National Clinical Assessment Service: Expert Resolving of Practice Concerns

1. The National Clinical Assessment Service"Bringing expertise to the resolution of concerns about professional practice”General Practitioners Committee West Midlands08 November 2012 Mike Newton Adviser National Clinical Assessment Service

2. Background • 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)

3. What we do • Coverage • National – and associated states • Public and independent sectors • Self-referral • Currently free at the point of delivery

4. Where we fit – partners and stakeholders Employers Fitness for Purpose Regulators Fitness to Practise Deans and Universities Royal Colleges CQC / HIW / RQIA Systems and Services NCAS Professional Associations and Defence Organisations Health Care Management Health Care Performance Management

5. Why we do it • Public protection, patient safety and public assurance • 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 • 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

6. Core services “helping you resolve performance concerns” • Advice 24-hour helpline • Advice letters/QA • Support (includes local record review) • Assessment • Action planning • Education and training • Evaluation and research and development

7. Statistics • 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 • 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

8. Action plan outcomes 2008-2011

9. Contacting NCAS – what happens? • Initial contact with NCAS case management service • 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’

10. How NCAS settles the question of concerns about practice • Case management • 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 • 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

11. NCAS assessment – overview • Independent view on the performance of the practitioner within the wider context of their practice • Challenge • Create a developmental model in an adversarial environment • Credible, robust to challenge, affordable and practicable • Models • Full performance assessment – developmental, holistic approach across all domains: clinical skills, behaviour, health, work context • Clinical performance assessment – under contract to regulator • Method • Peer clinical, behavioural, lay assessors, trained & quality assured • Structured gathering of information across the scope of practice • 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

12. Back on Track (remediation, reskilling, rehabilitation) support • Supporting local development of structured action plans where • 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 • Training for local staff • Enhanced access to web based resources through the advisers

13. Resources/publications • Website www.ncas.nhs.uk/Resources • Good Practice Guides • 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

14. Education and training • Internal training • Staff training • Assessor training • External training • Managing concerns workshops • Responsible Officer introductory training and specialist workshops • Local record review training • Customised workshops • You can register online for information

15. Changes and challenges • 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