The Role of the Medical Royal Colleges and Faculties in Quality Assurance, Quality Management and Quality Control: A Discussion Paper

Transcription

1 9 October 2012 QA Review Workshop for Colleges and Faculties The Role of the Medical Royal Colleges and Faculties in Quality Assurance, Quality Management and Quality Control: A Discussion Paper Purpose 1. This discussion paper describes the current role of medical royal colleges and faculties within the Quality Improvement Framework and explores ways in which this might be enhanced. 2. The ideas in this paper are not exhaustive and we welcome other suggestions and comment from colleges and faculties at the QA Review Workshop on 9 October Further information 3. Richard Marchant Jennifer Barron rmarchant@gmc-uk.org jbarron@gmc-uk.org

2 Summary of discussion points Discussion point 1: How can the colleges best contribute to quality assurance of trainee progress and consistency of the ARCP process? (paragraphs 27-30). Discussion point 2: How best can colleges contribute an external perspective to the organisation of training programmes in their specialty? (paragraphs 31-35). Discussion point 3: How can colleges best contribute to the investigation of poor practice in their specialty and share examples of good quality training delivery? (paragraphs 36-39). Discussion point 4: How can the GMC make best use of college specialty expertise within its visits process? (paragraphs 40-45). Discussion point 5: How can the quality of external advisors and visitors who are part of the regulatory process be assured? (paragraph 46). Discussion point 6: How can we make better use of college examination and portfolio data to inform the quality assurance process? (paragraphs 47-50). Discussion point 7: What should be the purpose of the ASRs and how might this purpose be met? (paragraphs 51-53). Discussion point 8: How can we ensure that colleges and faculties are able to raise concerns about new posts or programmes if they feel they will not meet the requirements of the curriculum and assessment systems or would otherwise deliver poor training? What information would colleges and faculties need to provide an informed view? (paragraph 54). Discussion point 9: How can colleges contribute to the better dissemination of good practice? (paragraph 55). 2

3 The QA Review 4. In 2011 the GMC published its Quality Improvement Framework (QIF). 1 This consolidated our previous work on the quality assurance of basic medical education (QABME) and the Foundation Programme (QAFP), and the work inherited from PMETB covering the quality assurance of specialty including GP training. But it also represented a bolting together of different approaches to quality assurance based on different legislative frameworks. Since the QIF was introduced, therefore, we have been working to enhance the way it operates and achieve greater overall coherence across the different stages of education and training. Initiatives have included piloting different approaches to visiting medical schools and postgraduate deaneries, developing a smarter evidence base to help shape those visits, and new arrangements for responding to concerns about the delivery of training. 5. We have also begun a more fundamental review of our approach to quality assurance. 2 One element of this review concerns the role of the medical royal colleges within the QIF. This paper looks at how that role is currently carried out and discusses some ideas about how it might be performed in the future. 6. It is important to stress that these ideas do not necessarily represent current GMC policy. Nor are they exhaustive. Some of the ideas in this paper will have more merit than others. The colleges will no doubt have additional ideas which are not covered in this paper but which should be discussed in the forthcoming workshop. The aim here is simply to begin to explore options and identify those which might be worth pursuing as part of our review. Given the provisional nature of much of its content, we will refer to this document as a draft, emphasising that it is likely to be subject to change and revision in the light of discussion. The QIF and the colleges 7. The colleges and faculties are in a unique position as they and their representatives have a role at all levels within the learning environment. For example, they operate locally and regionally through their networks of college tutors and regional advisors and through their work with the deaneries. At a national level the Specialty Advisory Committees (SACs,) work with deaneries to ensure that curricula are delivered at local level. Colleges also work through the AoMRC and through their contributions to the GMC s work. 8. Colleges and faculties are also central to the design and delivery of specialty training. They are the authors of the GMC approved-curricula and assessment systems, the hosts of the trainees portfolios and they administer the national specialty examinations which are a crucial element of postgraduate assessment systems. Colleges and faculties also consider applications for CCTs and CESRs and drive policy and improvements within the specialties they represent. However, there are marked differences between specialties in terms of trainee numbers and scale of operation, and differences too between colleges and faculties in terms of available

