Once every five years, a GP should provide ten consecutive medical records
from his/her normal surgery or ten random samples of ten medical records.
Evidence criteria
Each record should be legible and should include:
presenting complaint
treatment given
significant finding(s)
dates.
Standards
All criteria should be present 70% of the time.
Observation
Collecting the evidence
The observation should be based on five routine GP consultations, once
every five years, discussed with a colleague. GPs may choose either:
video
peer observation of consultation
MRCGP simluated surgery.
Evidence criteria
For video and peer observation:
a peer review proforma is completed, covering clinical skills, communication
skills, decision-making skills
a self-evaluation statement resulting from the peer discussion is completed.
Standards
For MRCGP simulated surgery:
doctor passes simulated surgery at MRCGP level.
For video and peer observation:
peer review and self-evaluation statements are complete.
Management plan
Collecting the evidence
Once every five years, a GP should submit a plan used in the management
of patients with chronic disease in his/her practice.
Evidence criteria
One written protocol, which conforms to either local or national guidelines
a written description of how the protocol has been used in treating a particular
patient or an audit in relation to the management plan.
Standard:
The protocol submitted is referenced to local or national standards
The example clearly illustrates compliance with the guideline.
Case report
Collecting the evidence:
One problem or random case selected by GP in a 5-year cycle from GP’s normal
surgeries.
Evidence criteria
A standard proforma is completed to cover the areas:
Clinical knowledge
Decision-making
Thoughts or reflections on the case
Learning points
How this new learning will be used in future.
Note: The relevant patient’s record (anonymised) should be available,
as supporting evidence
Standard:
Report submitted in standard format.
Proforma complete.
Supporting case record available.
No major clinical error made by doctor in case report.
Analysis of prescribing data
Collecting the evidence:
Once every 5 years, using SPA Level 2 data, or individualised feedback
from an appropriate source, a GP should:
analyse the top 4 drugs used within one therapeutic grouping
comment on the range of items used on a standard proforma.
Evidence criteria
The analysis should cover the following points:
cost effectiveness of drugs prescribed
clinical effectiveness of drugs prescribed
learning points or other points identified.
Standard:
All the prescribed criteria are present in the analysis.
Account of records transfer
Collecting the evidence:
A GP should provide a written account of the system utilised to transfer
information from out-of-hours contacts to the patient’s usual doctor.
Evidence criteria
The account should include:
type of copy (hard or electronic)
method of delivery of copy (manual, post or electronic)
timing when copy is available in GP’s practice.
Standard:
All criteria present 100% of the time.
Patient satisfaction survey
Collecting the evidence:
Once every 5 years, GPs should conduct a survey of 50 consecutive consultations
or 50 random consultations over one week using a validated questionnaire.
Evidence criteria
Aggregated scores presented.
Brief statement by doctor in relation to results of data and action to
be taken.
Standard:
No concerns expressed by patient about multiple areas of practice.
GP is able to explain any areas of concern or demonstrate changes necessary
in response to the survey results.
Peer review questionnaire
Collecting the evidence:
Once every 5 years, a GP should nominate 20 colleagues to complete peer
questionnaire (minimum of 10 responses required for analysis).
Evidence criteria
Results in form of aggregated scores to be returned to GP.
GP comments on results may also be included.
Standard:
No concerns expressed by peers about multiple areas of practice.
GP is able to explain any areas of concern or demonstrate changes necessary
in response to the review.
Note: to ensure anonymity, the team review questionnaire will be
administered externally by Tayside Audit Resource for Primary Care.
Team work account
Collecting the evidence:
Once every 5 years, a GP should provide a written account of one episode
illustrating how the GP interacts with other primary care colleagues in
the delivery of patient care.
Evidence criteria
The account should include:
description of the episode
list of team members involved
GP’s relationship to the other members of the team
outcomes as a result of team work
learning points: a) personal
b) for the team.
Standard:
All the prescribed criteria are present in the report.
The account should be 1-2 page(s), A4, or 400 words approximately, and
be clearly legible.
Complaints handling
Collecting the evidence:
Once every 5 years, the GP will provide:
a documented practice complaints procedure
anonymised copies of all written complaints in which the GP was implicated,
including a written summary of how each complaint was handled and any changes
made
evidence of any disciplinary action against the GP by the NHS or GMC.
Evidence criteria
Relevant documentation.
Standard:
The practice complaints procedure conforms with NHS guidelines.
Any complaint is handled in accordance with the practice complaints procedure.
Note: GPs working within out-of-hours organisations such as co-operatives
will also have to submit the co-operative complaints procedure and ensure
they complete the above process in respect of complaints received against
them, while working in the co-operative.
Significant event analysis
Collecting the evidence:
Once every 5 years, the GP should describe one significant event.
Note: a significant event is defined as any event where patient
care was or may have been sub-optimal as a result of problems in organisation
of care or delivery of care.
Evidence criteria
Recording of a critical event should include:
the circumstances of how the event occurred
an exact description of the event
the outcome
an analysis of the problem or potential problem
what was learned or requires to be changed
action needed to prevent recurrence and evidence that it is in progress
or achieved.
Standard:
The significant event should involve the revalidating doctor.
All the prescribed criteria are present in the report.
An action plan is in progress or has been achieved.
CPR skills
Collecting the evidence:
National/regional certificate in CPR undertaken in last three years.
Evidence criteria
Not applicable.
Standard:
Recognised CPR certificate.
Clinical audit
A clinical audit involves measuring an area of medical activity undertaken
by the doctor and comparing his/her performance to accepted standards of
good practice. The doctor will determine what % of his/her work should
meet the agreed standards. If the doctor’s performance falls below his/her
defined standards, he/she will determine reasons for this and barriers
to change, and then proceed to make changes that will enable him/ her to
meet the defined standard. The doctor will then re-measure his/her performance
to see what improvement has taken place.
Collecting the evidence:
Once every 5 years, the GP will audit one area of medical practice.
Evidence criteria
The audit process will include:
identification of audit question
criteria and standards stated
performance measured
analysis and changes proposed
changes made
re-measurement of performance.
Standard:
The audit is on an area of activity relevant to the doctor’s practice.
Criteria are based on current medical evidence.
Each step of the audit cycle is completed.
Referral letters
Collecting the evidence:
Once every 5 years, a GP should provide:
10 consecutive, anonymised referral letters, or a random sample of 10 anonymised
referral letters with analysis and comment from GP against defined standards.
Evidence criteria
Letters should include:
date
administrative details of patient
reason for referral
drugs prescribed
relevant examinations
relevant past medical history
relevant psychosocial details.
Standard:
All of the criteria must be present in at least 50% of referral letters.
Miscellaneous forms of evidence
There are numerous other forms of evidence suggested in the models
for which we did not specify specific requirements or standards. However,
we believe GPs could equally well submit such evidence for revalidation
purposes. Sometimes, the evidence is simply too personal and it would be
inappropriate to set down standards, eg a reflective diary. In other cases,
the standard is implied by the course/evidence, eg RCGP PEP. Other evidences
are simply relevant documentation,eg a health and safety policy or NHS
target figures.
These evidences include:
Log books/investigation data
Reflective diary
GP signed statements
Practice accreditation certificates
Recognised course/PGEA certificates
Minutes of meetings
Feedback from peers/patients (other than a survey)