Outstanding Questions

What’s the difference / interaction between revalidation and concerns?

AP

Concerns must be considered as part of a revalidation recommendation. So the responsible officer (dean) recommends whether a trainee should be revalidated based on any concerns, a review of the ARCP history and the form R (trainee self declaration). Concerns could come from a number of sources e.g patient complaint.

GMC integration - what does this look like, what does it do and how is it maintained?

AP

We have to send recommendations to the GMC. Revalidate, Defer or Non-Engagement. currently through an API with GMC connect

[IO] Are there any issues with this integration and/or are there other considerations for building something new?

there are some GMC driven changes that are upcoming so yes. Have sent doc to Ify.

[AN] I understand from @Mark Jackson (Unlicensed) that there are some other technical issues with the GMC API (the new one), that may mean we need to do some post-processing once we’ve called the API

What specifically is reviewed by Reval Admin? What are the recommendations?

AP

Revalidate if everything is in order.

Deferral is usually to line the dates up with an ARCP or if the trainee is OOP on mat leave etc.

Non Engagement basically never used as the trainee would be contacted before it reaches this stage.

[IO] do the rules around these recommendations need to be automated / verified in any way? If so, where can we find the business rules?

No it’s all based on the review of the information by the admin. The reval portal was designed to collate these pieces of information together. We have ARCP history on TIS already so that is the only bit that is really working. Concerns log was never really used so we need to understand why and how we can change that while the form R is going to be part of the functionality in trainee UI so we will be able to link that up.

Does the GMC ever query a recommendation?

AP

My understanding is it’s very rare but there is a process of approval.

[IO] will the SMEs have this available, or can you point me to it? @Alistair Pringle (Unlicensed)

What is the snapshot of the GMC outcome? How is it added to TIS?

AP

the recommendation is a point in time so the snapshot shows what data was available to the user when they made the recommendation.

[IO] what format is it provided in and how is it appended to Reval details?

Is receiving trainees to be revalidated from GMC consistently an automated process? What happens if the integration fails, how is Admin notified, what’s the mitigation? (Also see 11)

What are the rules/parameters that are in place for managing the Reval process? Deadlines, communications, other?

AP

The revalidation window is 3 months every 5 years where the GMC must receive a recommendation in this period.

[IO] if it’s not received, what happens?

The GMC follow up with our teams in an annual compliance report, but SMEs will have the detail.

What does CDC refer to?

Paul

If you’re referring Change Data Capture, it’s a system that captures changes to records in the database and pushes them to a destination.

What we’ve done for the ESR project is capture all DB changes and feed it to our messaging system so that any service can listen for change events

When does the requirement for Reval kick in?

IO

1 year post Foundation year + full registration with GMC (payment made)

How are fully qualified doctors revalidated? Same process, managed by HEE and at what point does it stop being managed by HEE?

AP

When trainee gets CCT and is no longer a trainee.

[AN] Where are fully certified Doctors revalidated - direct on GMC Connect, I guess? We only concern ourselves with Trainees? If I haven’t got the wrong end of the stick, is this ‘other’ reval process not something we’d like to parallel?

Is 3 month lead time still valid, is there a range, or is it always this period? What does the GMC pre-notification look like? How is the start date calculated - no of days + full registration date? What if no notification is received for someone who should be Reval’d imminently? (Also see 6)

AP

3 months still valid as far as is known. Not sure of exact calculation.

[IO] to be confirmed with stakeholders

Who assigns Reval Admin? Do they manage from end to end? Are there dual-duties? i.e. do they need access to the rest of TIS for other points/during the Reval process?

AP

Depends on the team. London have more generalised admins compared to more specialised in other offices.

[IO] to be confirmed with Stakeholders

Whats “Ready to review” as a status, and how is it different to “Ready to submit”?

AP

allows admins to take laptop to review their recommendations with the RO if desired and move them over into ‘ready to submit’

Is Reval status captured separately to Recommendation status, or are they part of a single flow?

AP

unsure of question

[IO] can I clarify what all the statuses are for Revalidation and the order in which they can be applied + triggers? @Alistair Pringle (Unlicensed) so you’re ‘under notice’ when you’re in the 3 month window. And then you’re either deferred, or revalidated or waiting one or the other. There is a marker to indicate that the GMC decision is pending.

Is the GMC outcome final, can it be updated within a timeframe for a particular Reval cycle? If so, how will TIS be notified this has happened?

AP

I assume local reval teams have contacts at the GMC to support edge cases/issues.

[IO] to be confirmed w/Stakeholders

Connection discrepancies? Remind me what these are…

AP

Trainees must be allocated to the correct designated body. Designated Bodies run on the same lines as local offices. Each has a responsible officer who is a Dean. Trainees can go onto GMC connect and connect themselves to a DB. They often do this incorrectly so we developed a tool that is supposed to recommend actions to the admin.

For example if a trainee is in a programme at EOE on TIS but is connected to the NW DB then it should highlight that as being incorrect.

[IO] So should this sit as part of revalidation, or somewhere else?

Yes sorry the whole point of being connected is so you have the correct RO for your revalidation so it’s all part of reval

[AN] is there associated work here to validate the Trainee assigning the correct Designated Body? I.e. working with the GMC, and/or validating the data we pull from the GMC before processing it?

How does HEE ARR (reporting) factor into this process?

AP

?

[IO] There is a page on reporting here, is this still a valid requirement and is it solely related to Revalidation? Is this related to your comments about sending data to NDW? Yes send data to NDW and also ask admins about reports to the regulator of which i believe there is at least 1 annual report.

What’s the difference between Deferral and Amending submission date?

AP

Amend submission date is bringing the date forward in line with a final ARCP usually.

