Transcript The National Clinical Assessment Service

The National Clinical
Assessment Service
"Bringing expertise to the resolution of concerns about
professional practice”
General Practitioners Committee West Midlands
08 November 2012
Mike Newton
Adviser
National Clinical Assessment Service
Background
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Created in 2001
Independent Health Authority
ALB review 2010
NPSA/NICE
NHS Litigation Authority from April 2013
Initially Doctors then Dentists (2003) and Pharmacists (2009)
What we do
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Coverage
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National – and associated states
Public and independent sectors
Self-referral
Currently free at the point of delivery
Where we fit – partners and stakeholders
Royal Colleges
Employers
Regulators
Fitness for
Purpose
Fitness to
Practise
Deans and
Universities
NCAS
Professional
Associations and
Defence Organisations
CQC / HIW / RQIA
Systems and
Services
Health Care Performance
Management
Health Care
Management
Why we do it
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Public protection, patient safety and public assurance
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c1000 referrals yearly – small population (0.5%) with disproportionate
impact on public confidence
Cases coming earlier – 82% less than a year old in 2009/10, compared with
36% in 2002/03
Impact
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Suspension/exclusion – down by 80% and average length down by 33%
since 2003 – estimated annual saving >£10million (NAO)
Outcomes – two-thirds of most serious cases back in work after remediation
Complaints and litigation – earlier, better handling of performance failure
Reduction in high profile cases and resulting public inquiries
Core services “helping you resolve performance concerns”
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Advice 24-hour helpline
Advice letters/QA
Support (includes local record review)
Assessment
Action planning
Education and training
Evaluation and research and development
Statistics
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2011 – c 900 + cases
In 2010/11 45 GPs suspended (84 previous year), average suspension
44 weeks
Reduction in GP referrals
Current cases (November 2012). Total Cases 2001-2012 12325
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Current open cases: 2086 (5 Self referrals), 5 Dentists, 16 Pharmacists
Referrals in October 2012 highest for 11 years
Assessments – over 50 this current year
Adviser Team c 9 FTE
Action plan outcomes 2008-2011
Return to work
3%
3%
3%
Referral to regulator
4%
16%
Retired on grounds of
age
Retired on grounds of
health
71%
Resigned from
performers list/hospital
Self erasure/removal
from register
Contacting NCAS – what happens?
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Initial contact with NCAS case management service
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Caller from Referring Body (RB) should carry decision-making authority, so
usually CEO or relevant Director (HR, MD, CD, DPA or PA) (transitional
arrangements apply in primary care)
Brief details of the case given and a time agreed for NCAS Adviser call-back
– RB decides the priority and timing of this
Detailed telephone discussion with Adviser – letter confirms advice (not
copied to CEO unless specified)
If not resolved at first instance, continuing support from NCAS as required –
i.e. ‘from telephone call to action plan’
How NCAS settles the question of concerns about practice
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Case management
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Ranges from relatively light touch advice on the use of local or national
systems, to intensive support aimed at resolving a performance dispute
Lightest touch may not require named details of the practitioner – but robust
local governance must be clear
Most intensive support can involve specialist skills and services, e.g.
mediation
In all cases, the nature of the performance concern must be clear – or
irrelevant to the handling of the case; if not so, assessment will be needed
Specialist interventions to facilitate diagnosis and management
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Workplace-based performance assessment across the scope of practice –
as a whole or elements of practice – e.g. behaviour, health, communication,
local record review
Performance assessment under contract to regulators
Team reviews and support to addressing team dysfunction
Back on Track services to support return to safe practice
NCAS assessment – overview
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Independent view on the performance of the practitioner within the
wider context of their practice
Challenge
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Models
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Create a developmental model in an adversarial environment
Credible, robust to challenge, affordable and practicable
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Full performance assessment – developmental, holistic approach across all
domains: clinical skills, behaviour, health, work context
Clinical performance assessment – under contract to regulator
Method
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Peer clinical, behavioural, lay assessors, trained & quality assured
Structured gathering of information across the scope of practice
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Direct observation of practice in all work contexts (e.g. in operating theatre, MDT
meetings)
MSF from colleagues and patient feedback
Case-based assessment – based on own clinical practice
Record review
Back on Track (remediation, reskilling, rehabilitation) support
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Supporting local development of structured action plans where
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Concerns emerge during the appraisal cycle
Practitioner is likely to have difficulty revalidating
Following investigation or service review
Following NCAS or Regulator assessment
The practitioner has been out of practice for a significant period of time
Providing
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Training for local staff
Enhanced access to web based resources through the advisers
Resources/publications
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Website www.ncas.nhs.uk/Resources
Good Practice Guides
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Handling Concerns about a Practitioners Health
How to Conduct a Local Performance Investigation
Back on Track Framework for Further Training
Handling Performance Concerns in Primary Care (being revised)
Casework Statistics/Annual Reports/ Handbook
Education and training
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Internal training
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Staff training
Assessor training
External training
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Managing concerns workshops
Responsible Officer introductory training and specialist workshops
Local record review training
Customised workshops
You can register online for information
Changes and challenges
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NHS Commissioning Board, Local Offices, CCGs
Appointment of Responsible Officers
Performers List Regulations Review and Consultation New regs. in April
2013
Revalidation – December 2012
GMC Employment Liaison Advisors
NCAS New Business model