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GPwER Dermatology and Skin Surgery

The Royal College of General Practioners (RCGP) have published a framework for Dermatology and Skin Surgery in collaboration with the British Association of Dermatologists (BAD) and the Primary Care Dermatology Society (PCDS)  in the context of the College’s new generic framework for GPwERs and the implementation of a new national dermatology accreditation process, which will be overseen will be administered by the BAD.

The dermatology framework replaces the 2011 Department of Health Guidelines for General Practitioners with a Special Interest (GPwSI) in Dermatology and Skin Surgery and includes and reflects up to date and current national guidance.

The accreditation process is for new GPwERs and also the transition of current GPwSIs.

The guidance and competences for GPs with Extended Roles (GPwERs) for Dermatology and Skin Surgery includes the curriculum and core competences required to be accredited as a GPwER in Dermatology and Skin Surgery. 

Candidates are now able to access and download all the information required to submit evidence to be assessed by a trained generalist and specialist assessor and validated by the BAD Dermatology and Skin Surgery accreditation panel as below.

You can view the general framework at RCGP here: 

GPwER generic framework

Please view below for the Dermatology and Skin Surgery Framework and information about how to apply for Dermatology and Skin Surgery accreditation here:

Dermatology and Skin Surgery Framework 

 

Guidance for Clinical Supervisors

Introduction

Clinical supervisors (CS) are required to support the training of candidates and to assess relevant competencies. It is preferable, although not always possible, to have more than one clinical supervisor for any given candidate.

Definitions

  • clinical supervisor (CS) is a pre-accreditation supervising peer, who may be a specialist in the relevant extended role or another health professional supervising within their sphere of competence.
  • senior clinical supervisor's (SCS) is a senior health care professional who is required to complete the clinical supervisors report as part of the accreditation process. A SCS can also act as a CS. It is expected that a SCS would be a consultant or RCGP accredited GPwER working in the same scope of practice as the candidate. In exceptional circumstances (for example, there is no recognised local SCS) a candidate may suggest a different individual to take on the role of the SCS, this must be proposed by the candidate in the pre-accreditation phase and then considered by the GPwER accreditation team. If the proposal is accepted then the candidate can proceed with training and accreditation.

Guidelines

A CS needs to be familiar with the relevant guidelines:

Candidate training

At the start of the training process a CS needs to meet with the candidate to identify learning requirements and how these can best be achieved - it may be helpful to do an 'interim' clinical supervisor's report to aid in this assessment. 

Assessment tools

A CS needs to:

  • Be familiar with the assessment tools required for accreditation. These include Mini-CEX and DOPS (direct observation of practical procedures), and a log diary used for case-based discussion and continuous professional development
  • Discuss the results of a patient survey and any audit undertaken with the candidate
  • Provide a clinical supervisor's report towards the end of the training/assessment period (this must be undertaken by a SCS)

 All the relevant tools and other supporting documents used by the candidates can be found on the GPwER accreditation section of the RCGP website. 

Assessment notes

The following notes are intended to support the effective use of the assessment tools (and other supporting documents):

