Revalidation of GPs

Re: Revalidation of GPs

Clive Ansell — Mon, 08 Mar 2010 19:55:04 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Hannah Wynne Richards"] I think that CPD should be mandatory,[/quote]

I think the point that others have already tried to make is that CPD is already effectively mandatory (or compulsory........ I'm not absolutely sure of the difference).

That is not to say that I have any respect for the fill-yer-record-card-in-with-35-hours scheme, not allowed to record more than 10 of your many hours of "undocumented" (so surely everyone just sticks down 10 hours anyway, leaving them with 25 hours to actually record), but you are allowed to count hours of lectures on business management, salesmanship, how to flog stuff to the punters. I'd resist that being enshrined in law.

[/quote]

Why record any "undocumented" reading at all, the amount of recordable documented reading is infinite. I recorded over 100 hours of reading in 2009, it was probably more actually. I record it in an Excel spreadsheet so very easy.

If CPD becomes mandatory/compulsory I cannot see how it can be verified or enforced, after all my 100 hours may or may not be true (It is), and it cannot be proven or disproven either way ?? . Similarly, I attended 2008 BSAVA congress which "ticks off" 35 hours, but in truth it would have been nearer 15 or 20. It is becoming more about ticking boxes than what is actually learned or gained from it.

Re: Revalidation of GPs

Evelyn Barbour-Hill — Mon, 08 Mar 2010 18:50:37 GMT

[quote user="Hannah Wynne Richards"] I think that CPD should be mandatory,[/quote]

I think the point that others have already tried to make is that CPD is already effectively mandatory (or compulsory........ I'm not absolutely sure of the difference).

Re: Revalidation of GPs

Hannah Wynne Richards — Mon, 08 Mar 2010 10:37:55 GMT

The PSS inspection does include producing CPD Records, and one of the standards is that everyone in the practice does their 35 hours. One of the things the inspector complimented me on is that not only myself, but also my RVN do far more than our required minimum, and my ANA also has time off, and fees paid for CPD.

Sorry Evelyn, this time I'm not with you (though I admire your very practical way of demonstrating that it's possible to have a razor-sharp brain at 2 am , despite working all day -our generation are obviously tough !!!!!!!!!!!!!!!!) I think that CPD should be mandatory, though obviously this will have to wait for a new VSA. I do agree with you that the clients of some practices will need educating about the necessity for increased fees

Vikki Although generally I'm very strongly in favour of the disciplinary committee judging "without fear or favour " and only taking the actual complaint into consideration, this is one time when I would favour a pragmatic approach-make CPD (which admittedly is only 1 part of re-validation) compulsory, and then if necessary make allowances for those in EXTREME circumstances-but not get so lenient that ANY lame excuse of difficulty is accepted

Wynne

Re: Revalidation of GPs

Evelyn Barbour-Hill — Mon, 08 Mar 2010 02:08:12 GMT

[quote user="Philip Goddard"]

If you had read between the lines, it would have said '.....have already given up the will to stay awake!'. Here we are exactly 1 wk later and the same will apply.

Philip

[/quote]

What, at only quarter past ten?

Re: Revalidation of GPs

philip goddard — Sun, 07 Mar 2010 22:17:29 GMT

Evelyn

If you had read between the lines, it would have said '.....have already given up the will to stay awake!'. Here we are exactly 1 wk later and the same will apply.

Philip

P.S. Hi Sue!

Re: Revalidation of GPs

sue dorey — Sun, 07 Mar 2010 20:44:23 GMT

Love your replies Virginia!You should be writing books in your spare time.Don't forget the grannies too!!

Re: Revalidation of GPs

sue dorey — Sun, 07 Mar 2010 20:32:25 GMT

Yes , that Cert would be great to do, the costs of some of these courses however is more than some people's mortgages!

Re: Revalidation of GPs

Evelyn Barbour-Hill — Sun, 07 Mar 2010 16:11:49 GMT

[quote user="Virginia Campbell"]Just thought of another very valuable group that shouldn't have multiple choice exams and cast iron legal CPD requirements inflicted upon them: the grandaddies ( Evelyn, I don't mean you, you're not old enough yet but you will know the type). They're great, every practice should have one.[/quote]

What have I done to be excluded? I do have four grandchildren.

