BOARD OF DIRECTORS - 30 th JUNE 2016 MEDICAL SERVICES BI-ANNUAL REPORT

Transcription

1 BOARD OF DIRECTORS - 30 th JUNE 2016 MEDICAL SERVICES BI-ANNUAL REPORT Executive summary This paper is a regular biannual report on medical services addressing issues of recruitment, retention, revalidation and medical education Revalidation updates have also been presented to the Workforce, Equality and Diversity Committee This report covers the statutory obligations with regard to the provision of the RO role and trust responsibilities as a designated body for revalidation of medical staff Medical Education GMC Trainer recognition From the 31 st July 2016 all medical trainers must be formally recognised by the GMC. As a trust we will have t provide evidence to the GMC and HEEM with regards to how we formally identify, train and appraise trainers. In preparation for this we have contacted 107 consultants who have had roles as named Clinical or Educational Supervisors for junior doctors; or have roles within the Medical Education infrastructure. Of these, 96 have either been fully recognised (86) or removed from training without affecting clinical services (10). Of the remaining consultant trainers (11), all have given an undertaking to complete the necessary Clinical Supervisor/Educational Supervisor training. We have made their Clinical and Training Directors aware of the current position and given a Trust deadline of 1 st July for full compliance, so that notice can be given of any necessary changes. We are confident, given the current figures and undertakings from colleagues that we will meet our target of 100% compliance without disruption to services in advance of the GMC 31 st July deadline. The second phase will be ensuring recognition is maintained and we have worked with the Trust medical appraisal team on a solution linking this efficiently with the appraisal system. GMC visit to HEE-EM and Nottingham University Medical School This visit is planned for October 2016 but at present is not planned to involve an inspection of Trust postgraduate training. It will however involve an inspection of the Medical School. The only issue anticipated to arise is with regard to provision of adequate space for medical students attached to the trust, particularly at the Highbury site. Page 1 of 8

2 Industrial action and Junior Doctor Contract There were no identified issues or incidents linked to the industrial action and induction and training was achieved in a way that was acceptable to trainees and clinical staff. Actions required to review rotas in light of the proposed contract have been identified but are on hold until the formal ballot from the BMA. The appointment of the Guardian of Safe Working is continuing with junior doctor involvement in the interview process. Interviews will be held on the 23 rd June, Non-medical Educator Posts for Medical Students These two new posts have now been appointed to and are working well from informal feedback. We intend to continue this initiative, which provides a costefficient way of promoting interdisciplinary learning and breaking down barriers between professional groups. Admin of Medical Education In order to improve efficiency and develop a shared culture, we have merged admin across Postgraduate and Undergraduate teams; and across Nottingham and Mansfield hubs. Quality improvements are already notable. Linking with IMH Longer term this should be seen as an important part of our recruitment and workforce development; and of enhanced quality improvement within the Trust. To this end we have piloted an integrated clinical/academic meeting attended by academics from the IMH, with very good initial feedback. We have also developed a number of new posts, including a post-ct Fellow, Academic Clinical Fellows and an Academic Foundation post, all working across the Trust and IMH in areas where we have international expertise. Multi-professional Training and Education Charter After a year of collaborative working this has been completed and agreed through the Workforce Committee, Trust Training Committee, Learning and Development and staffside. We will distribute this for the first time at the August induction. Both Learning and Development and Medical Education will monitor feedback and adherence to principles in order to report to the annual Quality Management Visit (next scheduled for Oct 2016). Medical Engagement As previously notified to the Board the Medical Engagement Scale (MES) was used across Forensic and local services in April 2016 to establish a more formal baseline of medical engagement. The medical engagement scale is a simple and short 30 item survey instrument, developed by the NHS Institute for Innovation and Improvement, consisting of ten reliable and valid scales focused on The active and positive contribution of doctors within their normal working roles to maintaining and enhancing the performance of the organisation which itself recognises this commitment in supporting and encouraging high quality care (Spurgeon, Barwell Page 2 of 8

3 and Mazelan 2008). These results are then benchmarked against other trusts with over 7,000 respondents. MES Scale Scale Definition [The scale is concerned with the extent to which..] Index: Medical Engagement...doctors adopt a broad organisational perspective with respect to their clinical responsibilities and accountability Meta Scale 1: Working in an Open Culture...doctors have opportunities to authentically discuss issues and problems at work with all staff groups in an open and honest way Meta Scale 2: Having Purpose and Direction...Medical Staff share a sense of common purpose and agreed direction with others at work particularly with respect to planning, designing and delivering services Meta Scale 3: Feeling Valued and Empowered...doctors feel that their contribution is properly appreciated and valued by the organisation and not taken for granted Sub Scale 1: [O] Climate for Positive Learning...the working climate for doctors is supportive and in which problems are solved by sharing ideas and joint learning Sub Scale 2: [I] Good Interpersonal Relationships...all staff are friendly towards doctors and are sympathetic to their workload and work priorities. Sub Scale 3: [O] Appraisal and Rewards Effectively Aligned...doctors consider that their work is aligned to the wider organisational goals and mission Sub Scale 4: [I] Participation in Decision-Making and Change...doctors consider that they are able to make a positive impact through decisionmaking about future developments Sub Scale 5: [O] Development Orientation...doctors feel that they are encouraged to develop their skills and progress their career Sub Scale 6: [I] Commitment & Work Satisfaction...doctors feel satisfied with their working conditions and feel a real sense of attachment and reward from belonging to the organisation Approximately 50% of the medical staff group responded with a reasonably well distributed spread across the directorates. The overall trust results were disappointing with all areas of the 10 scales falling within the lowest or low relative engagement groups. Page 3 of 8

