5. Continuing professional development (CPD) March 2019

• 5.1. Myth: Only courses and conferences count as CPD
• 5.2. Myth: I must do an equal amount of CPD every year despite different circumstances
• 5.3. Myth: As a part-time GP, I only need to do part-time CPD
• 5.4. Myth: My CPD for each part of my scope of practice must be different
• 5.5. Myth: My supporting information from part of my scope of practice already discussed elsewhere should be presented again at my medical appraisal for revalidation
• 5.6. Myth: The GMC requires GPs to complete Basic Life Support and Safeguarding Level 3 training annually to revalidate successfully
• 5.7. Myth: I cannot claim any credits for a learning activity if I do not learn anything new
• 5.8. Myth: My appraiser will be impressed by my hundreds of credits
• 5.9. Myth: I must do 50 credits of CPD every year
• 5.10. Myth: I need 50 credits of clinical CPD every year
• 5.11. Myth: I must demonstrate 50 credits each year even if I have not been able to practise for much of the time
• 5.12. Myth: 50 credits is always enough CPD
• 5.13. Myth: I can stop learning and reflecting once I have reached 50 credits of CPD
• 5.14. Myth: There is a maximum number of credits I can claim for any one type of learning or one activity
• 5.15. Myth: I cannot include contractual training as part of my CPD
  

5.1. Myth: Only courses and conferences count as CPD

Continuing professional development (CPD) activities should be very broadly defined and include personal, opportunistic and experiential learning as well as activities targeted at identifying ‘unknown unknowns’. Any learning activity where you spend time learning something and deciding how it can be put into practice in your current, or proposed, work can be counted as CPD. You should only expend time and energy in documenting a sample of your most relevant and important learning.

The aim is to demonstrate a balance of learning across the curriculum relevant to your scope of practice over the five-year revalidation cycle. You should choose to demonstrate reflection on your most valuable learning events across a variety of learning. This is not just courses and conferences and may include:

• learning from cases, data, events and feedback
• personal reading and online research
• online modules
• professional conversations about clinical care
• everyday learning from your work and the experiences of others.

As there is so much learning in primary care that takes place in teams, you should demonstrate where this has led to important changes and developments.  It is also important, where possible, to demonstrate some learning with others outside the usual workplace to allow for external calibration of ideas and processes. For any learning activity, you need to reflect on what you have learned and any changes you have made (or not) as a result, but you only need to document and share your most valuable learning. Many GPs have been doing far too much and making the recording of their CPD disproportionate. Your documentation should not detract from your patient care, or family or leisure time.

5.2. Myth: I must do an equal amount of CPD every year despite different circumstances

You do not have to do the same amount of CPD every year. Your revalidation recommendation will be informed by a portfolio that will normally cover a five-year cycle. We recommend that you should learn from a wide variety of sources and ensure that you always keep up-to-date as part of normal professional practice.

You should view documentation of CPD as a selective process that must be kept reasonable and proportionate, documenting your reflection on your most important learning and any changes made as a result every year. Sometimes it is obvious that a major commitment, such as a postgraduate qualification, in one area of your scope of practice, will take up almost all your CPD time in one year. It is important to ensure that there is a spread from the GP curriculum over the five-year cycle if you are doing undifferentiated general practice. This may involve identifying and making up any gaps in your knowledge.

You should talk and work with your appraiser to ensure that the spread and variety of your CPD across the curricula for your scope of practice are documented. Your appraiser can help you to recognise gaps and document your CPD appropriately. They can also help you to plan to ensure that your portfolio covers the whole of your scope of practice over the five-year cycle.

5.3. Myth: As a part-time GP, I only need to do part-time CPD

When you are providing undifferentiated primary care, whether full-time or part-time, you cannot expect to demonstrate that you are up-to-date and fit to practise on part-time CPD. You need to cover the whole of the GP curriculum. The RCGP recommends that part-time GPs, who have less experiential learning to draw on, need at least the same amount of CPD as full-time GPs. It would be inappropriate for a doctor working one surgery a year as a GP to suggest that they could demonstrate that they were up-to-date for that role after completing only one credit of CPD relevant to such work.