4 resources and infrastructure. So while it may be possible to achieve consistency in terms of underlying principles, consistency of processes is unlikely to be possible and it is important to acknowledge that point. Thus, an approach which is effective in one specialty may not be replicable elsewhere. On the other hand, the fact that something has not been done before in a specialty should not be an excuse to avoid desirable change and innovation if the means are there to do it. 9. The QIF therefore acknowledges the importance of the colleges and faculties as holders of speciality knowledge at a local, regional and UK wide level and describes the ways in which they contribute to quality assurance, quality management and quality control. Quality assurance (QA) 10. Quality assurance is the responsibility of the GMC. But colleges and faculties support the GMC in carrying out this role by providing annual reports to the GMC outlining any good practice, trends or concerns within their specialty at a local or UK wide level and analysis of trainees performance in specialty examinations. 11. The annual specialty reports from the colleges and faculties are among the key sources of evidence used to support the QIF. 3 They are intended to provide an essential specialty perspective, a national overview by specialty and sub-specialty. 4 They should focus on analysis of activity such as trainees performance in national exams, training courses and externality the college or faculty has provided to support deanery quality management activity. The reports should identify good practice, concerns and trends both locally and nationally. Quality management (QM) 12. QM refers to the arrangements through which a medical school or deanery satisfies itself that local education providers (LEPs) are meeting the GMC s standards. The QIF highlights the importance of deaneries working in close partnership with the medical Royal Colleges and Faculties. 5 It acknowledges that as part of their QM activity deaneries, in conjunction with medical Royal Colleges and Faculties, may need to carry out a form of local visiting with the goal of improving education and training opportunities. 6 Indeed, visits should include expertise external to the programme being reviewed. 7 Where there are concerns about a training programme colleges and faculties are expected to raise these with the relevant deanery in the first instance and, if problems persist, with the GMC The QIF requires deaneries to ensure external scrutiny in the QM process. At specialty level such advice will normally come from the medical royal colleges and 3 QIF paragraphs QIF paragraphs QIF paragraph QIF paragraph QIF paragraph QIF paragraph 34 4

5 faculties. 9 External advisors are expected to have appropriate expertise and be independent of the deanery Colleges and faculties are a key partner to deaneries that provide externality on quality management visits to training units, in ARCP panels and selection processes. By the same token, the role of the lead deans is an important support for the work of the colleges in the development of curricula and understanding what is feasible and deliverable. Quality control (QC) 15. QC describes the arrangements by which LEPs ensure that trainees receive education and training that meets local, national and professional standards. The colleges and faculties contribute to this by overseeing the supervision and assessment provided by specialists in the relevant discipline The colleges and faculties are therefore embedded in all three levels of the QIF. It is possible to object that a person or organisation involved at a particular stage of a process cannot legitimately be involved in the quality assurance of that same process. You cannot be part of a process and provide externality for that same process. The practical reality, however, is that the college interface with the quality framework operates at a variety of different levels. There seems little value in insisting that it be restricted to one or other part of the process. The key is to acknowledge and act upon areas of potential conflict of interest or overlap with the responsibilities of others. 17. Yet difficulties remain because although the QIF acknowledges the importance of the college role throughout the QA process, the role is not always clearly defined. For example, the QIF says little about the sort of criteria and standards expected of college engagement in the process. Survey of college and faculty QA activities 18. To help inform discussion at the workshop on 9 October 2012, each of the colleges and faculties has described the ways in which their structures and activities support the QA process overall. A matrix summarising these activities is provided at Annex A. A spreadsheet showing the returns in full is at Annex B. Although this reveals much commonality in the approaches taken by the different colleges there are also some notable differences. These are evident, for example, in the approaches to the selection and training of college representatives involved in quality assurance processes. Such differences may, of course, be legitimate reflections of the size, nature and organisation of the specialties in question. But there may also be opportunities to identify and share effective practice. 9 QIF paragraph QIF paragraph QIF paragraph 46. 5

