«24 Broughton Street Registered Office: Edinburgh EH1 3RH (UK) St Paul’s House Tel; +44(0)131 478 7505 Fax; +44(0)131 478 7504 Warwick Lane Email; ...»
General Dental Council
Revalidation Stage 1 Feasibility Study
24 Broughton Street Registered Office:
Edinburgh EH1 3RH (UK) St Paul’s House
Tel; +44(0)131 478 7505 Fax; +44(0)131 478 7504 Warwick Lane
Email; firstname.lastname@example.org London EC4P 4BN (UK)
VAT No: 502 484862 No: 2364135
Document Title: GDC Revalidation Stage 1 Feasibility Study:
Final Report Prepared For: General Dental Council Prepared By: George Street Research GSR Project Number: 6010 Issue Date: October 2009 Author: Neil Costley Further information on this document can be obtained by contacting Neil Costley (0131 478 7542) at George Street Research Ltd.
1 EXECUTIVE SUMMARY 1
1.1 Understanding of and support for revalidation 1
1.2 Potential impacts of revalidation 1
1.3 Areas for assessment 1
1.4 The evidence gathering process 2
1.5 Views on portfolio based approach 3
1.6 Patient feedback 3
1.7 Integration with other initiatives 4
1.8 The standards and evidence framework 4
1.9 Alternative approaches 4
1.10 Recommendations 5 2 BACKGROUND & OBJECTIVES 6
2.1 The General Dental Council and Revalidation 6
2.2 Revalidation development principles 7
2.3 The process of revalidation 8
2.4 The Revalidation Stage 1 Feasibility Study 8
2.5 Research Objectives 9 3 METHOD & SAMPLE 10
3.1 Recruitment 10
3.2 The evidence gathering process 11
3.3 Focus groups 11
3.4 Semi-structured interviews 12
3.5 Sample structure 12 4 MAIN FINDINGS 14 4.1 Concept of Revalidation 15 4.1.1 Why revalidation 15 4.1.2 Support for revalidation 17 4.1.3 Understanding of revalidation 2
1.1 Understanding of and Support for Revalidation At a conceptual level, there was widespread understanding that revalidation has
been inevitable for some time; a consequence of:
• High profile malpractice cases;
• Movements in the medical profession towards revalidation of doctors and;
• Increasing accountability of professionals to the GDC.
In terms of support, the views of the profession towards revalidation are widespread.
A significant proportion thinks it is both necessary and likely to have an impact, whilst a smaller, though significant proportion feels it is unnecessary, a waste of time and unlikely to have any impact.
Those least likely to be supportive of the initiative appear to be those with many years of experience (in excess of 25 years) and, surprisingly, those most recently qualified.
1.2 Potential Impacts of Revalidation The majority of respondents agreed that revalidation is unlikely to uncover ‘the next Harold Shipman’; however, there was some agreement that there could potentially be
some smaller – though significant – impacts, including:
• The establishment of a set of minimum standards to which all professionals must perform;
• Prioritisation of other regulatory initiatives which are currently being ignored by some, e.g. PDPs and appraisal;
• An opportunity for those less well organised to improve.
1.3 Areas for Assessment There was widespread agreement that three of the four key areas of assessment for revalidation were intuitive – Professionalism, Communication and Clinical. Many however felt that Management and Leadership was not an area which should be assessed on an individual professional level. The view was that for Associates, VTs and others, Management and Leadership is not an important issue. Oftentimes,
When asked of the key attributes of good dentists, responses tended to group into
four specific categories:
• Professionalism / Conduct
• Clinical competence / aptitude
• Patient Focus
• Compliance-related / Quality assurance.
1.4 The Evidence Gathering Process The range of time spent on the collation process was vast, from simply taking all information contained in one file / filing cabinet, to a full working week. The most significant impact on the time commitment was the extent to which evidence submissions were based on the interpretation of the individual. Some participants felt that a single certificate, e.g. Denplan Excel, was enough to cover the process, whilst others felt that they had to submit every document held in the practice for the last five years or so.
The most frequently cited time taken to complete the process across all groups was 1 – 2 hours (32%), followed by 2 – 4 hours (26%).
Around two thirds (66%) of respondents felt that it was very or quite easy to collect the relevant evidence to revalidate, whilst around a fifth (21%) felt it was very or quite difficult. The key issue appeared not to be locating the evidence, but rather discerning what was relevant for inclusion.
The actual types of evidence submitted were incredibly diverse and analysis of submissions was very difficult on the basis of the diversity and also the varied levels of organisation – whilst some submitted evidence referencing the standards and evidence framework, others simply sent in hundreds of sheets of paper in no logical order (which may account for the short time spent by many collating evidence).
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1.5 Views on a Portfolio Based Approach Nearly two thirds of all participants (63%) were positive about the appropriateness of a portfolio-based approach to revalidation, whilst around a fifth (22%) were more negative in their outlook.
The main perceived strengths in this approach included:
• The majority (83%) had retained all documents which they felt would be relevant to revalidation – only 17% had documents which had not been retained but could have been used;
• Administering the process in this way was a good way, for the majority, to avoid a face-to-face assessment;
• Practices with a well organised practice manager were able to delegate much of the work and;
• It allowed some individuals to ensure their filing was in order and well organised.
On the other hand, the key perceived weaknesses included:
• The potential administrative burden on the individual practitioner and their associated practices;
• The potential cost implications on the side of the GDC in evaluating portfolios and the subjective nature of success;
• The lack of ‘live’ experience with dentists in surgery;
• The extent to which revalidation relies on patient feedback in the framework.