  • The assessments should be performed by suitably trained CSs, having experience of the use of the appropriate assessment tool
  • The CS should be regularly undertaking the activity/skill being assessed and be appropriate to the assessment wherever possible more than one CS should be involved in the assessment process 
  • It is strongly recommended that a series of appropriate clinical assessments including mini-CEX and DOPS (where appropriate) take place at reasonable time intervals until competency has been demonstrated during the training period prior to accreditation
  • The CS is expected to be present throughout the session and to make assessments, covering different clinical domains, from several patient interactions 
  • Several mini-CEXs covering different areas are expected to be performed during each of the clinical assessment sessions
  • While the gold standard should be assessments performed while a patient is in clinic, there may be occasions when it is acceptable to use photographs of a patient or other images (for example, from the internet) for case discussion – in the former this scenario could arise if a candidate has seen a relevant case in a different clinical setting, in the latter this scenario could arise if the condition assessed is seen infrequently in the clinical setting in which the candidate is based. All relevant images must be treated as sensitive personal data and therefore appropriately redacted as well as stored and transmitted securely
  • For most of the assessments the outcome will be 'satisfactory' or 'unsatisfactory'. Time will be allocated for feedback. If a candidate is marked as unsatisfactory a relevant comment should be provided, similarly if a candidate is marked as satisfactory but performs well this should also be commented on
  • It is recommended that one of the assessments should include a review of case notes and, for those offering a surgical service, a review of histology reports (to consider appropriateness of procedure, completeness of excision etc)
  • Learning diary – candidates will keep a learning diary, which is an ongoing process that can be used for case-based discussion (including MDT meetings), CPD, and other competences that are not included but desirable 
  • As a post evolves and develops into new clinical areas following accreditation for a particular role, further assessments may be required to demonstrate new competences appropriate to a changing role.

Resubmission

Once a candidate has submitted their documents to the BAD accreditation office they will be marked by two assessors, one a consultant dermatologist, and the other a GPwER. If the assessors mark any sections of the portfolio document as borderline or unacceptable then further information will be requested. The candidate will have three months to submit further evidence for a borderline (minor) issue and six months for an unacceptable (major) issue, the later may require a further period of training. 

Panel assessment

The assessors will pass the marked portfolio of assessment and supporting documents to the BAD accreditation panel to give a final decision on whether the candidate is suitable for accreditation. Successful candidates will be provided with a certificate. If the candidate is not successful there is an appeal process.

Post-accreditation

GPwER will need ongoing support from a clinical guide, defined as a post-accreditation peer, usually the specialist (consultant or accredited GPwER) who undertakes the annual performance development review, which forms part of the whole scope annual appraisal. The clinical guide is likely to have been one of the CSs involved in the training and assessment during the accreditation process. The accredited GPwER is expected to work alongside the clinical guide at least once a month. 

 

Guidance for commissioners and appraisers

  • The RCGP Framework for GPs with Extended Roles (GPwER) defines what a GPwER is and provides a generic set of principles to underpin the governance of General Practitioners, regardless of the setting in which they work. 
  • The process of GPwER accreditation is about the individual and not the service. It is the responsibility of commissioning organisation to make sure that the service and premises meet the required standards, and ultimately decide whether a GP is competent to deliver an extended role. For more information refer to the 2018 RCGP Guidelines for Dermatology and Skin Surgery.
  • For DES/LES (and other) models of skin surgery please refer to the relevant FAQ.
  • Successful candidates will be provided with one of the following  certificates:
    • Group 1 – GPwER in General Dermatology (the diagnosis and management of inflammatory skin disease, the diagnosis of skin lesions, and the non-surgical management of pre-cancerous lesions  and low-risk basal cell carcinoma)
    • Group 2 – Skin lesion management (the diagnosis and management of skin lesions, including low-risk BCC, using both surgical and non-surgical techniques)
    • Group 3 – Combines groups 1 and 2

The management of suspected melanoma, squamous cell carcinoma, and high-risk basal cell carcinoma sit outside of the remit of GPwER work, and should be managed only in consultant-led clinics. 

  • Maintaining good medical practice
    • Successful candidates are expected to work at least one session a month with their clinical guide (consultant or RCGP accredited GPwER)
    • Under the new RCGP framework, accredited GPwERs no longer require reaccreditation; the RCGP now advises that they participate in an annual speciality performance review carried out by their clinical guide, which should be fed in to the whole scope annual appraisal document (to be discussed at their annual medical appraisal)

 

More information on Post Accreditation on the RCGP website.

Annual appraisal and revalidation 

The evidence that a GPwER is keeping the requisite knowledge and skills up to date and maintaining their competencies should be reviewed through the doctor's annual whole scope of practice appraisal. This replaces the former process of re-accreditation for GPwSIs. 

