Revalidation of Doctors - Health Committee Contents

Written evidence from the National Clinical Assessment Service (REV 26)


1.  The National Clinical Assessment Service (NCAS) is committed to supporting the introduction of medical revalidation as a process of clinical and professional governance.

2.  The role of the responsible officer is pivotal in the implementation of revalidation.

3.  NCAS' role in revalidation focuses on the situation where there are concerns about the performance of a practitioner that may lead to a failure to revalidate, and is to support the responsible officer at a local level to deal with this.

4.  This submission describes the support that NCAS will provide during the implementation of revalidation, in particular to responsible officers.


5.  The National Clinical Assessment Service (NCAS) is now in its tenth year of bringing independent expertise to the resolution of concerns about the practice of individual doctors. The service was established in April 2001, following recommendations published in the reports of the Chief Medical Officer for England, entitled Supporting Doctors, Protecting Patients (November 1999), and Assuring the Quality of Medical Practice: Implementing Supporting Doctors, Protecting Patients (January 2001).

6.  Following the recommendations in the review of Arm's Length Bodies it is anticipated that NCAS will move, over the next few years, to be come a self funded service. Currently NCAS receives more than 1,000 new referrals per year across three health professions (dentists and pharmacists, in addition to doctors). To date, about 90% of referrals have been about doctors and whilst not anticipating a significant increase in this number as a result of the introduction of medical revalidation, NCAS believes that support for early intervention (including if appropriate remediation) will be an important component in ensuring successful revalidation for doctors where concerns have been raised about their practice.

7.  NCAS is committed to supporting the introduction of medical revalidation as it believes that this is appropriate to enhance patient safety, and to provide public protection and assurance as part of clinical and professional governance. We believe the focus of activity in professional governance should be at the front line of services as far as possible, providing specialist expertise to support local activity and involving national organisations only where absolutely necessary. This carries two clear benefits:

7.1.  development of greater local expertise in predicting, preventing, identifying and handling performance concerns.

7.2.  ensuring a proper balance of priorities in the use of resources - skills, staff and financial.

8.  NCAS will take a tiered approach in the support available by providing a variety of interventions based on different levels of input in handling concerns about practitioner performance (and/or the revalidation process) and by using our experience to advise on the most appropriate intervention. The tiers consist of:

Advice and support

9.  NCAS will provide advice and support to responsible officers (ROs) as they develop their role and are faced with concerns that are identified about a practitioner which emerge through local governance systems, following appraisal, or during the process of considering an individual for recommendation for revalidation. Advice on handling performance concerns is currently a core area of work for NCAS. We expect that the introduction of ROs and revalidation will enable identification of concerns about performance at an earlier stage. 

Local review

10.  NCAS is designing two methods for use in local review - a review of clinical records and a structured interview with the practitioner to explore issues arising from the record review. We will recruit and train a panel of reviewers who will be available to ROs wishing to undertake a review using local resources.

11.  The local review will provide information about a practitioner's performance to enable the RO to decide whether there is a problem that needs further investigation or assessment.

12.  When an RO considers a local review is required, NCAS expects that they will contact members of the panel and contract with them directly. The RO will organise and fund the review locally, to a timetable which suits the local situation. The local review should expedite the process and, in our opinion, will be useful in identifying concerns at an earlier stage, ensuring that doctors can be supported as necessary.

13.  We will establish a transparent process for the recruitment and selection of reviewers. We intend to develop and test the methods over the next six months and should have the first members of the panel (GPs, psychiatrists and paediatricians) trained by June 2011.

Support for remediation

14.  Remediation may be appropriate where there are performance concerns and NCAS will use its experience to contribute to local remediation at all levels. NCAS experience suggests that the focus of remediation needs to be local and workplace-based so ownership is maximised by both the practitioner and their organisation. NCAS will continue to support the planning of further training programmes and will work alongside the providers of interventions (including Deaneries and Royal Colleges) to ensure a robust and practicable process. In addition we intend to share this way of working and our experience through certified training and web based tools and other resources.


15.  NCAS is currently developing a portfolio of initial training and ongoing professional development in areas of NCAS' expertise and experience which will be available to ROs. Areas to be covered will include:

15.1.  handling performance concerns, including statutory obligations and record keeping.

15.2.  undertaking investigations.

15.3.  handling concerns about a practitioner's health.

15.4.  handling concerns about a practitioner's behaviour.

16.  This training is being developed in conjunction with the Revalidation Support Team (RST) and the GMC.

17.  This training will also be available to others who deal at first-hand with performance concerns, to support the development of effective local governance arrangements more widely within NHS organisations.


18.  Revalidation will be central to providing public assurance of good professional governance of doctors, and the role of the responsible officer is pivotal. The revalidation process requires an effective response where concerns emerge as a result of enhanced clinical governance systems. The services described above will, we believe, significantly contribute to supporting ROs in discharging their statutory obligations and, as it develops, the successful implementation of professional revalidation. This approach will enable the development of maximum expertise at the front-line and ensure a flexible and cost-effective approach.

19.  The Select Committee is asked to note NCAS' role in supporting the effective introduction of medical revalidation in those cases where there may be concerns about an individual's ability to revalidate.

November 2010

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