Deferral is moving the date out and requires a formal submission . When we developed Reval in TIS, there was no API for bringing forward submission date so users still have to use GMC connect for this.

[IO] are users the Admins in this process, or trainees?

Admins

Archiving - there’s a page on Confluence with no content - is this a valid requirement or has the page been created in error? https://hee-tis.atlassian.net/wiki/pages/createpage.action?spaceKey=NTCS&title=Revalidation%20archiving&linkCreation=true&fromPageId=1496613100

 Still a valid requirement.

Are the roles involved in the process the same - TIS Admin, Reval Admin, RO & GMC? Any others? What are associated permissions?

AP

Reval admin is same as normal admin but with reval perms. We do have a role that only allows observation/administering a recommendation but does not allow a submission through the API.

How does RO participate in this process?

AP

Some delegate all responsibility to admins, others take a more direct approach.

Whats the purpose of concerns log, how is it used and when? Breakdown of components of this?

AP

Rarely used because people were concerned about the sensitivity of the concerns I believe. Most teams probably keep this info on a spreadsheet.

[IO] so possible this does not need to be included in Reval, but need to explore what the specific worries are about data security and how they can be mitigated

Yes

What does the outcome determine for the doctor? i.e. what do the outcomes mean?

AP

MJ

If you’re not revalidated you’re not eligible to practice as a Doctor as it’s like an MOT

[IO] can you point me to the full list of outcomes please? @Alistair Pringle (Unlicensed) / @Ashley Ransoo

Based on Prod data:

The statuses a doctor being revalidated goes through on TIS:

Open

Proposed statuses for revalidation submitted from TIS after admin review:

Open

GMC confirmed statuses passed back to TIS after submitting a recommendation:

 Outcomes from ARCP:

See https://lasepgmdesupport.hee.nhs.uk/support/solutions/articles/7000021950-what-does-each-arcp-outcome-mean-

1 Satisfactory (on going training)

2 Focus on specific areas required

3 Inadequate progress – Additional training time required

4 Resignation, death etc (NTN terminated)

5 Missing evidence

6 6a. Gained all required competencies for the programme (clinical)

6b. Gained all required competencies for the programme (academic)

6c. Gained all required competencies for the programme (non-clinical)

7 7.1 Satisfactory progress in or completion of the LAT / FTSTA placement

7.2 Development of specific competences required – additional training time not required

7.3 Inadequate progress by the trainee – additional training time

7.4 Incomplete evidence presented – LAT / FTSTA placement

8 Out of programme for clinical experience, research or a career break (OOPE/OOPR/OOPC)

9 9.1 Satisfactory progress in or completion of post-CCST training

9.2 Development of specific competencies required- additional training time not required

9.3 Inadequate progress by the trainee- additional training time required

9.4 Incomplete evidence presented

Can outcomes be appealed, if so what are the holding states that need to be considered? What’s the appeal process, timeline etc?

I’m not sure, I’ve not come across this.

What scenarios is the “non-engagement” recommendation used in? @Ashley Ransoo

From the GMC (see below), certain criteria have to be met to reach to that stage and as you can see, the numbers from prod quite low (6):

https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/making-a-recommendation-about-a-doctors-revalidation/recommendations-of-non-engagement

Is there a need to bulk revalidate, if so what would that process look like?

MJ

There needs to be a mechanism to submit multiple revalidations in one go to GMC

For pre-live environments TIS can't use live GMC data, so a GMC Sync is mocked with a Springboot application called GMC Connect, serving up SOAP responses for pre-live environments (https://github.com/Health-Education-England/TIS-GMC-CONNECT - You don't have permissions to view Try another account ) Note: this is the same name as the GMC provided user interface, also called GMC Connect, which could cause confusion

Does the GMC SYNC ETL populate Connection Discrepancies ES?

What happens to Connection Discrepancy ES indexes when a user add or remove a doctor from a Designated body? (when TryAddDoctor() or TryRemoveDoctor() are called from GMC Connect API?

Does GMC SYNC only pushes indexes to Connection Discrepancies ES and that data then syncs with Connection Disc. MySQL DB? Are there any other interactions between GMC SYNC and Connection Discrepancies? 

There is an assumption that when a recommendation is submitted to GMC, it may not come back straight away with an Approved status. At what intervals/frequency does the CheckRecommendationStatus() gets called from the GMC API in order to update the status on TIS Revalidation? 

Does the REVALIDATION ETL use GMC No. from Revalidation ES Indexes to identify Person records using the TCS Service? 
Or does it Retrieve GMC No. from the Profile Service?

Does the RV Officer role need to be refactored to allow for multiples per Local Office/Designated Body? Currently, you are able to assign it to multiples per LO via user management and make the application to error for an RO in a non-user friendly way.

AR

No. There should legally always be 1 RV officer per Local Office/Designated body who has the ability to delegate the responsibility for reviewing and providing recommendations on their behalf.

The RV Officer role has been removed from User management so as to avoid this happening. They can only be amended for a Local Office from the BE on an on-request basis.

Concerns and revalidation are split into 2 separate processors

In future we should merge these 2 separate ETL processors from gmc-sync into tis-new-core etl jobs so that all etls will run as part of single application and single docker container. (c.f. TSNR-657

• Update GMC-SYNC for syncing MySQL data and split concerns, revalidation processing 

DONE)

Is this still an outstanding piece of work? Does this provide any value?

Submitted to GMC is limited by date - you will only see 4-month-old data. Is this accurate? Can this be confirmed by looking at the code?

Notification Service is turned off - Is this a correct assumption?

There is not enough or No FE and BE End-To-End tests to test the revalidation app if we were to re-build, preserving the end user behavior/journeys but refactor the internals?

How long does the GMC review / respond stage take and are there multiple updates that can be made?