Re: Revalidation of GPs

Evelyn Barbour-Hill — Sun, 07 Mar 2010 16:04:01 GMT

[quote user="Philip Goddard"]Of course there are ancient clinicians out there who know this and do not the like the idea of re-validation as they have already........[/quote]

Have already what, Mr. Goddard?

Made their pile?

Lost their marbles?

What?

Re: Revalidation of GPs

Vikki Halliday LLB — Sun, 07 Mar 2010 13:46:59 GMT

[quote user="Julian Earl"]What do clients care about - the equipment or the people? This is one reason why the general public do not really care about Tier one/two/three. [/quote]

I think clients generally go for the "face" behind the practice as you suggest, however I do find more and more that working in different practices, the type of client is changing. Yes personalities and faces are important, but more and more young generation clients are choosing a veterinary practice over the internet and on publicity, less by personal recommendation. Image is important, and whilst many will not be interested in far less understand the complexities of the Tier system, the mere fact a practice is registered under the PSS I think gives some degree of guarantee that the place will be clean, reasonably well equipped, and their animals will receive up-to-date treatment and care.

[quote user="Julian Earl"]You do make a valid point about people moving on so maybe the PSS should require annual information about CPD that has been undertaken whilst having less emphasis on other paper trails and bizarre requirements?[/quote]

But I think you have missed my point here, which was originally about revalidation. It was not about CPD, although I feel a move toward more mandatory CPD for all would be a strong move for the profession. And I am not even going to be prescriptive about the length or number of hours CPD here, as other contributors have indicated that in very rural or island areas, 35hrs may be almost impossible to achieve. I think if you can demonstrate you are trying to keep up to date, and not just reading journals, perhaps a clinical audit, comparing results with a neighbouring colleagues by telephone?

But I think the main thrust of my argument is that all veterinary surgeons regardless of age, should be obliged to revalidate at certain points in their career. The PSS is only one of a few possible mechanisms by which this could be assessed, but the results should be relevant to the individual surgeon, not merely another exercise in gnerating paperwork for the practice.

Re: Revalidation of GPs

Julian Earl — Sun, 07 Mar 2010 12:37:44 GMT

[quote user="Vikki Halliday"]

[quote user="Julian Earl"]Personally, I think the costs of CPD are not far short of outrageous in many cases[/quote]

I disagree. There are many excellent free and subsidised courses/meetings that form the backbone of much of my CPD quota, and are therefore excellent value for money. The specialised CPD providers do charge a high fee, but as I have only recently carried out online CPD that was chargeable, I cannot comment on anything else. However it was of huge benefit to both me as a vet and financially to the practice as I was more confident to carry out procedures on a regular basis, rather than referring of seeking second opinions.

[/quote]

That's why I said "many". The most cost-effective CPD is undoubtedly the local BVA evening meeting or the referral centre that we attend for a fraction of the price of the £300-ish that other providers charge. I am not challenging the benefit of CPD at all, but it is a truism about having to use the information within a few weeks for the information to stick and unless you see the relevant cases then the value is diminished.

[quote user="Vikki Halliday"]

[quote user="Julian Earl"]To have mandatory CPD would surely not do anything to bring the costs down but would almost certainly drive them even higher[/quote]

I think were CPD mandatory, the market of CPD providers would widen, and therefore by definition become more competitive.

[/quote]

I disagree. If CPD were mandatory then the providers may increase in number but what about the quality? Also, if there is a sudden increase in demand for a product, what tends to happen to the price?

[quote user="Vikki Halliday"]

[quote user="Julian Earl"] but please let's stop repeating this mantra that we undercharge.[/quote]

Why? I think we do undercharge. I think it is a valid economic point. I think we are all guilty of pre-judging what clients are expecting to pay. Having recently had several trips to the dentist, I found their price list to be on a par with ours for professional services. And this is subsidised by the NHS!. I would fully expect bills two or three times the NHS level were I to choose a private dentist. (Truth be told, I couldn't afford a private dentist!)

[/quote]

I do not entirely accept this argument about x raying pockets, in that I do not think that is how we decide our charges, by and large. If you do believe it, why not simply double/triple/other multiple your fees tomorrow and see how your clients respond?

