To update the Board on the progress made towards ensuring the successful implementation of medical revalidation during the year

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1 NHS BOARD :- 25 th June 2014 Lanarkshire NHS Board Kirklands Fallside Road Bothwell G71 8BB REPORT ON REVALIDATION OF LICENSED DOCTORS PURPOSE To update the Board on the progress made towards ensuring the successful implementation of medical revalidation during the year CONSIDERATION BY OTHER GROUPS This report will be considered by the revalidation/appraisal steering group and the relevant Clinical Governance and Risk management Committees in CHP and Acute Division. The update will also be shared with Healthcare Improvement Scotland as part of their national quality assurance process for medical revalidation. 3. SUMMARY OF KEY ISSUES Overview During 2013/14 we have moved from a preparation phase into full implementation of the revalidation process. Enhanced appraisal that was delivered for a proportion of doctors in 2012/13 was delivered for the majority in 2013/14 and will be delivered for all eligible doctors during 2014/15. Each month during 13/14 there have been a significant number of doctors recommended for revalidation for the first time and then commencing on a second five year cycle toward their next recommendation. Overall the implementation has progressed well, with difficulties and challenges being addressed at each stage as they emerge. A few key areas of progress are covered below: Appraiser training Early in the planning phase we identified appraiser capacity as a major risk to our ability to implement revalidation effectively. During 13/14 there has been active recruitment of appraisers in both Primary and Secondary care. At March 31 st 2014 there were 54 NES trained appraisers in Secondary care with a further 9 people booked on courses to be trained. Each appraiser is encouraged to do 10 appraisals per year. At 31 st March 2014 there were 577 doctors eligible for appraisal in secondary care.

2 Capacity in Primary care proved more of a challenge during 13/14. Some resignations and special leave meant that 7 sessions of GP appraisal time were unfilled until late in the year. The sessions have now all been successfully filled and there is capacity to offer all GPs a trained appraiser in 14/15 but there is a backlog of around 100 appraisals not completed in 13/14 Appraiser allocation Allocation of appraisees to appraisers in secondary care has followed the revalidation requirements, with those in year 1 allocated to the first tranche of trained appraisers and those in the final group allocated mostly to the more recently trained appraisers. In years 1-3 allocations have been made by a small group involving 2y care appraisal lead and Acute Divisional Medical Director but now the majority of allocations are complete further changes will be made administratively, with clinical input from appraisal lead and Associate Medical Directors. A small number of objections to allocated appraisers have been dealt with on a case by case basis and resolved satisfactorily. Support for appraisers and appraisees Workshops describing the enhanced appraisal and revalidation process have been offered at each of the three acute hospitals each year. The third year of these workshops completed in June 2014 and was targeted at those due to have their first enhanced appraisal in 14/15 for a revalidation decision in 15/16. This is the last group to be fully engaged. The appraisee workshops have been well attended each year but are unlikely to be required on an ongoing basis. Doctors joining NHS Lanarkshire as Consultants or Specialty Doctors are encouraged to join the Medical Induction and Professional Development programme run through Medical Education which includes a 2 hour session on appraisal and revalidation. We are continuing to support appraisers through regular (quarterly) workshops. A variety of topics have been discussed including consistency of form 4 s, particular issues relating to specialty doctors, difficulty in engagement and health and probity issues. Appraisers are also supported through training on the NES multi-source feedback tool. The process of making recommendations for revalidation All doctors with a prescribed connection to NHS Lanarkshire are now on a data base called GMC Connect which is available to the RO. GMC Connect contains a list of doctors who are under notice and invites the RO to recommend revalidation, defer decision or notify non-engagement. Doctors are added to the under notice list 4 months ahead of their revalidation date. Each month a list of the latest additions to the under notice list is circulated to Divisional Medical Directors in Primary and Secondary Care. Any doctors where concerns have arisen outside the appraisal process that might need to be addressed prior to revalidation are highlighted and discussed at this stage. In parallel the status of appraisals required for revalidation is checked for each doctor by the revalidation admin team and the secondary care appraisal lead prior to a discussion about each individual with the RO. Where information is missing or insufficient this is discussed with appraisee and appraiser as early as possible to allow time for more information to be collected prior to decision.

