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Stage 2 Roadmap verification process

The portfolio tools, including WPBA are used to evidence capability in day-to-day practice in primary care and is based on the process undertaken by GP trainees. 

(For guidance re Stage 1 evidence.)

  • Ensure that the stage one and stage two checklists have been completed and signed by both the trainee FCP and the Roadmap Supervisor. 
  • The trainee FCP should have a discussion with their Roadmap Supervisor to decide if they agree readiness to seek verification.  
  • The verification form is a summary of the evidence in the portfolio –relating to Stage 2 - objective in nature. 
  • The trainee FCP will need to complete the FCP Verification Form. They should use the form to undertake a self-rating by linking a range of evidence to each capability heading (please see the example form) 
  • If they have enough evidence to demonstrate capability across all the headings, they can pass their portfolio to their Roadmap Supervisor for review, along with their self-ratings on the verification form.  
  • Throughout the verification form there should be a range of evidence - so COTs, CBDs, CEPs, CSR, Learning Log entries, MSF, PSQ, audit/QIP, tutorial record, etc.  Suggestion of 3 pieces of evidence per capability heading 
  • The Roadmap Supervisor must review the trainee FCP self-ratings and make their own rating either agreeing or disagreeing whether there is evidence of capability across all the headings. Further evidence should be linked by the Roadmap Supervisor. 
  • If the Roadmap Supervisor supports a rating of capable or excellent then the final page with declarations can be completed and process for recognition with the HEE Centre completed. 
  • The HEE Centre will audit a percentage of FCP applications for recognition, liaising with both the FCP & the Roadmap Supervisor
  • Stage 2 is to evidence the application of the trainees KSA of stage 1 in day-today practice and to demonstrate capability in primary care. 
  • The portfolio of evidence for stage 2 must use the portfolio tools in the framework otherwise the evidence will not be valid.  Each Roadmap has a table of requirements for stage 2. 
  • One learning log reflection a week by the trainee would build up evidence of application of knowledge and skills in everyday practice. Work-place based assessments (WPBA) provide an assessment of capability by a trained Roadmap supervisor. 
  • One COT & one CBD per month is stated in the roadmap and this should take an average of 45-60 minutes a month. These must be completed by a Roadmap Supervisor (as must CEPs assessments)
  • Feedback from patients/the public and the primary care team also provide evidence for your portfolio. The portfolio tools with guidance how to use them is included in the Roadmap appendices.
  • The Verification Form must be completed to show how the evidence in the portfolio demonstrates capability in primary care. The trainee undertakes a self-rating and links to the evidence in their portfolio. The Roadmap Supervisor then makes a rating and can add additional evidence. Examples of how to completes these forms are available on the resources page. 
  •  Once the FCP Verification Form has been completed by both the trainee FCP and Roadmap Supervisor, upon the successful completion of Stage 1 and Stage 2 of the Roadmap, both the trainee FCP and Roadmap Supervisor should complete the recognition survey links as detailed in the roadmap (Primary Care clinical level 7- FCP supervisor survey & FCP survey).
  •  HEE’s Centre for Advancing Practice are currently exploring the opportunity of issuing a digital badge for FCPs, however this is a novel concept for the NHS and is currently still under development. Once the process is available to us, HEE will contact all FCPs who have completed the survey with further information.
  • Following the launch of the CQC Mythbuster: Primary Care First Contact Practitioners (FCPs) colleagues in FCP roles in Primary Care are expected to have completed Stage 1 and Stage 2 of the Roadmap. This is illustrated by presenting your completed portfolio to your employer, including the signed ‘verification of evidence form’, as you would any other evidence of learning.

Roadmap supervisors

  • HEE recognised Roadmap Supervisors are being trained by HEE Roadmap National Trainers or are existing GP educational supervisors. 
  • As detailed in the roadmap each practitioners will require 2 workplace based assessments (WPBA) per month which will take on average a total of 45-60 minutes to complete both.  In addition to the WPBA there will be at least a daily debrief of approximately 20-30 minutes in length.
  • Some debrief can be done remotely if the ‘debriefer’ has access to the patient record – eg. phone/teams
  • Each full-time equivalent Roadmap supervisor can supervise up to four practitioners at a time.

Debriefing  

Debriefing is essential not only to ensure patient safety but also to provide specific and constructive feedback to the trainee. The debrief is an ideal opportunity to encourage complex clinical reasoning and reflection. The learning opportunities provided by debriefing should not be underestimated. Trainees are more likely to remember information when linked to a patient they have seen.

Whatever the style of feedback/debriefing, the aim is to have a conversation that is genuine, mutual, clear, and trusting. The conversation must also set out to understand personal and situational factors.  Human factors can influence practice enormously and should be recognised and acknowledged. For example, you may behave differently if you're running late; if you are feeling stressed; if the computer is running slowly; if patients behaviour is challenging.

Here are some ideas to help you debrief. This is NOT a script just ideas to get you going.

Ask the trainee to talk through the consultation, including the history, data gathering, examination and clinical management plans.  Ask questions:

  • How did you gather the history, what questions did you ask?
  • How did you assess for any red flags?
  • What examination did you undertake and why ('show me how' for junior trainees)?
  • How did you make your decisions?
  • What were you thinking?
  • Why do you think you made that decision?
  • What different decisions might you have made, and on what basis?
  • Let us discuss similar and variant cases.
  • How do you think the patient/care/relative felt?

Ask the trainees about their strengths and points for improvement

  • What were you happy with?
  • What went well and why?
  • What were you not happy with?
  • What would/could you do differently next time?
  • How did that make you feel?
  • So, in summary

Provide the trainees with some feedback regarding their strengths and points for improvement:

  • … was good/excellent
  • I liked.....
  • Maybe you need to improve or to consider, or to do differently…
  • What about trying/thinking...
  • Has this identified any learning needs?
  • So, to sum up…

Please check documentation and read coding has been done appropriately.

Further useful question suggestions

  • I see that you… What was your intention then?
  • How was that compared to last time?
  • What was different?
  • I am concerned that… How does that sound to you?
  • How did it go with the team?
  • I am interested to know how you are getting on with…
  • I am getting worried that you may be… Is that a possibility do you think?
  • I think… How do you see it?
  • So, how will you proceed now to increase your flexibility/speed of response/team communication?
  • What other questions does this raise for you/the team?
  • So, what have we discussed?

Obviously when debriefing we have a finite amount of time so you will need to select the things you wish to discuss in more detail. Any learning needs should be identified and then the trainee can address these through self-directed study, a tutorial, shadowing etc.

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