On attempting to write an article that encapsulates the evolution of the ICGP Professional Competence Scheme (PCS) over the last five years, I had to stop and think what it was like when this was first introduced, because as time moves on one easily forgets that there was a beginning. I will focus on a couple of key examples to demonstrate what resources were put in place to facilitate GPs to enrol and engage in activities for their maintenance of professional competence. 

As we operate the PCS under arrangement with the Medical Council, we are not permitted to use the PCS data in a public arena so this does limit, to a degree, the information that can be contained in this article. I acknowledge that the schemes are still in their infancy; however I can confidently report that those enrolled on the ICGP scheme have demonstrated a continued commitment to their ongoing professional development.  

The regulatory framework

The ICGP operates a professional competence scheme under arrangement with the Medical Council, in accordance to Section 91(4)(a) of the Medical Practitioners Act  (MPA) 2007. When this section of the Act became enacted, in May 2011, the PCS scheme framework had been defined and each of the postgraduate medical training bodies was contracted to operate a scheme. Ultimately, the Medical Council defined the PCS requirements and the postgraduate medical training bodies’ responsibility was to provide a supportive, collegiate, professional development environment to facilitate GPs’ enrolment, engagement in and recording of continuing professional development (CPD) activities. 

As with any new major development this presented a huge learning curve for our College, GPs and even the Medical Council. Our ongoing aim over the past five years has been to provide accurate information and quality supports to all ICGP PCS enrollees to ensure that they are well informed in relation to their requirements. We also strive to make the process of achieving, recording and monitoring requirements as streamlined and user-friendly as possible. The uptake of the PCS requirements by GPs is commendable.

2011 – the beginning

Significant resources were required to establish and maintain the systems and supports required to implement and operate a PCS. The ICGP approached the implementation of the scheme very strategically and acknowledged upfront that this would present challenges, especially for GPs. There was an immediate appreciation that time was required for GPs to familiarise themselves with the new requirements and systems, that merely formalises the recording of activities in which they have already been involved. The exception to this was the inclusion of an audit requirement, which was less practised as a CPD activity.  

The development of the operating systems to facilitate the enrolment and recording of PCD activity were driven by Kieran Ryan, Angela O’Byrne, Margaret O’Riordan, Claire Collins and Maureen Dempsey in the College in the lead up to the schemes becoming live on May 1, 2011. Their foresight and dedication to this task resulted in systems and processes that, with minor enhancements, have served us well through the years.

ePortfolio and help desk

The systems established to support GPs with engaging in this mandatory process were also very carefully considered.  A bespoke ePortfolio for recording CPD and a dedicated help desk were instrumental in supporting GPs with initially enrolling on and understanding the new Medical Council requirements. The help desk receives over 2,000 calls and emails each year; initially this would have been around 4,000, and the PCS webpage has the highest number of hits each year on the ICGP website. To this day both of these tools continue to be well utilised by GPs and the online resources are regularly updated to better reflect the requirements. 

Testing the formal model of learning

The first couple of years focused on testing the formal model of lifelong learning and the systems that were established to facilitate this. What the data illustrates is that initially there was confusion with requirements set by the Medical Council, what could be recorded in each of the four categories, what an audit entailed, how they accessed activities to meet the internal requirements, etc. At each stage we developed supports that reflected the level of understanding of the scheme’s requirements as set by the Medical Council. Overall though, aside from the expected frustrations and annoyances with having to formerly record their CPD activity, the data produced at the end of the first year demonstrated that GPs’ commitment to lifelong learning was already embedded in their practice.

Tracking the data over the next couple of years demonstrated that there was a shift in understanding the reporting categories. This was facilitated via an extensive communication exercise in the form of developing online tutorials, presenting at conferences, producing monthly FAQs in Forum and sending individualised correspondence to all GPs identifying areas for improvement.  

Two key developments that have recently been launched following a two-year planning and development phase include the online CPD recognition application process and a mobile/tablet-friendly version of the ePortfolio to facilitate autopopulation of CPD activity on the spot. These were favourably received and I’m sure, like many other instruments that have been introduced over time, use of them will become second nature.  

Resource expansion 

The resourcing of this programme is fee-based, which is also set by the Medical Council. The fee is used to enhance the supports that were established initially and to develop new supports in the form of systems and educational tools. This article focuses on some of the developments including: 

• Audits
• Governance
• Retired GPs 
• Educational activity. 

Audits 

The ICGP, particularly Claire Collins, has actively looked at and implemented a range of diverse strategies to facilitate GPs with their audits. As with all aspects of the PCS requirements, significant effort went into assisting and supporting GPs with understanding the audit requirement.  