It is recommended that GPwERs participate in an annual speciality performance review that satisfies the following criteria:

  • It is best practice to include a clear description of the governance arrangements for the service being provided as a GPwER and reflective note on how the individual would respond to patient safety issues or concerns
  • Documentation demonstrating that the required competencies in the specialty specific framework for the GPwER role have been maintained, or improved, with evidence and reflection on:

a.      Continuing Professional Development (CPD)

b.      Quality Improvement Activity (QIA)

c.      Significant Events

d.      Patient feedback

e.      Colleague feedback

f.       Complaints and compliments

  • Specialty specific personal development plans 

Where possible the annual specialty performance review should be carried out by a clinical guide (a specialist working in the relevant extended role area, for example the main clinical supervisor involved in accreditation), who should also provide a structured reference. Once complete, the relevant documents should be uploaded to the GPwER’s appraisal portfolio for review as part of the whole scope annual appraisal. 

The Responsible Officer will need to be assured that the governance arrangements are robust enough to provide timely information about any concerns about the GPwER at any point in the revalidation cycle, and an assurance that there are no outstanding concerns in the period preceding the revalidation recommendation. 

 

Information for GPwER applicants

Competences and Eligibility for Accreditation

Accreditation Process and Supporting Documents

 

Forms

New GPwER Group 1

New GPwER Group 2

New GPwER Group 3

GPwSI previously accredited against DH 2007/2011 guidelines

Portfolio of evidence submission  form [Word]
(includes monitoring form, and  declarations)

Y

 Y

 Y

 Y

Evidence of former successful  accreditation through an appropriate  body (for example a Deanery, clinical  commissioning group, primary care trust)

 N

 N

 N

 Y

Form 1 Mini-CEX skin lesions [Word]

 Y

 Y

 Y

 N

Form 2 - Mini-CEX for inflammatory  dermatoses [Word] 

 Y

 N

 Y

 N

Form 3a – DOPS [Word]
 

Y

(candidates carrying out biopsies)

N

(candidates not carrying out biopsies) 

 N

 Y

 N

Form 3b - DOPS [Word]
(where applicable)

 N

 Y

 Y

 N

Form 4 - Learning diary [Word]

 Y

 Y

 Y

 N

Form 5a - Patient survey - guidance,  results and declaration [Word]

 Y

 Y

 Y

 Y

Form 5b - Patient survey  questionnaire [Word]

 Y

 Y

 Y

 Y

Form 5c - Patient survey data entry  tool [Excel] (optional)

 

 

 

 

Form 6 - Audit guidance [Word] Groups  2 & 3)
We are now providing a template for  audits. We ask all candidates to use  this from now on.

 N

 Y

 Y

 Y (2,3 only)

RCGP skin surgery audit - data  collection log [Word]

 N

 Y

 Y

 Y (2,3 only)

Form 7a - Clinical supervisor report –  new candidates [Word]

 Y

 Y

Y

 N

Form 7b - Clinical supervisor report –  transition candidates [Word]

 N

 N

 N

 Y

Unsupported applicant form [Word] 
(if applicable)

 Y

 Y

 Y

 Y

 

GPwER FAQs

1) What is the eligibility criteria for GPwER Dermatology and Skin Surgery accreditation?

In addition to the speciality criteria the candidate must meet the following requirements:

  • provide evidence of Certificate of Completion of Training (CCT) or equivalent in general practice
  • to be actively working in General Practice and be registered on a performers list (or equivalent) 
  • undertake an annual medical (whole scope of practice) appraisal 
  • provide evidence of GMC registration  
  • to have undertaken at least 40 core (undifferentiated) general practice sessions in the 12 months prior to application (please contact the team if you wish to apply for accreditation but are unable to meet this requirement)

Please also refer to the GPwER Terms and Conditions [PDF], section 2.