Practices charge on the basis of how busy we seem to be, what costs we have both generally and specifically, and what the figures say at the end of each accounting period; we (or most of us probably) chuck those into a gut-feeling melting pot and come up with what "seems" to be right. Nowadays there is more of a tendency to try and cost out the, errm, costs of procedures but it is fairly complicated to do and I would guess that some wild price alterations would occur in many practices if we did this accurately.

[quote user="Vikki Halliday"]

[quote user="Julian Earl"]The scheme should be more about CPD and less about having the wrong type of door into kennel areas [/quote]

I guess my answer here is along the lines of "the clue is in the title". Practice standards. If it were personal competence then CPD would be a much parger part, but to be fair, the PSS does what it says on the tin. I think to include a degree of CPD in the PSS is a requirement, but in terms of revalidation, the PSS does not move whan your assistants do, therefore it cannot be effective in terms of measuring personal competence and fitness to practice.

I do however agree that the PSS as is stands is ideally placed to include a specific measurable assessment of personal competence, so long as that marker applies and moves with the individual.[/quote]

But what makes up the practice - the equipment or the people working there? What do clients care about - the equipment or the people? This is one reason why the general public do not really care about Tier one/two/three. You do make a valid point about people moving on so maybe the PSS should require annual information about CPD that has been undertaken whilst having less emphasis on other paper trails and bizarre requirements?

Re: Revalidation of GPs

George Cooper — Sun, 07 Mar 2010 11:10:52 GMT

[quote user="Virginia Campbell"]

Just thought of another very valuable group that shouldn't have multiple choice exams and cast iron legal CPD requirements inflicted upon them: the grandaddies ( Evelyn, I don't mean you, you're not old enough yet but you will know the type). They're great, every practice should have one. Nobody knows exactly how old the grandaddy is (I've seen some in their 80s and suspect there may be nonagenarian vet practice grandaddies). They finally sold the practice ten years ago but stayed on for a couple of years to TB test and never left even though they don't test any more. The limp they acquired from a kick in 1973 is pretty bad in the cold weather, you have to hand them their bifocals when you want them to look at anything and their hands are too arthritic to do surgery. They do gradually less work and more pottering.

But... when Mrs Ancient who has brought her cats to grandaddy since he was a stripling young vet comes into the surgery...when the new grad drops a pedicle and everyone else is out on calls...when some weird once-in-a-very-long-career case comes in and nobody else in the practice has seen the like....who ya gonna call...grandaddy! They're also useful to have in the vet tent at the show where they've been officiating for years: to tweak new grad's official show vet badge straight on the way out and pour them a G&T when they come back in after they've told Mr Beltex Breeder Bigshot that his hyperthermic ram is not going into the ring in an hour's time. Also brilliant to produce when the argumentative client who has been breeding Boxers/Burmese/Belgian Warmbloods for 20/30/50 years comes in...however long they've been doing it, grandaddy has been vetting longer. Every grandaddy I have seen still reads the journals over a cup of tea, but that doesn't mean that they should have to reach for the bifocals and fill in the Self Directed Learning section of the CPD record every time. Yay to the grandaddies and may they retain their RCVS membership much longer than their teeth.

[/quote]

Er,... ...have we met? Do I know you?

Re: Revalidation of GPs

Virginia Campbell — Sun, 07 Mar 2010 01:11:05 GMT

Re: Revalidation of GPs

Virginia Campbell — Sun, 07 Mar 2010 00:18:03 GMT

[quote user="Jonathan Wray"]the RCVS requirement for CPD is "mandatory" in the same way that 24/7 is. Neither of these are enshrined in law, in the VSA 1966. They have become part of the Guide to Professional Conduct consequent upon a general agreement and understanding with the profession[/quote]

May it stay this way. This allows for some flexibility and circumstances of individual cases to be taken into account. Suppose for example that you are solo practitioner with a mixed practice on some far flung Scottish island. You'd like to go to more clinical club meetings, but the nearest clinical society meets 60 miles away, and you need to get a ferry on Tuesday to go, stay on the mainland and hope that the weather isn't rough enough to stop the Thursday ferry which is the next one back to the island, and that none of your clients need you for calvings in the meantime, and that your practice won't suffer too much for being closed for 2 days for the sake of a 2 hour meeting. You do some internet CPD but mobile reception is so crap that your dongle keeps cutting your connection in the middle of the webinars which is a bit annoying. Of course you could try to persuade a locum to come for a week so you can go to a conference and cram a year's worth of CPD into your brain in one go and get it over with, if mandatory CPD becomes enshrined in law any old conference will do (you can't go to the one you want cos it's in the spring) and hope that your rural clients won't notice a wee bit of a price hike to pay for your locum (£200/day plus £70/night on call is more or less the going rate), your CPD and accomodation and travel expenses for you and probably the locum as well.