4 There was however considerable variation between different directorates in their responses and between those medics who identified themselves as having management responsibilities or not. Page 4 of 8

5 WITH a position of managerial responsibility NO position of managerial responsibility Index of Medical Engagement Meta Scale 1 Meta Scale 2 Meta Scale 3 Sub Scale 1 Sub Scale 2 Sub Scale 3 Sub Scale 4 Sub Scale 5 Sub Scale 6 Working in a Collaborative Culture Having Purpose & Direction Being Valued & Empowered Climate for Positive Learning Good Interpersonal Relationships Appraisal and Rewards Effectively Aligned Participation in Decision-Making & Change Development Orientation Work Satisfaction n Feedback was presented by Professor Peter Morgan to the executive operational director, deputy directors, associate medical directors, clinical directors and general managers, facilitated by the medical director. An action plan will be drawn up focusing on co-producing solutions with the consultant body specific to directorates but with oversight maintained by the medical director and building on the recent external facilitated development work with the local services clinical directors. The full report and initial action plan will be shared with all medical staff by the medical director. The full action plan and progress reports will be reported back to the Workforce, equality and diversity committee. Revalidation and Appraisal The annual audit is a standardized return made yearly by all responsible officers to NHS England and forms part of the overarching Framework of Quality Assurance. The process enables responsible officers to assure themselves and their boards that suitable systems are in place underpinning the recommendations they make to the GMC regarding fitness to practice, the arrangements for medical appraisal and responding to concerns. It also provides a mechanism for designated bodies to provide assurance to NHS England, the England Revalidation Implementation Board and the GMC that they are fulfilling their statutory obligations and their systems are sufficiently effective to support the Responsible Officer s recommendations. The full audit document is attached at appendix 1, key items to highlight are: In 2015 out of 20 items in the audit, 5 were responded to negatively, following the project work agreed at that time with the Board a positive statement of compliance was made by the Trust in September 2015 and all of the responses in the return this year were positive. The actions identified by the internal audit of revalidation in November 2015 have all been completed and are awaiting sign off by the internal auditors. A verification visit was conducted by NHS England in November No concerns or recommendations were made at the visit and Page 5 of 8

6 we have still to receive a formal response confirming the outcome. The trust was congratulated on the robust response to the audit issues. Of the 133 consultants with a designated connection, 96% had a completed appraisal in 2015/16 compared to 76% in 2014/15. Of the other doctors with prescribed connection, 100% had a completed appraisal in 2015/16 compared to 52% in 2014/15. 4 deferrals were made in 2015/16. These are listed below with the reason for the deferral. Date Deferral Reason 18/8/2015 Dr 1 Ongoing investigation 03/03/2016 Dr 2 Ongoing investigation 14/03/3016 Dr 3 Ongoing investigation, this revalidation recommendation has now been made 28/04/2016 Dr 4 Insufficient Evidence, this was a second deferral and formal communication has been made to the doctor that non engagement processes will commence if the agreed plan is not complied with. The doctor is now working with the appraisal lead and Cd to ensure this plan is met and it is anticipated that a revalidation recommendation will be made Key actions in 2015/16 Medical Appraisal Policy updated to bring it in line with NHS England MAPS Appointment of Clinical Appraisal Lead August 2015 Appointment of Medical Revalidation Administrator in February 2016 Development of E-Learning package for Medical Appraiser Training (October 2015) 8 New Appraisers trained in November 2015 bring total of Trust Approved Appraisers to 33 for total of 173 doctors (Appraiser:Appraisee ratio now in line with NHS England standards 1:5 ) Implementation of SARD (went live on November 30 th 2015) o Database of all appraisals o Online completion of appraisal forms and appraisal outputs o Independent logging of complaints and SUI data o Built in multi-source feedback facility benchmarked on GMC data o Built in tracking of due dates and automatic reminders o Live appraisal compliance figures o Built in Appraiser feedback facility with reports generated Roadshows conducted by Clinical Appraisal Lead on All Trust sites (Between December 2015 and February 2016) to: o Raise awareness of Appraisal policy and evidence required for revalidation o Show doctors how to use SARD 97% of all consultants and career grade doctors have logged onto SARD Page 6 of 8

7 Implementation of new Process Maps to ensure that new starters and leavers are tracked routine collection of MPIT forms etc. Introduction of welcome letter and induction interviews Bi-annual Appraiser Development Days now in place to keep Appraiser skills up to date o One held in February 2016 introduced the ASPAT Audit Tool => this led to an improvement in quality of appraisal outputs o One booked for 27 th May 2016 will be co-facilitated by GMC Liaison Officer Quality Assurance Event will be revamped this year to use the ASPAT, booked for July 2016 Clinical Appraisal Lead to introduce 1:1s for Appraisers, selection for 1:1 based on ASPAT scores. Conclusion and Recommendations The Board is asked to note the report Author: Dr Julie Hankin Date: 20/6/16 Page 7 of 8

8 Other work to note Pilot of solution focused coaching development programme for Clinical Directors in Local Services, starts January HEEM integrated fellow in primary care and psychiatry to work in Rushcliffe as part of vanguard work. Improved integration between Learning & Development and medical education. Work on educational charter and workforce education strategy. Integration of clinical academics back into medical academic programme. Participation of Julie Hankin, Chris Packham and Steve Geelan as fellows in the HEEM medical leadership and management faculty and teaching programme. Dr Julie Hankin Executive Medical Director December 2015 Page 8 of 8