5.4. Myth: My CPD for each part of my scope of practice must be different

Most doctors find some of their CPD appropriately demonstrates they are up-to-date in more than one part of their scope of practice. For example, the learning about diabetes done for a specialist interest role is likely to be applicable to a broader undifferentiated GP role. You can use the same CPD to demonstrate keeping up-to-date for all applicable roles.

If different organisations, in different parts of your scope of practice, have required training in common, such as Equality and Diversity training or Information Governance updates, an annual update in one organisation should be accepted by others. This avoids duplication which could take you away from clinical care. You should check with the organisations in which you work that your training will cover all your roles. Organisations should be prepared to accept equivalent learning and understand the importance of not taking doctors away from front line care.

It is the responsibility of individual GPs to check that the content of the training they undertake is appropriate to all their roles and to agree the equivalence with the organisations in which they work.

5.5. Myth: My supporting information from part of my scope of practice already discussed elsewhere should be presented again at my medical appraisal for revalidation

Some parts of your scope of practice may be subject to some form of local ‘appraisal’ or performance review. Where this happens, the RCGP recommends that your portfolio should include a signed-off summary of that appraisal discussion and outputs and your reflective notes on them, rather than the original supporting information. You should not be appraised twice on the same material but you should discuss your reflection on the outcomes of such a review at your main appraisal.  You should include appropriate contact details for the appraiser and relevant organisation for parts of your scope of practice appraised elsewhere. Your responsible officer can follow up on that part of your work if they need to. If part of your scope of practice is not appraised elsewhere, the GMC requires the six elements of supporting information and reflections about that part of your practice to be shared in the portfolio and discussed in the main medical appraisal for revalidation before a positive revalidation recommendation can be made.

5.6. Myth: The GMC requires GPs to complete Basic Life Support and Safeguarding Level 3 training annually to revalidate successfully

The GMC does not set any specific revalidation requirements in relation to CPD or specific types of training. The GMC’s requirements for revalidation are about maintaining your licence to practise as a doctor. You must demonstrate to the GMC that you are up-to-date and fit to practise as a doctor.

In many areas, responsible officers (ROs) have asked doctors to include additional training requirements in their portfolio of supporting information. This is to ensure that organisational requirements are understood by every doctor. This does not make them part of the GMC requirements for revalidation. It is important that you recognise the difference between the requirements for revalidation and training requirements for other purposes, and that your appraiser and RO do not allow the two to become confused.

The GP curriculum includes demonstrating competence in Basic Life Support and Safeguarding Level 3 training, so keeping these up-to-date is an RCGP recommendation, but not a GMC requirement. The organisations in which you work might set specific training requirements, or your inclusion on a performers list might require you to undertake specific training. These are not requirements for revalidation. You should be aware of any training required by your organisation, as well as any training required for inclusion on a performers list to ensure that you remain fit for purpose. The RCGP recommends that you demonstrate how you have covered the breadth of the GP curriculum over the five-year cycle to demonstrate fitness for purpose as a GP. Some doctors who qualified as GPs might demonstrate that they are up-to-date and fit to practise as a doctor, without being able to demonstrate that they are fit for purpose as a GP, if they are no longer in a GP role.

5.7. Myth: I cannot claim any credits for a learning activity if I do not learn anything new

When you have spent time undertaking a learning activity, it does not always result in learning something new. If it simply reinforces your existing knowledge and skills, and you discover that you are already up-to-date without learning anything new, you can still count your CPD credits for the time you have spent consolidating your knowledge or skills. You may also wish to provide a reflective note that explains that there are no changes that you need to make at the current time. This can be very reassuring and provide a confidence boost.

5.8. Myth: My appraiser will be impressed by my hundreds of credits

The GMC does not set any specific revalidation requirements in relation to CPD or training. You need to demonstrate that you have done sufficient relevant CPD to keep up-to-date at what you do in a proportionate way. Your appraiser will not be impressed if you have spent time that would be better spent on your patients, family or relaxation on documenting credits over and above the recommended amount. If you wish to demonstrate more than 50 credits it is your responsibility to ensure that the way that you record and demonstrate your CPD is proportionate and reasonable and does not become unduly time consuming. Your appraiser should be trained to challenge you to keep your documentation proportionate and make sure that your recording of your reflection is done in a way that is useful to you.