Now imagine that you are the same practitioner, but you are thinking about retiring in a year or two. Will the financial outlay and investment of time be worth it to keep you legal for another year? Or will this be a factor in your decision to hang up your TB guns and spay kit now, leaving the islanders vetless earlier than they otherwise would have been? Who benefits?

OK this may be an extreme case, but I think most vets try to keep learning throughout their careers and obey the spirit of the guidelines. If they were made a legal requirement it would be quite a lot harder for some to stick to the letter of the law. Not too bad if you have a good CPD allowance, no OOH so you don't have to do swapsies to get to the evening meetings, and live in an area of the country with loads of choice of good relevant affordable CPD within easy reach. Not so easy for locums paying for it all out of their own pocket and finding it hard to apply what they've learned as they move from practice to practice losing case followup; or people working a 1 in 2 OOH and arguing the toss over who gets the right to finish early to drive an hour and a half to get that evening meeting; or part timers who work a couple of days a week having to shell out for the same amount of CPD as everyone else (I think this has been well covered elsewhere in this forum).

As it stands, if you get hauled in front of the RCVS, if you can show that you have done nearly enough relevant CPD despite trying circumstances they can look leniently upon you instead of saying tough, you're half an hour short of the legal requirement, out ya go.

Re: Revalidation of GPs

philip goddard — Sat, 06 Mar 2010 23:23:36 GMT

only the old correspondents, and they cannot remember what has been said before. BG.

Mind you they know how to type so they cannot be that old. Oh, I remember when the 386 was leading edge and very expensive so I bought a 286 as it was well beyond anyone's needs at the time. Before you say it, I must be getting ancient. And if you don't remember the 286, our original practice computer before my time was then was on a mini computer, well before PCs had been invented.

Old but not yet grey, and for a short while still in my naughty forties.

Re: Revalidation of GPs

Vikki Halliday LLB — Sat, 06 Mar 2010 23:09:26 GMT

[quote user="Philip Goddard"]Of course there are ancient clinicians out there [/quote]

Watch out! Some correspondants do object to ageism!

Re: Revalidation of GPs

philip goddard — Sat, 06 Mar 2010 23:04:27 GMT

<<Personally, I think the costs of CPD are not far short of outrageous in many cases. The amount spent does not seem to correspond with the value to the practice. >>

ok that will get a response from me even at this time on a Saturday night:. Most ofo the CPD courses in the country are in some way sponsored and represent very good value even at full price.

If not sponsored then often it only takes one clinician to work up one or two cases more properly subsequent to the cpd with additional blood tests/x-rays/scans/mrendoscopy etc to get the costs back for the CPD. The economic issue is also potentially superficial as most clients want their cases worked up properly, so an investment in CPD to make one aware of the correct and fuller work up will give financial returns; longer term the reputation of the practice will improve as the cases are being worked up better.

Of course there are ancient clinicians out there who know this and do not the like the idea of re-validation as they have already........

Too late - night all

Re: Revalidation of GPs

Vikki Halliday LLB — Sat, 06 Mar 2010 22:40:14 GMT

[quote user="Julian Earl"]Personally, I think the costs of CPD are not far short of outrageous in many cases[/quote]

[quote user="Julian Earl"]To have mandatory CPD would surely not do anything to bring the costs down but would almost certainly drive them even higher[/quote]

I think were CPD mandatory, the market of CPD providers would widen, and therefore by definition become more competitive.

[quote user="Julian Earl"] but please let's stop repeating this mantra that we undercharge.[/quote]

[quote user="Julian Earl"]The scheme should be more about CPD and less about having the wrong type of door into kennel areas [/quote]

I do however agree that the PSS as is stands is ideally placed to include a specific measurable assessment of personal competence, so long as that marker applies and moves with the individual.