3 Once all the available information has been collected RO is in a position to make a decision whether to recommend or defer revalidation for each doctor. Progress at 31/3/ doctors were identified for revalidation between 1 st April 2013 and 31 st March Of those 221 positive recommendations, 9 deferrals and 2 doctors were recorded as non-engagers. Both nonengagers were doctors who had confirmed retirement from practice but had not voluntarily erased themselves from the register. The deferrals were for a variety of reasons including health reasons and in a small number of cases a lack of suitable evidence in time for the decision process. In these cases it is expected that with support each individual will be able to be recommended at their second date. 415 doctors are due to revalidate during 14/15 and were due to complete appraisal during 13/14 for this purpose. At 31 st March completed appraisals had been received. There were 8 doctors where exemption had been granted (health reasons, maternity leave etc.), leaving 47 still to be completed. Of those 47, 30 are GPs who will be allocated as a priority to the new sessions available from April The remaining doctors have appraisal processes in progress but not yet complete. Communication with them and their appraisers is ongoing and increases as their date approaches. Any problems identified are being escalated to medical managers as appropriate. Challenges and priorities for 14/15 The biggest challenge remains our ability to recruit and retain doctors as appraisers, both in Primary and Secondary care. In Primary care the sessions are paid but attracting Lanarkshire GPs to fill those sessions has proved difficult at times and there will be a steady turnover of doctors willing to continue this work. In secondary care the expectation is that doctors will complete a minimum of 10 appraisals per year and this will attract 0.5 PAs within job plans as part of Supporting Professional Activites. We have a number of doctors willing to train as appraisers but the SPA time allocated in job plans to those who are already appraisers is often in addition to maintaining other SPA work rather than displacing it. Proposals currently under discussion with LNC to allow departments to prioritise use of SPA time will help to reduce the risk of this if they can be agreed. There will be a considerable challenge in sustaining the momentum in this process that has been generated by the initial implementation. Doctors will require enhanced appraisal each year from now on and RO and steering group have asked that a local database is developed to ensure we can monitor progress and be alerted early if any doctors experience difficulty in sustaining that engagement. The administrative support required for this process will need to be reviewed and increased support required to ensure sustainability. Priorities for 14/15 will therefore be further recruitment and support for appraisers in both primary and Secondary care, the development of a practical database for managing the appraisal process and a review of the administrative report required for appraisal/revalidation. HIS quality assurance process

4 The annual questionnaire assessing progress of each Board towards implementation of Revalidation was completed at the end of May Feedback and any actions arising will be auctioned through the Revalidation/Appraisal Steering Group. 4. LINKAGE TO CORPORATE OBJECTIVES 1.3 Improve safety 1.4 Deliver effective care 1.6 Workforce planning, selection, recruitment and development 5. CONTRIBUTION TO QUALITY The appraisal and revalidation process fit into the wider Quality Improvement framework of the Board. The process provides assurance that medical staff working for NHS Lanarkshire are sustaining high standards and keeping up to date with developments in their field. It also assures that all doctors are participating in Quality Improvement activities and that learning from Significant Events and Complaints are being discussed with individual doctors on a regular basis. 6. FIT WITH A HEALTHIER FUTURE STRATEGIC PLANNING FRAMEWORK The medical workforce is key to the provision of high quality patient care. The appraisal and revalidation process assures and improves the standards of care. 7. FINANCIAL CONSEQUENCES Development of database and review of administrative support may require additional resource but this has not yet been scoped. 8. EQUALITY AND DIVERSITY IMPACT ASSESSMENT All areas of care are eligible for involvement 9. RISK ASSESSMENT/MANAGEMENT Risks/challenges highlighted above are managed through the Revalidation/Appraisal steering group that reports into Healthcare Quality Assurance and Improvement structure. 10. CONSULTATION AND ENGAGEMENT Regular discussions with affected staff are described in section 3. There has been widespread consultation and engagement at national level about the implementation of this process. 11. FIT WITH BEST VALUE CRITERIA The revised appraisal process leading to revalidation has been implemented with little direct cost to the organisation. 12. CONCLUSION

5 The Board are asked to note the progress towards the successful implementation of Revalidation for licensed doctors within NHS Lanarkshire. There has been considerable commitment from appraisers, the administration team and those involved from OD, medical staffing and medical managers to ensure the good progress that has been made so far. Keeping a momentum towards full sustainable implementation will require continued commitment for those involved and the Board are asked to support that ongoing work. 13. FURTHER INFORMATION Dr Alastair Cook Director of Medical Education, 2y Care Appraisal Lead NHS Lanarkshire

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