.e) duration or less require demonstration of learning during these posts. Although short posts should be scrutinised looking for this evidence, these principles apply to all posts of whatever duration.

In order for a short post to be counted towards training the minimum evidence recorded in the trainee’s ePF to demonstrate their progress would include;-

  1. Completed WPBA assessments (CbDs etc.) pro-rata for the time in post
  2. PDP entry(ies) relevant to the post
  3. Learning log entries relating to the post
  4. A completed Clinical Supervisor’s Report on completing the post

Anecdotally, when trainees leave a post early e.g. due to complications of pregnancy prior to planned maternity leave, the CSR is often overlooked and this isn’t realised until the trainee’s next ARCP panel in post, which may be 18 or more months later. Trainees need to be made more aware of these requirements.

Occupational Health Assessments

Trainees who are off on long term sick remain a significant issue. If an Occupational Health review states trainees are fit for work then it is expected that they are fit to meet both their clinical work commitments and the requirements of their educational contract including engaging with all aspects of WPBA or sitting all exams in an extension and continuing WBPA on a pro rata basis. The School of GP needs to consider one by one how to manage these complex situations, it is appropriate to have discussions with the ARCP and or DiD tutors and school APD lead.

AKT fail

In various places those who had failed AKT at the end of ST2 were referred to school/ central panel. Though it may be appropriate for there to be continuing monitoring of those who have failed AKT the ARCP team would not see an AKT fail at the end of ST2 in the absence of concerns raised about progression in other areas as a reason for referral to a central / school panel.

Outcome 5

This is the first season in which as a school we have all been using outcome 5 for trainees where there is missing evidence but there is a reasonable expectation that within a short period this evidence can be provided. The overall experience with this has been good. It has meant that for those trainees who previously might have been given a new deadline after the scheme’s deadline for providing evidence of which there was no evidence a year later now have a clear record of this on their e portfolio.

The normal expectation is that wherever possible the review after the outcome 5 would be by the local panel with the school or central panels only taking on this review if it has not been completed by the expected date. This does require a reasonable time gap between the panels. If there is a doubt whether to review the outcome 5 locally or at a school panel it is appropriate to discuss this with the local ARCP tutor or lead.

Outcome 2 or 5 and using ARCP form as a referral document to the school panels

There is no agreement for local panels to give outcome 2.

The school has had feedback that sometimes local panels appear to have been using the ARCP report as a way to provide details of their concerns or decisions to the school or central panel. This is causing confusion and the local panel should not write their findings on the ARCP form if that panel is not giving an outcome 1 5 6 or 8. Instead it would be appropriate to write them as an educator’s note and to share them by e mail with the ARCP lead for the locality. At present there is not a shared referral form for the school, work is in progress to find a way to create one.

Panel structure and process

Composition of ARCP panels

·  In order to achieve consistency across the deanery, and to comply with the Gold Guide, future ARCP panels should have three professional members (e.g. GPs, TPDs, consultants etc.) who have had ARCP training.

·  Panel membership; this should record any administrator present as part of the panel. Some scheme and school panels had not included the name of any administrative team members who were present at the panels whether or not involved in the decision making.

Panel Timing

·  Some very short turn arounds meant that central panel chairs/ARCP team were unable to check that all necessary evidence was in place. There should normally be at least a week and normally 2 weeks between the scheme panel and the school panel.

·  ARCP panels running very late causing problems for trainees. The process of assessing the e portfolio and summarising this into appropriate competencies etc can stretch the 45 minutes often allowed for trainees especially when there is a run of complex cases. The EAs when visiting SYLO emphasised that the feedback given there was not as structured as it could have been partly because writing up was not completed during panel in an attempt to keep to time. It may be helpful to either offer longer intervals between trainees or invite trainees in 2 or 3s for blocks of feedback so that there is greater flexibility in the timetable and there are plans to trial this in SYLO for future panels. The practice of providing feedback at school panels (or locally if there is an outcome 1 with additional comments recorded) projecting the ARCP outcome form for the GPSTR is felt to be helpful.