Re: Revalidation of GPs

Julian Earl — Sat, 06 Mar 2010 19:58:05 GMT

[quote user="Vikki Halliday"]

[quote user="Philip Goddard"]

Want a negative? How about:

Have you thought about the cost involved.

[/quote]

Why need it be another expensive "jobs-for-the-boys" exercise.

It could be more formally linked to the PSS which already has a requirement for monitoring of CPD recording, and could be publicised to the general public as the benefit of attending a registered practice.

... the costs will rise, but as previous repondents have pointed out, where else could someone have a private consultation for 15 minutes for under £30 in most cases, or constant free telephone advice from a private professional outwith the NHS? Costs to the general public should rise to cover this.

[/quote]

Personally, I think the costs of CPD are not far short of outrageous in many cases. The amount spent does not seem to correspond with the value to the practice. To have mandatory CPD would surely not do anything to bring the costs down but would almost certainly drive them even higher.

As for the public having to pay, yes, they probably would have to - but please let's stop repeating this mantra that we undercharge. Some work that we charge for is undercharged, some is not, and dare I say that some may - emphasis on may - be overcharged in order to subsidise other parts of a practice. Ultimately though, we charge what the market will stand. If we charged less we would all be driving round in secondhand Ladas and living in council houses, but if we charged more, the clients would not use us.

Back when the BVA council were discussing the PSS I asked whether the scheme would focus on the levels of skill of the staff, or on "gobbledegookometers" that looked impressive but never used, and sad to say the scheme so far has concentrated on the latter not the former. The scheme should be more about CPD and less about having the wrong type of door into kennel areas (as actually happened).

Validation (to return to the main point of the OP) could be a major part of the PSS by the use of case reports demonstrating how CPD has improved working practices. I would rather spend my time printing out examples of representative cases than creating written evidence to show we know how to sharpen dental instruments for example.

Re: Revalidation of GPs

Vikki Halliday LLB — Sat, 06 Mar 2010 17:54:15 GMT

[quote user="Matthew Scotter"]

That is where the CertAVP(GP) is great as it is based on providing evidence for learning and how this affects your general clinical practice.

[/quote]

Yes but the Cert AVP is by no means compulsory, and it would devalue it's meaning if it were.

Re: Revalidation of GPs

Vikki Halliday LLB — Sat, 06 Mar 2010 17:53:10 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Vikki Halliday"]This would not of course take into account many ageing members of the profession who have failed to embrace the practice standards scheme citing it as expensive, unneccesary or even an intrusion into private business.[/quote]

Why do you insert the word "ageing" there, young lady?

[/quote]

Evelyn, you may note I said "many ageing members", I certainly never implied all members over a certain age fall into this category! I agree with a previous post regarding classification of attitudes in veterinary practice, Type 2 being the one which I was mainly referring to.

I have worked for and with many vets, some of whom by nature have been older than me, and I'm not being ageist!. Some were excellent examples of forward thinking, enthusiastic and experienced practitioners, for whom the lust for knowledge had not ever dimmed, and would strive to continually update and expand their knowledge and skills.

However I have also worked for and with those whos attitude with regard to continual development and learning left a lot to be desired, and would rather carry on in ignorance of the exciting developments in medicine and surgery. Perhaps in some cases it was due to a fear of failure to understand such developments that lead to their entrenched position. Many of these vets could never see that by embracing the novel, it became the norm, and it is to these types of vets I was referring.

Perhaps I should have defined my comment more clearly, but unfortunately age was a huge factor in a number of these vets, I rarely found middle aged graduates or young vets to be as tunnel visioned and insular.

[quote user="Evelyn Barbour-Hill"]

[quote user="Vikki Halliday"] perhaps a 5 yearly multiple choice paper[/quote]

Set and marked by whom, I wonder? Vet school lecturers?

[/quote]

I have no aspiration to return to the ivory towers from whence I came, and I made no suggestion as to who should mark the papers. In fact I would rather it was done by an experienced general practitioner as they are more likely to appreciate local and economic factors, not being isolated in research or lecturing.

[quote user="Evelyn Barbour-Hill"]

[quote user="Vikki Halliday"]Costs to the general public should rise to cover this.[/quote]

Ah, sweet innocence of the youthful radical. Suppose the general public disagrees?