1.6 Patient Feedback Patient feedback was a subject which attracted a widespread degree of concern from participants. When asked in the telephone interviews about what types of required evidence were not good indicators of performance, the most frequently received answer related to patient feedback. The principal argument was that for the majority of standards, patients are not well placed to assess the extent to which the dentist is performing acceptably.
A number of participants commented that patients in general only care about three things: how long the treatment will take, how much it will cost and how much it will hurt. Therefore whilst expensive and painful treatments may be the most appropriate solution, patients run the risk of being dissatisfied after appropriate treatment.
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1.7 Integration with Other Initiatives It is essential that revalidation is integrated with other, already established initiatives.
Many felt that, as a superior certification to revalidation, a Denplan Excel certificate should be enough on its own to revalidate. Others argued that the BDA Good Practice Scheme, together with CPD logs and certificates should be enough – though there was some suggestion that other initiatives too should be included.
1.8 The Standards and Evidence Framework There was widespread agreement that the use of a framework as guidance for portfolio collation was essential. In general, the outcomes listed on the framework, though often difficult to provide evidence for, were generally warmly received. in addition to concerns about the over-reliance on patient feedback, participants were also concerned about the lack of specificity in the framework in terms of evidence required and for how many retrospective years evidence was required.
Much of the discussion around the framework focussed on its need to be simple and prescriptive. Much of the information in the outcomes was left open to interpretation or was seen as too non specific in terms of the amount – and type – of information required. The consequence of this was that participants were often left feeling uncertain about what to include and often would send too much information, or too little.
1.9 Alternative Approaches Participants struggled to determine any alternative, suitable methods of revalidation beyond that which is being proposed. Throughout the interviews and focus groups,
three possible alternatives were suggested:
1.9.1 Face-to-Face Assessment For many, this was the only way to ensure the acquisition of reliable, clinical information about a professional. Nevertheless, most understood that the prospect of carrying out in excess of 20,000 face-to-face assessments was both costly and impractical.
1.9.2 Auto-CPD Updates This suggestion, although again potentially impractical, was for the GDC to take on the burden of revalidation. This would involve submission of all CPD course
1.9.3 Educational Approach The final suggestion was that, rather than an evidence-based approach, registrants should be required to attend core training days / conferences, hosted by the GDC covering the key points of revalidation. Those who do not attend for any reason would then go on to some form of face-to-face assessment.
1.10 Recommendations Based on the experiences of participants in this study, we would recommend consideration of the following.
• Reconsider the reliance within the framework on patient feedback;
• Improve the specificity on the standards and evidence framework in terms of outcomes, what evidence is required / acceptable and over the course of how many years evidence should be produced;
• Ensure revalidation is effectively integrated with other, well established initiatives;
• Consider the production of a storage facility (a file or a box) for registrants to store evidence as they collect it, together with a CPD log diary / pro forma;
• Invest in the capacity to manage revalidation online, through eGDC;
• Reconsider the importance of a census approach, versus random sampling;
• Reconsider the inclusion of Management and Leadership in the four key areas of assessment.
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2 BACKGROUND AND OBJECTIVES
2.1 The General Dental Council and Revalidation Once they are registered with the GDC, dental professionals have to show they have kept their knowledge up-to-date by meeting the GDC’s continuing professional development (CPD) requirements. Over a five year period, all dentists must complete 250 hours of CPD, of which at least 75 hours should be verifiable, and the remainder non-verifiable. Dental Care Professionals (DCPs) should complete 150 hours of CPD in this time, of which 50 hours should be verifiable.
In light of its principal aim to protect patients through effective regulation, the GDC identified a need to expand the scope of its regulatory activity beyond compulsory CPD (which only ensures that knowledge is kept up-to-date), to ensure dental professionals can demonstrate continued fitness to practise by meeting the standards required for registration on a regular basis. As such, the GDC has proposed a programme of revalidation for all dentists. The principal aim of revalidation is to allay concerns about patient safety, by reassuring the public that professionals are up-to-date and fit to practise.
Revalidation through the GDC means that, in addition to CPD requirements, dental professionals will need to be able to demonstrate that they are fit to practise in the respective fields in which they perform and meet the standards required for registration through the GDC.
The GDC has outlined the following series of objectives and principles in the
development of revalidation, to which it is committed:
• The principal objective of revalidation is to give reassurance to patients and the public that dental professionals meet a satisfactory standard to maintain their registration with the GDC. It is not a guarantee that nothing will ever go wrong;
• The GDC will take the views of patients into account when developing revalidation;
• The GDC aims to develop a process which requires all dental professionals to be able to show, on a regular basis, that they meet the standards required for continued registration in the field(s) of practice in which they perform;
• The product of revalidation will be a binary decision; either the dental professional is revalidated or (s)he is not;
• The GDC will not delegate revalidation to employers or commissioners of services.
2.2 Revalidation Development Principles In the development of the revalidation programme, the GDC has committed itself to the following set of principles to ensure protection for the public whilst also peace of
mind for the profession:
• The process of revalidation should be proportionate to the problem it seeks to address;
• The process should not place burdens upon registrants except insofar as it is necessary to protect the public interest;
• The GDC will use pre-existing mechanisms and evidence where possible and appropriate;
• Revalidation will be simple and flexible, summative and formative;