Initially it commenced with developing a comprehensive and well recognised audit toolkit, conducting multiple workshops and attending faculty meetings to present the audit model and respond to the many concerns. This then progressed into developing sample audits, the number of which has increased over the years, and incorporating audits in ICGP eLearning modules and courses. This is in conjunction with communication via Forum, the website and in individual correspondence made available to GPs. 

Ultimately, conducting an audit is about examining whether you are doing what you should be doing and what you can do to improve? Audit is not just about clinical practice but also quality improvement in that you can review the systems in your practice such as record management, critical incidences, sharps management, infection prevention and control and record these as audits. All of these examples lead to an improvement in quality and safe patient care.

Overall, while audits are being completed there is room for improvement, particularly with completing the audit cycle.  Further opportunities to engage in audits will be offered, particularly national audits. These will be promoted as they are developed. 

Provision of education 

The ICGP is committed to the development and delivery of high quality ongoing professional development to all scheme members. Since the inception of the PCS the number of and mode of CPD has evolved. The College education department, under the direction of Nick Fenlon, offers CPD activity in a number of guises: events, short and long courses and eLearning. We went from having a small number of eLearning modules to having 40 of them. This is in direct response to GPs identifying this mode of education as valuable.  

The College also approves a number of CPD activities offered by external providers which range from workshops, lectures,hot topics and courses offered by academic, private and non-governmental institutions. In addition attendance at the very well organised and attended CME small groups, CPD activity offered by our fellow colleges and academic institutions both within and outside or Ireland is equally valued. It is safe to say that there are no shortages in broad-ranging CPD activity.  

Please check out the ICGP education page on the website and the events calendar for an updated list for all educational activity offered by or CPD approved by the college.

Retired/semi-retired GP Discussion Group

One initiative that we are particularly proud of is the establishment of a retired GPs discussion group, which has been championed by David Thomas and Monica McWeeney. This group was established in direct response to the challenges in meeting retired GPs’ PCS requirements, namely internal CPD credits and audit. 

The members consist of GPs who are retired or semi-retired, are no longer in active clinical practice, but wish to retain their name on the IMC register. They meet monthly, have an active membership with up to 40 plus members attending each month and have developed a formal programme with guest speakers. Over the past year they have focused on the history of general practice and patients’ end of life issues. This coming year they will be working on a history of general practice publication. 

The ICGP took a stand on behalf of this cohort by leading on the development of a detailed discussion paper submitted to the Medical Council which recommended that the model of registration be changed to better accommodate doctors no longer in clinical practice but who wish to retain their registration for a myriad of reasons, both professional and personal. We will continue to advocate for this change. 

Governance 

As with any new initiative in the College, appropriate governance arrangements are established to provide direction and guidance in accordance with the College’s core strategy and mission. The ICGP Professional Competence Programme is overseen by the ICGP Postgraduate Resource Centre director, managed by the author of this article, Jantze Cotter, and currently administered by Aoife McBride and Michelle Dodd. 

A committee oversees and monitors the development of the scheme and is chaired by Dr Ray Mulready. The committee representation includes: Claire Collins, Mary Favier, Nick Fenlon, Henry Finnegan, John Gillman, Mary Glancy, Brian O’Mahony, Brian Osborne, Margaret O’Riordan, Kieran Ryan and Mary Sheehan. The PCS Committee chair reports to the ICGP Quality and Standards Committee, which is a member of the board of the ICGP.  

The ICGP is required to provide detailed reports to the Medical Council on the operation of the Scheme and this includes a strategic plan, qualitative and quantitative reports against key performance indicators, and a financial report. We have also been a very active member of the Forum of Postgraduate Medical Training Bodies’ subcommittee on professional competence, which offers a mechanism to jointly address key policy and programme issues that impact on the schemes and their evolvement.  

Conclusion

I have enjoyed managing the development and operations of the Professional Competence Scheme and observing the changes over the past five years. The successful implementation is testament to the committee and the many areas of the College working together to support the evolvement of ICGP PCS. This includes the education department, the project directors who facilitate specialised education, the research department for audit development, IT for systems development, the library services for literature searches and the finance department, which ensures the budget aligns. 

My thanks especially go to outgoing CEO Kieran Ryan and former Medical Director Margaret O’Riordan for giving me both direction and autonomy in relation to this programme. Also I must thank the programme administrators, Mairead Delaney, Carol White, Aoife McBride and Michelle Dodd, as without them it wouldn’t work as well as it does. 

I predict that the Medical Council will be looking at ways to progress the PCS models, but as always, the College will advocate on behalf of its members as a facilitator, not a regulator.  

If you have any questions please contact the College by Email: professionalcompetence@icgp.ie or give us a call.