 

2) Do I need to be nationally accredited to be a GPwER in Dermatology and Skin Surgery

National Accreditation of a GPwER in Dermatology and Skin Surgery is deemed as best practice and is supported by the Royal College of General Practitioners, the British Association of Dermatologists, the Primary Care Dermatology Society, NHS England, and patient groups,  with interest from the GMC in the context of their developing credentialing proposals. There are many benefits to RCGP accreditation to the individual GPwER, which include:

  • It enables GPs to demonstrate competence against a national standard, including some GPwSIs who have not had the opportunity to accredit against national guidelines.
  • The accreditation is portable, meaning that a GP should not need to re-accredit if they move to a different geographical area.
  • In accordance with the RCGP's generic GPwER framework, GPwERs accredited through the RCGP only have to go through the process once, avoiding the need for re-accreditation.
  • GPwERs accredited through the RCGP process can act as clinical supervisors and train/mentor other GPs wanting to become a GPwER.
  • It is likely that GPwERs accredited through the new process will be better recognised by defence unions.

 

3) Is the accreditation applicable to those delivering minor skin surgery through a Local Enhanced Service (LES) or Directed Enhanced Service (DES) contract?

There are significant differences between a GP providing a commissioned skin surgery / minor surgery service (such as under a DES or LES contract) and a GPwER:

GPs providing surgical services - manage benign skin lesions and small low-risk BCC beneath the clavicle. They are first and foremost surgical services. GPs would be expected to have an understanding of lesion recognition appropriate to their surgical remit but they have not undertaken specialist training and competency based assessment in skin lesion recognition and management. In essence, skin surgery services such as DES or LES only cover clinical remits that are within the normal scope of General Practice; as such the RCGP does not consider that such roles warrant extended role accreditation. It remains good practice to make certain that the premises used are fit for purpose, and that the GP has their surgical competencies assessed (for example using a Direct Observation of Practical Procedure assessment tool) and periodically reviews their quality of their care.

GPwERs – work as an integrated team with commissioned secondary care services. GPwERs have undertaken formal specialist training and assessment in the diagnosis (clinical and dermoscopic) of skin lesions, enabling the GPwER to be commissioned to provide skin lesion clinics (excluding 2-week waits). Groups 2 and 3 GPwER can also provide surgical services with a wider remit, which may include certain BCC on the head and neck (refer to Annex C in the 2018 RCGP framework Guidance and Competencies for GPwER – Dermatology and Skin Surgery). The remit described is broad and so formal accreditation is required.

 

4) As a Group 2 GPwER in Skin Lesion Management do I have to manage basal cell carcinomas as part of my clinical remit?

Most Group 2 GPwERs manage basal cell carcinomas as part of their clinical remit, but this is not mandatory. A few Group 2 GPwERs diagnose skin lesions but surgically only manage the benign lesions.

5) How much general practice do I need to do to be accredited as a GPwER?

The BAD and RCGP's position is that a GPwER is first and foremost a GP with a UK licence to practise, and practising in a primary care role. Such GPs bring important additional skills in practising holistically and dealing with complexity and uncertainty to extended roles. Therefore, for the purposes of accreditation, the candidate is required to demonstrate they have undertaken at least 40 core (undifferentiated) GP sessions in the 12 months leading up to accreditation. The figure of 40 sessions has been chosen because it is recognised by the RCGP, BMA and NHS England as a threshold for a low volume of work. The RCGP recognises there are exceptional circumstances and therefore if a GP wishes to apply for accreditation but can't meet this requirement, they are encouraged to contact the GPwER office to discuss their particular circumstances.

 

6) As somebody seeking accreditation for the first time, can my pre-CCT clinical training count towards my accreditation?

Yes, you can use evidence from your Foundation Year 2 or, if applicable, any relevant specialty training undertaken prior to GP Specialty Training within the five years prior to accreditation

 

7) I have completed a diploma in dermatology, how do I get experience in a clinic?