Panel Sign off and dates

·  There was at least one instance a trainee not signing off the previous ARCP form, which affected the ability of the panel to hold this year’s panel. It would be appropriate for all local scheme administrators to check that ARCPs have been signed off by 6w after the panels have been held and to support and enable those where this has not happened to do this.

·  Problems with the dates arise when there is a gap in the periods being assessed on the ARCP write ups. It doesn’t matter if there is an overlap but the Certification unit will likely reject a recommendation for CCT unless all periods of training have been shown to be assessed.

·  There is an inconsistent use of the date of next panel between chairs. For admin purposes it would be better if this was more consistent. Probably need to adopt the NEYNL approach of using the 1st of the month in which the next ARCP must be held by as the date.

Resignations

Resignations midway through a post are fortunately quite rare. It is important that, as a resignation from a training programme will mean a change of RO from a revalidation perspective, a panel is held reasonably soon after the date of resignation to review the evidence. Trainees also need to be reminded that until the date of their resignation they need to contribute evidence of learning and progression. A checklist for trainees, ESs , programmes and locality offices has been drafted and will be shared in due course.

Events after the last panel but before the August changeover

It is difficult to assess when best to review events which happen in late July / August, after that year’s panel. If there are events though which raise concerns these should either be addressed through the DiD tutor of the locality, and/or it may be appropriate to review them 6m later at a panel. The experience of reviewing them 1 year later at ARCP was probably one which it is worth avoiding in future.

DOPS

There was a relatively common finding that some DOPS had been signed off by people who were not sufficiently senior. All DOPS should be looked at by people, who have a clinical need to assess that procedure themselves, and for doctors as a minimum ST4 or above.

Quality Improvement activities and NOE

In line with the DAL /EA guidance 2012 this deanery does not require any evidence beyond those required by RCGP. However the School of GP continues to encourage trainees to provide certain types of Naturally Occurring Evidence including mapping of their COT, Mini CEX and CbDs (so that they can monitor their own evidence of competencies), and evidence of Quality Improvement in line with the GMC recommendations for Revalidation including: Clinical Audit, Review of Clinical Outcomes, Case review/discussion, SEA. The RCGP external assessors commended the local recommendations for NOE. A revised “NOE booklet” is being updated and will be shared separately

Thus an absence of NOE cannot give rise to an Outcome 5 missing evidence recommendation but a failure to participate in audit or significant event analysis could give rise to an Outcome 2 missing competence in regard to primary care admin, IM&T and or maintaining performance, learning and teaching. Etc.

Similarly Safeguarding level 3 training in child protection is strongly recommended but not mandatory. (But failure to demonstrate a professional obligation to demonstrate competency in safeguarding might affect judgements about competencies 10 and 12)

OOH

Recent changes to the OOH services in March 2013 have meant that the availability of sessions for GPStRs with a Clinical Supervisor is much reduced across WYLO as a whole but varies widely by scheme. Panels in the affected areas have been asked to look for a minimum of 48 hours experience throughout training and a summary entry in the OOH section where the GPStR directs the ES or panel to evidence of their OOH competences (essentially telephone consultation with triage and referral plus recognition and management of acute illness) in the OOH sessions and elsewhere on the portfolio. A holistic view needs to be taken in this area but a GPStR who attends no sessions and does not highlight any evidence could find themselves in some difficulty

Absences

  1. There are rumours about a switch from calendar days to working days for time off sick during any year. However final guidance has yet to be confirmed and so at present we continue to work to an “allowance” of 14 calendar days per training year for sickness absence. It is likely that there will be new guidance shared during winter 13/14.
  2. Currently we require trainees to submit a statement of leave as an attachment to a learning log entry. The deanery is also required to monitor absences.
  3. Future developments for ensuring absences are appropriately recorded are likely to include
  4. An addition to the fitness to practice section of the ESR requiring trainees to declare the number of days absence in the period under review
  5. A section in form R where the trainee self declares the amount of absence since their last ARCP.

Feedback on ESRs which create concerns from panel members

There are few concerns over the vast majority of ESRs seen by panels and the standard generally in Y&H is high (though we do not at this point have figures from central checking to confirm this). However occasionally there are ESRs which raise concerns. For the majority of ESs the feedback will come through the Tales from the Panels summary of experience from all panels.