[/quote]

I'm not as youthful and radical as I'd like to be!.

However I do think that if it costs us more to provide a service, then the clients must bear the cost in some way. If we all do the same, and explain why I can't see it as that big an issue. If my dentist puts his fees up because he has had to undertake costly improvements or professional development, who am I to argue? If clients don't like it they may vote with their feet, but will quickly find that everyone is in the same boat. Idealistic I know, but we can but dream...........

I think as a profession we grossly undercharge for some professional services, whilst hiding behind each other with the excuse that clients would not pay more realistic prices. But I think x-raying pockets of any client is a mistake, and am constantly surprised at how much people are prepared to pay.

Re: Revalidation of GPs

ms1083 — Sat, 06 Mar 2010 17:38:18 GMT

[quote user="Adi Nell"]

I don't understand why the idea of mandatory CPD, as originally proposed, would be of "unproven benefit to the public".

Also, having to submit a basic log of CPD attended (and countersigned / evidenced by the CPD provider) need not involve major costs, just a recording system.

[/quote]

it is very possible to attend a course, get the certificate and learn nothing, if there is no learning the CPD hours is total useless and technically would count as zero.

That is where the CertAVP(GP) is great as it is based on providing evidence for learning and how this affects your general clinical practice.

Re: Revalidation of GPs

Evelyn Barbour-Hill — Sat, 06 Mar 2010 16:49:39 GMT

Why do you insert the word "ageing" there, young lady? Is it your opinion that only those over a certain age have failed to embrace the practice standards scheme? If so, what age in particular did you have in mind as the cut-off point?

[quote user="Vikki Halliday"] perhaps a 5 yearly multiple choice paper[/quote]

Set and marked by whom, I wonder? Vet school lecturers? What about those topics in which no expertise exists in the vet schools? And should our answers be the ones that will please the examiners, or the ones that we know are correct?

[quote user="Vikki Halliday"]Costs to the general public should rise to cover this.[/quote]

Ah, sweet innocence of the youthful radical. Suppose the general public disagrees?

Re: Revalidation of GPs

J G Wray — Sat, 06 Mar 2010 11:53:22 GMT

Dear Mr Nell,

[quote user="Adi Nell"]I don't understand why the idea of mandatory CPD, as originally proposed, would be of "unproven benefit to the public".[/quote]

Is mandatory CPD what I was referring to? I'm pretty sure it was revalidation towards which CPD would be a contribution.

Beyond being a Sophoclean aspiration, what proof does anyone have that revalidation is a necessity? Just because others, in another world, have a system why should it be taken as read that that model is absolutely required in ours. We do not have the Sipman problem for instance. We do have to meet the costs and if fewer people can access services because costs rise then what would the overall benefit be and to whom -[ the answer is the the CPD/Training providers. Where have I heard that before?]

[quote user="Adi Nell"]I think the public expects vets to keep up to date and would be surprised (and probably not pleasantly) to find out that we don't have mandatory cpd requirements. Enter RCVS Council stage left....[/quote]

Well, the RCVS requirement for CPD is "mandatory" in the same way that 24/7 is. Neither of these are enshrined in law, in the VSA 1966. They have become part of the Guide to Professional Conduct consequent upon a general agreement and understanding with the profession. You probably know this, but it always makes me uneasy when this is forgotten.

The RCVS cannot impose these things. That would require new primary legislation (sic). The RCVS will not be able to require revalidation, so it has come up with an alternative system and hasn't [yet] fallen into the trap which is mimicry of the healthcare sector systems.

Re: Revalidation of GPs

Hannah Wynne Richards — Sat, 06 Mar 2010 10:45:20 GMT

I'm in favour of revalidation, have enrolled for the Cert AVP, but like Jonathan distrust the idea of academics examining experienced practitioners. The vast majority of them even in clinical departments have very little practice experience, in some cases none at all, so won't have the faintest idea of what actually constitutes a GOOD GP.

One of the reasons I like the Cert AVP is that for some modules the examiners/assesors are EXPERIENCED PRACTITIONERS

I am planning on spending most of this afternoon on a case history !!!!!!!!!!!!!!!!!!!!!!!

Wynne