6 Quality assurance review workshops 19. At the recent GMC QA Review workshops in London, Manchester and Edinburgh delegates were asked to consider the role of the colleges in the QA process. Feedback from participants included the following comments from individuals: College relationship with the QIF The colleges seem to sit outside the QIF and their precise role is unclear. They should be integrated with a more formal role in the regulatory process. Use of specialty expertise Colleges are a source of external specialty expertise. External advisors have knowledge of the specialty curricula and the learning environment, but the quality and training of external advisors is variable. The GMC should consider establishing standards for external advisors. The ability of external college advisors to participate in QA activities is increasingly affected by funding issues and the willingness of employers to release advisors to take part in such activities. College relationships with the deaneries There is tension between the role of deaneries and the role of the colleges and sometimes a lack of feedback and linkage between the two. But the colleges need to work through the deaneries with the deaneries sitting between the colleges and the LEPs. The Academy of Medical Royal Colleges could play a greater role in coordinating the individual colleges and developing a more consistent approach to engagement with the deaneries and LEPs. QA visiting The end of college visiting has resulted in a loss of focus on whether the training is delivering the requirements of the curriculum. GMC QA visits should include a college resource able to provide relevant specialty expertise. Such individuals could be appointed by, and accountable to, the GMC and need not be present as representatives of their college. Greater use should be made of intelligence provided by the colleges to target GMC visits. 6

7 Annual Specialty Reports The Annual Specialty Reports (ASRs) have improved, but still lack a sufficient evidence base. ASR evidence was variously described as subjective, anecdotal, repetitive and difficult to interpret. The utility of the qualitative data collected was questioned. 12 There is insufficient feedback from the GMC to the colleges and deaneries in the light of the information provided for the ASRs. It is therefore not obvious how the information colleges have provided is being used to drive improvements. The GMC needs to be clearer about what it wants from the ASRs. ARCPs and e-portfolios The GMC should explore how ARCPs could be better used for quality assurance and how the ARCP data could be made more robust. There should be a common e-portfolio that students and trainees use throughout their training. This would allow progression to be monitored across all stages of training. The RCGP was cited as a good example of using the e-portfolio to assess educational supervisors reports. College exam data More use should be made of college examination data. This was identified as a useful source of evidence as it directly assesses the knowledge of trainees and regional variation may indicate local issues. 13 What is the function that needs to be performed 20. The previous sections of this paper have described how the colleges and faculties currently contribute to the QIF and identified areas where participants at the previous workshops felt the present arrangements might be enhanced. Before looking at where the colleges can best add value, it may be useful to be explicit about the function that needs to be performed and the principles for that function is carried out. 12 It has also not previously been published, which has impeded deaneries understanding of the colleges views and evidence on training programmes. 13 We have set up a project to collect raw examination data, which will enable us to use it more fully. Currently only untested aggregated data is collected and used for risk assessment and visits. 7

8 21. The role of colleges and faculties in developing and maintaining their specialties through national curricula and assessment systems is clear although recent revisions to the GMC s approval processes challenge colleges and faculties to be more proactive in engaging with trainees and employers on changes and identifying an evidence base to support new proposals. 22. However the way in which colleges and faculties contribute to deanery processes by acting as external advisers (sometimes referred to as providing externality has been the subject of much debate. 23. Externality is crucial to robust and effective quality assurance but external advice can come from a range of sources. It may come from patients, non-medical/lay input from individuals with specific expertise (for example in quality systems or education) or from doctors with expertise relevant to the training programme under review. The joint Academy of Medical Royal Colleges and Conference of Postgraduate Deans guidance 14 identified a distinction between medical and non-medical external advice and described ways in which external advisers from colleges and faculties could bring their expertise in the curricula and assessment systems and broader knowledge of the specialty to assist deaneries. Whatever form externality takes, it is generally performing two functions. The first function is to bring expert knowledge to the QA process. The second function is to bring an independent (external) view of the quality management of postgraduate training. In the future, it may be helpful to use different words to distinguish between the role of colleges and faculties and other types of external advice that help deaneries ensure their systems are robust and fair. 24. The principles which should govern externality (using that word for the moment) are: a. Externality should be external to the training programme concerned and external to the LEP where the programme is being delivered. b. Externality must be provided by individuals who are appropriately knowledgeable and trained to a defined standard. c. Where colleges provide externality this must be as part of the regulatory framework overseen and assured by the GMC. d. College involvement must be undertaken in partnership with the deanery. All reports must go to the dean in the first instance, but if there is a failure by the deanery to act on issues highlighted by the college the GMC should be informed as part of the Response to Concerns process. 25. In relation to 24(c) and (d) above, the feedback from the earlier workshops suggests that there is an appetite among some to return to the arrangements for college visiting which existed before PMETB was established. There can be no question of this happening. PMETB s broad view, building on comments by Sir Ian