We suggest that in the first instance you approach your nearby dermatology services (hospital and/or community) to ask if they are willing to take you on and support your dermatology training. You can also contact your Clinical Commissioning Group, or equivalent in devolved countries, to find out if there are any existing GPwER services in your locality, or plans to develop such services.

 

8) What happens if I can't identify a local Clinical Supervisor to support my application?

An unsupported applicant refers to an individual who has no local senior clinical supervisor and so is unable to progress with accreditation. This situation may arise for a GPwSI seeking transition to GPwER status, or a first-time applicant who has not been a GPwSI. 

A senior clinical supervisor can be any of the following:

  • A consultant dermatologist
  • An RCGP accredited GPwER&
  • Another consultant working in the same scope of practice, for example a consultant plastic surgeon for Group 2 GPwERs

If there are no such individuals within a respectable commuting distance and there is real patient need to develop a local dermatology/skin surgery service, then in exceptional circumstances the RCGP may consider accreditation of a candidate by other means, for example, an associate specialist in the relevant scope of work could be considered as the senior clinical supervisor, or the use of teledermatology. Individuals in this predicament should complete the Unsupported Candidate Form [Word] and email it to the accreditation office for consideration by the GPwER panel (comprised of a GPwER, consultant dermatologist and lay member). If the panel accept the proposal then the individual can proceed with the accreditation process. The panel will not review the document unless all the relevant sections are complete.

The BAD is unable to advise on issues where local senior clinical supervisors are unable/unwilling to support the accreditation of GPwERs. In such circumstances please contact the relevant organisations such as the Primary Care Dermatology Society.

 

9) Do I need a Diploma in Dermatology?

It is advantageous (especially for Groups 1 and 3 GPwERs) but not essential if you can clearly demonstrate other ways in which you have gained relevant knowledge in your extended scope of practice. There are a number of helpful learning resources including the RCGP Dermatology Educational Library, the Primary Care Dermatology Society website and the British Association of Dermatologists website

 

10) Is there 'grandfathering' of GPwSIs into the GPwER process?

No, there is no grandfathering of GPwSI. All candidates will need to demonstrate the required standard of competence, as defined by the RCGP in collaboration with the BAD and PCDS, through the submission of a portfolio of supporting information. However, the process for candidates who can demonstrate previous accreditation by a reputable body using the 2007 and 2011 guidance is very much simplified, for example candidates are required to provide a supporting statement from an appropriate clinical colleague, rather than repeat clinical assessments such as DOPS and mini-CEX.

Please refer to the 2018 Guidelines for GPwER in Dermatology and Skin Surgery [PDF] for more information.

 

11) Is the accreditation available to GPs outside of England?

The original Dermatology and Skin Surgery accreditation trial (due to external funding conditions) was restricted to GPs on the NHS England performers list.

The RCGP's Generic Framework to Support the Governance of GPs with Extended Roles and associated specialty frameworks are intended to be applicable to the four countries of the UK, and the BAD College of Dermatology is committed to making its dermatology accreditation process available to all UK-based GPs, regardless of the country in which they are based or the sector in which they work.

 

12) How much does the accreditation cost?

From September 2021 the cost of accreditation will be £850 per candidate. This fee includes one free resubmission.

Candidates who have been previously accredited (see FAQ 9) are eligible to submit a reduced portfolio. Payment is accepted via BACS or credit card. Please contact Khadeeja Kanth via gpwer@bad.org.uk for more information. 

 

13) How long does it take to become a GPwER in Dermatology and Skin Surgery?

There is no set time or required number of specialist clinics that a GP needs to partake in as part of the accreditation process. The outcome is based on competencies, and other attributes of the GPs performance that enables the GP to demonstrate that they are capable of practising autonomously in a specialist area of medicine.

 

14) How many patient feedback responses are required for GPwER accreditation?

For the purposes of accreditation, candidates are required to reflect on responses from 25 candidates. Further information can be found on the Patient survey guidance document [Word].

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