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Fellowship by Assessment

 

Thinking about it?

RCGP crest

What was FBA?

Fellowship by Assessment is a peer-referenced quality initiative.

For me, the raison d'etre of the college is to set (and improve) standards in general practice. Looking back, it was only in the 1960's that the first chair of general practice was awarded in Edinburgh. In 1965, the MRCGP examination appeared - with 5 candidates! - and this set the scene for the development of the fellowship by assessment. In the 80's, the "what sort of doctor" initiative began to set the criteria for the fellowship by assessment, along with the experience which had been gained from trainer assessment visits, and on 1st July 1989 the fellowship by assessment became a reality.

 

Where was it at?

The criteria for FBA are reviewed each year in the light of experience with the assessment and the relevance of the criteria to today's general practice. At November 1995 there were 70 Fellows by Assessment, coming from all over the country and by no means all "academics".

So why have more GP's not undertaken FBA? Perhaps this is because others have never even thought about it, or perhaps because the criteria appear so daunting. So let's have a look at what it involves... 

What did it involve?

It consists of fulfilling a (large!) number of essential criteria, defined as:

A criterion below which no fellow shall fall and the absence of which is, of itself and regardless of other merits, sufficient cause to render the candidate unaceptable.

Rather rigid - perhaps too rigid - but these criteria do set a relatively high standard, and a high standard is necessary to make the award of fellowship by assessment valid.

The FBA criteria are divided into sections relating to the doctor the partnership and the practice.

The RCGP - Fellowship by Assessment website will provide further details.

Why did Gs do it?

I have already mentioned the College's driving force - the pursuit of quality in general practice - and the FBA, if undertaken widely, would certainly result in this. The FBA, as it develops, is setting the standards for the general practice of the future, but underneath all this I wonder if there is a hidden agenda:

So why me? My stated aims were:

  1. Subjecting my own standards of patient care to peer review to see if they would stand up to close scrutiny
  2. To learn from the experience

But I had unstated aims too. The first was the challenge - to prove to myself that I could do it. The second was to test out my hypothesis about the "good" doctor. I saw two sorts of good doctor - the technically correct good doctor who did everything according to the rule book, and the popular good doctor who gave the patients exactly what they wanted, whether it was good for them or not. The ideal lay in a balance between the two, and the FBA was a tool to test out whether I could forge a marriage between "collegespeak" and reality.

My conclusion surprised and pleased me. Yes, there is a balance, but the college are searching for that balance too; they are not at one end of the scale, not sitting in the ivory tower, and their aims ARE realistic. 

Who could do FBA?

  1. You must have held MRCGP for 5 years or more (and paid subscriptions!)
  2. You must have been a principal for at least 5 years, and at least 2 years in your present practice.

How did they start?

  1. Obtain the criteria documentation via your local RCGP office, Vale of Trent Faculty office or from the internet.
  2. Look carefully through the criteria to see if there are any areas which you may find difficult. If so, discuss these with your local FBA adviser.
  3. You will need to notify your intention to apply for FBA (NIA) using the NIA form in the FBA documentation. When this form is sent in, it fixes your application to the current FBA criteria until 1st April: this is important as the FBA criteria change a little every year to keep pace with the change in general practice. It is best to plan in advance by submitting your NIA form in March, having already started working on FBA the previous April - this gives you a further year to complete your FBA documentation.
  4. Have a look at the documentation from previous applications to see what is involved and how the criteria were tackled. Talk to people in your Faculty area who have already done FBA.
  5. Join a group. Experience has shown that a lot of support and help is derived from a local FBA group: ask your local FBA adviser for details of your local group.
  6. Get your partners and PHCT involved. More than 1 partner in the practice undertaking FBA makes the process easier for both candidates, and they will be involved in the process anyway. You will need the support of the whole team too, especially the practice manager.
  7. Don't try to do too much! FBA does take time, so you will need to set time aside for it: put other projects on the back-burner for a year or so.
  8. You may be able to obtain some funding: some health authorities are prepared to fund FBA as a quality initiative. Consider a sabbatical period to write up your data. It may be possible to arrange PGEA accreditation for your work, too.
  9. How they got started