9 Kennedy in the Bristol public inquiry, was that under those arrangements there was little consistency in the way that different colleges carried out visits, but much duplication of activity 15 and burden on Trusts. The quality and frequency of visits was variable, visitors were sometimes untrained, and the effectiveness of visits in addressing failure and driving improvement was sometimes questionable. The costs were also considerable. 16 Above all, the fact that visits were not undertaken as part of an integrated and regulated quality assurance framework meant a lack of transparency and accountability which would not be tenable today. Whether or not one accepts all of the above points and some certainly do not accept them - the fact remains that the challenge the GMC faces today is how best to integrate college and faculty expertise within the regulatory framework we now have, not to go back to a period before there was a national regulator of education and training. 26. It is also important to remember that visits are only one tool of quality management. There is a need for externality in a number of other processes which the colleges and faculties are perfectly placed to provide. The question, therefore, is how best to use the independence and expertise of the colleges and faculties in ways which add value without creating unnecessary additional burden. Future college and faculty involvement 27. There are three key processes that the GMC needs to quality assure: a. The progress of trainees and the robustness and fairness of way points such as the ARCP process and national exams. b. The organisation of the training programme to deliver the curriculum and assessment system. c. The delivery of training in LEPs. The progress of trainees and the ARCP process 28. The GMC needs to be assured that individual trainees are appropriately assessed and demonstrate that they have met the requirements of the curriculum and assessment system for each stage of training before moving to the next and, ultimately, that all requirements of the curriculum and assessment system have been met before a CCT is awarded. This means that ARCP decisions must be based on reliable evidence provided to panels with clear reference to the relevant curriculum and assessment system, and the ARCP process and outcomes need to be applied consistently across deaneries. 29. Given the need to map trainee progress to curriculum and assessment requirements and deaneries obligations to demonstrate fairness across trainee cohorts, it would seem reasonable that externality is part of this process. It would not require physical college presence at ARCPs. Evidence and outcomes could be 15 PMETB consultation on the future arrangements for quality assurance of training, Grant et al. The cost of hospital inspection visiting. Open University Centre for Education in Medicine. April

10 reviewed by sampling e-portfolios remotely, following the model adopted by the RCGP. There is currently an expectation in the Gold Guide of 10% sampling. 17 Several of the participants at the QA workshops pointed to the RCGP model as an example of good practice. Is this a model that could or should be replicated across specialties? Are we confident that the Gold Guide expectation of 10% is being achieved? 30. The Royal College of Physicians provides another form of externality by offering an external review of individual trainees at a fixed waypoint. Its Penultimate Year Assessment (PYA) provides two assurances. First, it provides advice to the dean on whether the programme in the deanery has been able to provide the trainee with the experience and opportunities necessary to achieve their CCT. Second, it provides external specialty specific expertise to help identify how any outstanding areas that need to be covered by the individual trainee could be addressed within the final year of training. Although the discussion with the trainee probably needs to be undertaken face to face, the external input could be provided through scrutiny of the paperwork and enhanced use of tele/video conferencing. Could the Colleges, in conjunction with their Lead Deans, apply a PYA within their specialty and, if so, can the learning from individual cases be fed back into the programme as a whole? Discussion point: How can the colleges best contribute to quality assurance of trainee progress and consistency of the ARCP process? The organisation of the training programme to deliver the curriculum 31. The GMC needs to be assured that training programmes give individual trainees opportunities to meet all the requirements of the curricula and assessment systems designed by colleges and that there is fairness and equity in the way the programmes are administered and delivered across the UK. 32. One of the reasons that colleges engage with deanery specialty training committees is to provide external advice to the evaluation and management of specialty training programmes. Some colleges have adopted the system of fixed specialty advisory committee liaison members and others a more rotating model. Both are claimed to deliver different benefits. The former allows the member to gain understanding of the workings of a deanery programme over a period of time, but there is the danger of capture by the deanery system in a way which undermines independence. The latter allows a truly external view but may not allow the individual to understand properly what is going on in a programme or understand the continuity issues. Often the relationships are determined by geography so as to avoid excessive travel. However, this may mean that the individuals are not sufficiently removed from the issues. In specialties with small numbers there is an additional challenge of a limited pool of experts without apparent conflicts of interest. 33. None of these arrangements is perfect. They are also expensive in terms of time and travel. 17 A Reference Guide for Postgraduate Specialty Training in the UK, : The Gold Guide, Fourth Edition, June 2010, para