You should not expect your appraiser to review huge amounts of supporting information over and above what is required. Nor should you spend a disproportionate amount of time and effort on documenting your reflection on everything you learn throughout the year. Try to create sensible habits that make your documentation simple and streamlined and use the knowledge and skills of your appraiser to help you.

5.9. Myth: I must do 50 credits of CPD every year

The emphasis for CPD is on the quality of your reflection on what you have learned and the impact it has had on quality of care, not the quantity of credits documented. In fact, it is impossible to put a number on the credits that you need to do to keep up-to-date and fit to practise. The GMC requires you to do enough CPD to keep up-to-date across your whole scope of practice but they do not attempt to define or require a quantity.

We recommend that you demonstrate 50 credits for every twelve months in work with a spread across the GP curriculum over the five-year cycle if you are doing undifferentiated general practice. This recommendation can help you estimate what is right for you as an individual GP - but it is not a GMC requirement. If you demonstrate 50 credits, your portfolio is unlikely to need any additional scrutiny of your CPD. If you do not, then it is likely that your responsible officer (RO) will want to understand exactly why you believe that your CPD is sufficient to keep you up-to-date and fit to practise and the RCGP recommends that you provide a reflective note of explanation.

The recommendation that you undertake 50 CPD credits relates to the Academy of Medical Royal Colleges (AoMRC) recommendation for all doctors, bringing the RCGP into line with other specialties, to try to ensure that there is a level playing field for everyone. We recommend that those who have a restricted, or extended, scope of practice should discuss with their appraiser what constitutes sufficient CPD to keep up-to-date at what they do and to agree this with their RO if necessary.

For example, those who were historically GPs, but now have a very restricted role providing only family planning services, will follow the recommendations of the Faculty of Sexual and Reproductive Health (FSRH) for their CPD, to demonstrate that they are fully up-to-date across the whole of their practice. However, GPs who wish to remain entitled to undertake undifferentiated primary care sessions need to keep up-to-date across the whole of the GP curriculum.

5.10. Myth: I need 50 credits of clinical CPD every year

The RCGP recommends demonstrating 50 credits across the whole GP curriculum, which is much broader than purely clinical CPD. It has always been important to have a balance across the whole GP curriculum relevant to the work that you do.

5.11. Myth: I must demonstrate 50 credits each year even if I have not been able to practise for much of the time

If you have a prolonged career break in an appraisal period, for example due to maternity or sick leave, we recommend that you demonstrate CPD proportionate to your time in work. You should not be burdened with a double load of demonstrating CPD in the year when you return to work.

While you may choose to front load your CPD to be up-to-date and confident to return to work, this would not be appropriate for everyone. If you have a shortened appraisal interval, for example because you have pulled your appraisal forwards for organisational or personal reasons, you should demonstrate CPD proportionate to the time in work between your appraisals. The GMC requirements for revalidation remain constant whether the review period is three months in work or twelve, but the supporting information demonstrated should be proportionate to the time in work.

For example, if your appraisal is brought forward so that it is nine months after the previous one, then you should consider what supporting information is proportionate for a nine-month period in work. We recommend that you focus on making progress with your previous PDP, even if not all goals can be achieved, and that you document reflection on a proportionate number of credits of CPD as well as the other types of supporting information. Similarly, if an appraisal takes place more than twelve months after the previous one, the supporting information presented should be proportionate to the whole time spent in work between appraisals. You should discuss any question about what is appropriate and proportionate in advance with your appraiser and your responsible officer (RO) if necessary.

If it has been impossible for you to demonstrate all the GMC required supporting information before your revalidation recommendation due date, for good reason, then the RO has the option of deferring your revalidation recommendation. This gives you more time to collect the information you need. Deferral is a neutral act to enable you to maintain your licence to practise during the deferral period. For many doctors, a deferral decision gives them extra time - rather than trying to produce a disproportionate amount of supporting information in a shortened space of time after a period when they have not been able to work.

5.12. Myth: 50 credits is always enough CPD

The GMC requires you to do enough CPD to keep up-to-date across the whole of your scope of practice. This may require more, or less, than 50 credits depending on the scope of practice and your qualifications and experience in each area of work.

