The Responsible Officer: Moving Forward

Michael Wright Clinical Governance Team, Department of Health

14 June 2011

Overview

     Management of doctors Linking doctors and responsible officers Functions of responsible officers Conflicts of interest Changes to the NHS Architecture

Management of doctors

Standards Revalidation Erasure or other sanctions Fitness to practise processes PDP Improving practice Recommendation Annual appraisal Assessment Management processes Supporting Information Multi Source Feedback Concerns and adverse incidents Rehabilitation, remediation and reskilling

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What is the difference?

The Responsible Officer Regulations:       Specific link Statutory responsibility Statutory functions Formalises the role Resource the role Enable conflicts of interest to be identified and managed

Linking Ros and doctors - An example

X NHS GPs Employees Practising privileges X Trainees X Locums Full time Part time >5 sessions X Part time 2 sessions 4 sessions for another Private GP X Consultant Employed by NHS Consultant Not employed Works mainly here

Who am I the responsible officer for?

Am I a postgraduate trainee?

No Am I on a Performers List?

No BUT The majority of my work is in the forces Otherwise My deanery The armed force I work for PCT, Local Health Board (Wales) or Health Board (Scotland) of my Performers List My employer Am I employed by a designated body? No Do I work as a locum?

No I locum in Scotland?

My agency is part of the PASA Framework agreement Otherwise The Health Board The locum Agency Do I have practising privileges with an independent hospital?

No Am I a member of ?

Independent Doctors Federation Faculty of Pharmaceutical Medicine Faculty of Occupational Medicine Faculty of Public Health

No The PCT/LHB Healthcare provider I have practising privileges with My Faculty or Society The arrangements for revalidating the minority of doctors falling outside this framework are subject to further discussion and consideration and will be set out in due course 6

What does this mean for responsible officers?

• Identify doctors that you employ or contract with • Ask them where they work • Identify doctors that have a connection with you • Maintain records

Roles of responsible officers

• Setting up local systems of clinical governance, in particular those relating to – medical revalidation  doctors appraised  cohort of trained appraisers – information – concerns over the performance and conduct of doctors – liaison with the GMC • Personal involvement in individual cases – serious concerns over the performance, conduct and health of individual doctors – recommendations to GMC on revalidation

The statutory functions

 evaluation of fitness to practise  monitoring of conduct and performance

Evaluating fitness to practise

Responsibilities relating to the evaluation of fitness to practise 

to ensure that the designated body carries out regular appraisals;

 to establish and implement procedures to investigate concerns about a medical practitioner’s fitness to practise;  where appropriate, to refer concerns about the medical practitioner to the General Council;  to monitor compliance with GMC conditions or undertakings;  to make recommendations to the General Council about medical practitioners’ fitness to practise;  to maintain records of practitioners’ fitness to practise evaluations, including appraisals and any other investigations or assessments.

The Medical Profession (Responsible Officer) Regulations 2010

Whole practice appraisal

 GMC

“If you work across different roles and specialties you will still ideally, where possible, have one appraisal, which covers all your roles as a doctor. This is known as a 'whole practice appraisal'.”

 Responsible Officers  ensure that the designated body carries out regular appraisals; and  The RO must ensure that appraisals carried out … involve obtaining and taking account of all available information relating to the medical practitioner’s fitness to practice in the work carried out for the designated body, and for any other body, during the appraisal period.

What does this mean for the RO?

 Identify other places each doctor works  Who knows  Timing  Establish systems to gather information  Multi source feedback  Contact other organisations  Portability of information  Establish systems to provide information  Locums  Other doctors  Role of the RO networks

Monitoring conduct and performance - 1

     

review regularly the general performance information held by the designated body, including clinical indicators relating to patient outcomes;

identify any issues arising from this information relating to medical practitioners, such as variations in individual performance; and

ensure that the designated body takes steps to address any such issues.

where appropriate take any steps necessary to protect patients; recommend to the medical practitioner’s employer that the practitioner should be suspended or have conditions or restrictions placed on their practice; and identify concerns and ensure that appropriate measures are taken to address these, including but not limited to —    requiring the medical practitioner to undergo training or retraining; offering rehabilitation services; providing opportunities to increase the medical practitioner’s work experience; 

addressing any systemic issues within the designated body which may have contributed to the concerns identified;

 maintain accurate records of all steps taken in accordance with this paragraph.

The Medical Profession (Responsible Officer) Regulations 2010

Monitoring conduct and performance - 2

      initiate investigations with appropriately qualified investigators; ensure that procedures are in place to address concerns raised by patients or staff of the designated body or arising from any other source; ensure that any investigation into the conduct or performance of a medical practitioner takes into account any other relevant matters within the designated body, for example wider concerns about operational or systems issues; consider the need for further monitoring of the practitioner’s conduct and performance and ensure that this takes place where appropriate; ensure that a medical practitioner who is subject to procedures under this paragraph is kept informed about the progress of the investigation; ensure that procedures under this paragraph include provision for the medical practitioner’s comments to be sought and taken into account where appropriate.

The Medical Profession (Responsible Officer) Regulations 2010

What does this mean for the RO?

 Improve clinical governance information systems  Identify doctor specific information  Provide to the doctor?

 Consider further information  Establish systems to improve quality of care  Identify issues  Verify improvement opportunities  Implement  ORSA action plan  RO Networks  GMC ELAs

Conflicts of interest

 Duty to nominate or appoint additional responsible officers in cases of  conflict of interest; or  appearance of bias.

 The body must ensure no further conflict or bias  Second RO becomes the RO for the doctor

RO roles in changing NHS architecture

• PCTs – – Performers List agency locums (Non framework, secondary care) • SHAs – – Responsible officer’s responsible officer; Trainees.

The future NHS architecture

• PCTs and SHAs abolished • Instead – – – NHS Commissioning Board; Commissioning Consortia; Employer Skills Networks.