11 34. Additionally, there are other sets of information that colleges and faculties could usefully share with deaneries to assist with the evaluation of training programmes, for example, national exam results, e-portfolio information on workplace based assessments, comparative attendance records at national trainee and trainer days. 35. Given that most Specialty Training Committees (STCs) meet about three times a year and many combine this with providing external advice in ARCPs or RITAs, it might be appropriate to develop an annual cycle of external advice across deaneries that co-ordinates college and faculty advice on progression and programmes with sharing of college data. Discussion point: How best can colleges contribute an external perspective to the organisation of training programmes in their specialty? The investigation of training delivery in LEPs 36. Deaneries are responsible for ensuring that the delivery of training in LEPs meets the GMC s standards, including enabling trainees to meet the requirements of their curriculum and assessment system. In many deaneries evaluation and management of the training programmes and the constituent posts in LEPs is undertaken by Heads of School or similar. Where they exist these roles are useful as they are joint deanery/college appointments. However, these individuals, (even when joint appointments and not directly responsible for managing the training programme or posts under review) will not generally be sufficiently removed from the local training programme to provide external advice to the dean. Therefore, the GMC would normally expect that when investigations of issues and concerns about the quality of training are conducted by deaneries help is sought from the relevant college to identify expertise outside the deanery. 37. One of the benefits of external advice in these situations is to bring examples of good practice or learning from outside the deanery on how to address failings or risks. 38. The Joint AoMRC and COPMeD/COGPeD Training Advisory Group Guidance on external advice from medical specialists (March 2010) suggested that deaneries should always use external input for visits undertaken where there is an established serious issue impacting on training, but that externality should be at the dean s discretion for routine monitoring visits to LEP or programmes and for visits undertaken to identify whether there is a serious issue. 39. Does this strike the right balance? Is an external college presence needed when deaneries undertake routine visiting to LEPs or when investigating whether there is a serious issue and what would be the resource implications? Would the costs of more routine college involvement be prohibitive? Is there are a risk that, in the transition to LETBs in England, these sorts of activities are starved of resources? Discussion point: How can colleges best contribute to the investigation of poor practice in their specialty and share examples of good quality training delivery? 11

