Friday 26 February 2016

Notes from RCGP Council meeting 26 Feb 2016

I am delighted to say that the proposal has been approved for all Council documents to be made available to all members in advance of discussion and for Council meetings to be live tweeted. This builds on a proposal I submitted with Jonathan Leach and Kirsty Baldwin last year. My thanks to the short life working group that finalised this proposal.
Appraisal and revalidation
In response to a paper proposing amendments to the process of appraisal and revalidation, I made the following intervention:
"I welcome this clarification, as local variation in implementation of appraisal and revalidation has caused some consternation and confusion.
"However, I wonder if we can go a lot further in reducing the workload burden. Whilst any individual idea might have merit, I cannot support any proposal for additional documentation [such as the proposal in this paper for written reflection on patient feedback every single year].
"Revalidation has been operating for 3 years and appraisal in roughly its current form for 12 years. Many GPs now feel that the general burden of workload has become intolerable. The Special LMC Conference on 30 January 2016 recognised the contribution appraisal makes to that workload and called for appraisal intervals to be lengthened to 2 years and for the process to be simplified and restored to a formative process. This is therefore a good time to review the process.
"I canvassed views on the Resilient GP Facebook group which has 3,700 members. In the interests of full disclosure, perhaps I should mention that I helped to found the group but left the Resilient GP partnership a year ago.
"Just asking the question clearly touched a nerve, as a lively debate ensued.
"One member suggested that preparing for appraisal makes him feel “irritated, demeaned, devalued and mentally shut down”. 86 out of 126 respondents agreed with him.
"I implied that revalidation should raise standards in General Practice. Numerous respondents expressed grave doubt that there was any evidence that revalidation had achieved that objective. We are calling on CQC to test its inspection regime against meaningful outcome measures; should we not insist on the same for revalidation?
"There was even the suggestion that raising standards had never been the purpose of revalidation. Given that the charitable object of College is “to encourage, foster and maintain the highest possible standards in general medical practice”, should we remain engaged in a process which does not?
"Let us withdraw our support for the collection of evidence and completion of numerous boxes, be they tick boxes or even more time-consuming, and promote a formative process in which documentation and writing is kept to a bare minimum."
Council nevetheless approved the paper without amendment.

Thursday 4 February 2016

Managing conflicts of interest of regulators on RCGP Faculty board

Prof Steve Field, Midland Faculty board member and Chief Inspector of General Practice "said that what he had found made him ‘ashamed’ of his own profession" and "that we’ve failed as a profession" - Daily Mail, 12 December 2015.

This evening, Bill Strange and I presented the following motion to RCGP Midland Faculty board which we had written with Mary McCarthy:

  1. “Senior employees of organisations whose main purpose is inspection and regulation to which a significant number of members of Midland Faculty are subject should be excluded from discussions and votes of the board of Midland Faculty RCGP, unless specifically requested by a majority of board members.”
  2. “Any board member who publicly presents a position that is perceived by a significant proportion of our members as being antagonistic and inflammatory, such that the role of the board might be questioned by our members, should be removed from the board.”
The motion was not carried. 11 voted against, 6 for and 1 abstained in a secret ballot.
Prof Field had submitted his apologies for the meeting.

We had set out our arguments in this accompanying paper.

Points of discussion included:
  • Unanimous disapproval of Prof Field's reported comments
  • Unanimous disapproval of CQC's approach to inspection in general practice, causing more disruption than benefit for the majority of practices as a result of a failure to target failing practices
  • Unanimous disapproval of CQC's "Intelligent Monitoring" data publication
  • Unanimous condemnation of CQC's failure to celebrate success as it had promised
Arguments against the motion included:
  • Might Prof Field behaviour have breached the RCGP members' code of conduct, which would be a matter for RCGP Hon. Sec. rather than a Faculty. (Any complaint must be made within 3 months of matter in question)
  • Adopting this as policy would require approval by RCGP Council, a process that could be exceptionally lengthy
  • Concern that reacting to a specific case was not the best way to make policy
  • Concern that point 1 could include members whose work includes regulation
  • Concern that point 2 amounted to censorship
If anyone else present at the meeting has a different recollection, do please leave details in a comment below.