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Arrested development?

Arrested development?

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Continuing professional development (CPD) was defined in the Chief Medical Officer's Report, Medical Revalidation – Principles and Next Steps, as "the process by which individual doctors keep up-to-date and maintain the highest standards of professional practice".

Continuing professional development (CPD) was defined in the Chief Medical Officer's Report, Medical Revalidation – Principles and Next Steps, as "the process by which individual doctors keep up-to-date and maintain the highest standards of professional practice".

The Royal College of GPs (RCGP) has developed a CPD strategy to enable GPs to be able to record and demonstrate their CPD. The College is committed to the continued development of a managed CPD scheme, with high-quality educational products designed to underpin improvement in patient care and support the revalidation needs of GPs. This will also include the ongoing process of identifying the educational needs for GPs and the management, quality assurance and provision of CPD.

Management of CPD
The Academy of Medical Royal Colleges has recommended that all CPD schemes include a minimum of 50 credits a year. Although many CPD schemes are timebased, the use of a solely time-based CPD scheme is educationally questionable. The RCGP piloted a credit system in 2008 and refined the scheme in 2009.

This is the only CPD scheme for doctors that recognises the outcomes of learning rather than simply time spent learning. The RCGP Credit-Based System for CPD is a mechanism for GPs to record their CPD based on the time spent on the activity and the impact it has on the doctor, his or her patients and the service. Details of the credit scheme are described in the RCGP Guide to Credits (see Resources). Basically, one hour of CPD is one credit.

However, if that learning is implemented in practice, the GP can double their time-based credits. Credits are self-assessed and verified at appraisal, and account should be taken of the need for GPs to use their CPD to ensure that they are upto- date in all areas of their work.The system will help GPs meet their revalidation needs by providing a mechanism for collecting and demonstrating their CPD credits.

Impact can be demonstrated in many ways: by patients (eg, a change in practice, implementing a new clinical guideline, initiating a new drug for the first time), individual personal development (eg, development of a new skill or further development of existing skills and service (eg, developing and implementing a new service, becoming a training practice, teaching others).

Appraisers should validate credits, aiming for a broad range of CPD appropriate for the work the GP undertakes. An example of how to collect credits is:

• A GP attends a meeting (one hour) on heart failure, acquires the knowledge that certain beta-blockers are beneficial to patients with this condition, and then records a reflective note. Credits claimed: 1.
• The GP then implements that learning in practice and records two patient case studies demonstrating the introduction of betablockers in heart failure. Credits claimed: 1 × 2 (impact) = 2.
• The GP then discusses with colleagues and plans an audit after consideration of current practice (one hour).
Following completion of the audit, changes are made following discussion with colleagues (one hour) and a second audit cycle demonstrates an improvement in care. Credits claimed: 1 (initial meeting (one hour)) + 2 (planning (one hour)) and discussion associated with audit (one hour) × 2 (impact) = 6.

Developing CPD products The RCGP has developed an online learning environment (OLE). This includes a range of e-learning products.

Essential Knowledge Updates (EKU) provide GPs with a quick and accessible way of updating their knowledge of best practice and new clinical guidelines. Updates are available at six monthly intervals.

Identification of learning needs is a key part of CPD planning, and the College has developed an online self-assessment learning tool called mPEP (Personal Education Planning) for use by GPs across the UK. This has been developed by RCGP Scotland but over the next year will be integrated into the OLE.

Over time, this will enable GPs to identify learning needs across all areas of the GP curriculum. It will thus provide a basis for appraisal and become a key support tool in preparing for revalidation. Future developments include adapting or rewriting the modules specifically for practice managers and practice nurses.

Supporting teams and quality
The RCGP delivers a suite of programmes to support GP teams with the aim of improving quality of patient care. Practice Accreditation (PA) is a voluntary, evidence-based accreditation system that is professionally led and patient focused. It has been developed in collaboration with the National Primary Care Research and Development Centre (NPCRDC) at the University of Manchester.

The system involves selfassessment by the primary care provider using a web based tool, followed by an external assessment by a three-person team. PA is appropriate for both NHS and private providers of primary care and will enable them to comply with the registration requirements of the Care Quality Commission and other statutory requirements.

The scheme will be launched at the RCGP Annual Conference in October 2010, following asuccessful pilot in 2008, and will be followed by a full national roll-out in the autumn.

In addition, the Quality Practice Award (QPA) encourages and supports practices to deliver the highest quality care to their patients. The 100th QPA award in England was achieved recently. During the past four years, a modular format of QPA has been developed to make it more accessible to practices, and this format has been further adapted specifically for the prison service.

Conclusion
The CPD needs of GPs is a priority for the RCGP with both the continued development of a managed CPD scheme and the development of high-quality educational products designed to underpin improvement in patient care and to provide benefits for GPs.

However, the College’s CPD strategy extends beyond its work with revalidation and encompasses a broad CPD remit, including an ongoing process of identifying the educational needs of GPs and the management, quality assurance and provision of CPD. This will include educational support for the strategy set out in the July 2010 white paper Liberating the NHS.

The RCGP CPD programme proposes to adopt a spiral curriculum approach, which will allow GPs to revisit topic and interest areas at different levels depending on their experience and to introduce an international dimension to its programme of activities. It will develop a more proactive approach to communicating with GPs and other stakeholders contributing to enhancing GPs’ role as leaders and deliverers of high-quality patient care.

Resource
RCGP Guide to the Credit-Based System for CPD www.rcgp.org.uk/default.aspx?page=2125

Professor Nigel Sparrow
FRCGP, FAcadMed
Chair, RCGP Professional Development Board
GPNottingham

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