Written evidence from the National Clinical
Assessment Service (REV 26)
EXECUTIVE SUMMARY
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.
NCAS' ROLE
IN
SUPPORTING
MEDICAL
REVALIDATION
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.
Education
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.
CONCLUSION
AND
RECOMMENDATIONS
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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