You should determine what is enough CPD for you to be up-to-date and fit to practise across all of your work. You should discuss this with your appraiser and, when necessary, get explicit agreement from your responsible officer that what you are doing is appropriate for your circumstances.

As an exception, if you have a complicated portfolio career and several roles to include, you may feel you need to demonstrate more than 50 credits to demonstrate reflection on appropriate CPD to keep up-to-date for each part of your work. You should keep the detailed documentation proportionate and reasonable. Most doctors find it easier to keep a learning log that builds up as they go through the year and this could amount to over 50 credits by the end of the year. If the documentation of your reflection has not been allowed to become disproportionate, you should be the one to decide what works for you.

The appraisal discussion should focus on the credits that reflect on the most valuable and representative learning. We recommend that you should reflect on the balance of your CPD and discuss it with your appraiser. If you are working as a GP providing undifferentiated primary care, we recommend that you demonstrate 50 credits of CPD relating to the breadth of the GP curriculum. Some elements of CPD are applicable across several roles and, where possible, you should avoid duplication.

5.13. Myth: I can stop learning and reflecting once I have reached 50 credits of CPD

No doctor should ever stop learning and reflecting on their practice if they want to keep up-to-date and stay safe.

You should not change your professional habits of learning and reflection, but you don’t need to document it all. You should focus on what has been particularly important or valuable to you over the course of the whole period being appraised.

5.14. Myth: There is a maximum number of credits I can claim for any one type of learning or one activity

We do not recommend any arbitrary limits to the number of credits that can be claimed by a doctor. The emphasis is on keeping the recording of reflection proportionate. You do not need to go on recording reflective notes once you have demonstrated that you are up-to-date and fit to practise.

It is not appropriate for appraisers to be unduly critical about the exact amount of time recorded, or credits claimed, as it creates tension where none is necessary. For example, most diplomas are hundreds of hours of learning, with direct impact on patient care, so setting an arbitrary limit to the amount of credits that can be claimed is not helpful, or proportionate. For you to spend time cutting down credits when you have done the learning and recorded your reflection is as disproportionate as spending time recording credits over and above those that are sufficient to demonstrate keeping up-to-date. GPs providing undifferentiated primary care need to have CPD that covers the GP curriculum over the five-year cycle. Documenting and evidencing hundreds of hours of learning from study for a diploma may not be enough CPD to demonstrate continued competence across the GP curriculum if you have not recorded any other CPD, as it might not cover your whole scope of practice.

We do not recommend an arbitrary limit for how much CPD can be attributed to one type of learning. It is possible to provide high quality reflective notes on 50 credits from just one type of learning that covers the whole scope of your practice. However, it is best practice to have supporting information about a variety of types of learning. To remain up-to-date across the whole scope of your work you should demonstrate:

• targeted structured learning aimed at addressing identified learning needs or your ‘unknown unknowns’
• opportunistic experiential learning from cases, data, events and feedback.

It is important to include evidence of learning with others to calibrate professional judgements and support team learning.

Doctors who do not have a breadth of variety of learning types or a significant proportion of learning with others should use their appraisal to discuss this. We recommend that you share a reflective note exploring why this is and what you plan to do to ensure that your practice remains mainstream and not isolated from peer support and review. If you have not included this type of reflection in the pre-appraisal documentation, you should discuss it during the appraisal. Your appraiser should document your reflection in the summary.

5.15. Myth: I cannot include contractual training as part of my CPD

We recommend that all learning activity should be eligible to be counted as CPD. It is important to reflect on contractual or required training, as it is required for good reason and part of being able to demonstrate that you are ‘fit for purpose’ in your role. The appraisal documentation is a good place to record when any mandatory training was completed. Because of the importance of being able to demonstrate compliance with this training in meeting contractual, or performers list, obligations, it may be appropriate to upload your certificates of attendance as well as any reflective notes.

If you have more than one part of your scope of practice with the same training requirements, for example, equality and diversity training, we recommend that you negotiate to ensure that the training that you do will meet the needs of all your roles. This avoids duplication of effort and the unnecessary burden of repeating the same training for different employers.