12 GMC visits 40. Earlier in this paper we set out why we consider that college inspection visits, independent of the regulatory process, are no longer appropriate. However, several of the participants at our summer workshops suggested that the type of visits now conducted by the GMC may make it more difficult to probe specialty specific issues. 41. It should be noted that GMC visits have focused on how deaneries manage programmes in a generic way. We are now focusing on how LEPs work with deaneries to respond to concerns about the delivery of training. But we have never used the visits process to look specifically at whether programmes are delivering specialty curricula and assessment requirements. Clearly, the QA process overall needs to address such issues. The question is whether visits are the best tool for doing so. Would a more effective mechanism be a review of e-portfolios and supervisors reports of the kind undertaken the RCGP? 42. Criticisms have also been levelled at the composition of visit teams. Although all teams contain relevant specialty expertise, visitors are not accountable for having detailed knowledge of curricula or any college guidance on best practice. But it may be time to re-examine our approach: the improving quality of the data now used to plan visits and target areas of potential concern, and the use of thematic QA visits, may make direct college involvement more relevant in the future where specialty specific issues have been identified for investigation. If there are known issues in a particular specialty in the location being visited the relevant college is the obvious source of expert input. The question is how that specialty input can most usefully be deployed. 43. It might, for example, be possible to develop a more integrated role for the colleges in the pre-visit stages of the process where risks are assessed by the visit teams and the response to concerns teams. It may also be helpful for the colleges to nominate one or more external advisors to whom the GMC could turn for a definitive college view and detailed knowledge of the curriculum and assessment system. Such advisors would need to meet GMC-determined standards/criteria. 44. Some participants at the summer workshops suggested that GMC visits teams could draw from a pool of college approved specialty experts. It is important to be clear about the implications of such a model. Experts would still need to be appointed and trained by the GMC on the basis of their competence for the role within the visit teams where specialty specific matters were at issue. The specialty advisor would need to be, and would be paid as, part of the visit team. At all times the individual would be representing the GMC and accountable to the GMC, and not to their college. Like any other visit team member, selection would be a matter for the GMC and those who perform poorly are likely not to be used. Thought would also need to be given to the practicalities in different specialties. In small specialties, for example, there may be particular difficulties finding sufficient suitable recruits. 45. A less formalised model could, therefore, be preferred in which colleges encourage individuals they regard as possessing the necessary expertise and other qualities to apply to the GMC to be part of its pool of visitors. Alongside this, colleges 12

13 could usefully prioritise the strengthening of their contribution to deanery processes, including representation on deanery specialty visits to LEPs. Discussion point: How can the GMC make best use of college specialty expertise within its visits process? Consistency and quality among external advisors and visitors 46. Whether those providing externality are providing advice in GMC led visits, deanery visits, the ARCP process or in some other way, there needs to be consistency of quality and approach across specialties and locations, and avoidance of conflicts of interest. The feedback from the summer workshops suggested that the quality and training of advisors was sometimes variable. The feedback from the college completed questionnaires points to differences in the person specifications, appointment processes, training and appraisal of those appointed to fulfil QA roles on behalf of the colleges. Is there scope, therefore, for the GMC to define the principles against which those deployed by the colleges in these roles are selected, trained and appraised so as to ensure confidence in the externality provided? This need not involve GMC approval of the kind recently introduced by the GMC for trainers, but might include agreed principles and criteria. Discussion point: How can the quality of external advisors and visitors who are part of the regulatory process be assured? College examination and portfolio data 47. Another suggestion from the summer workshops was that more use should be made of college examination data as indicators of quality. We already use this data by, for example, mapping specialty examination results against deaneries as a potential indicator of the quality of training provided in a particular area and to compare examination success with ARCP progress. 48. Others in the regulatory framework may also benefit from the sharing of exam data. For example, the workshops revealed an appetite among some medical schools to know how their graduates progress following qualification (which is a requirement of Tomorrow s Doctors). With this in mind, could colleges map their examination data onto candidates primary medical qualifications and provide data for medical schools about the performance of their graduates or is this role best performed by the GMC? 49. Some colleges and faculties have begun exploring how e-portfolio data could help in evaluating training, for example the RCGP review of the quality of educational supervisors reports. Others are exploring whether automated reports could be developed on the number, timing and nature of workplace based assessments undertaken within particular LEPs. There are sometimes significant cost implications in developing these e-portfolios and the value of data held in e-portfolios remains relatively underutilised. 50. The sharing and comparison of data might be facilitated by the use of a single, standard portfolio across all specialties which trainees maintained throughout 13

14 their career. One option would be for such a portfolio to be held by the GMC using its IT infrastructure and made accessible to trainees and colleges. If this was seen as desirable in principle, it might also help relieve individual colleges of the costs associated with maintaining their own e-portfolio systems and release resources which could be directed in other areas. Clearly, there would be significant financial, political and data protection considerations to be addressed in any such proposal. ASRs Discussion point: How can we make better use of college examination and portfolio data to inform the quality assurance process? 51. As we noted earlier in this paper, there has been considerable comment from participants at the previous workshops about the utility of the ASRs, the burden they impose on colleges and the value of the data they provide. 52. We need, therefore, to be clear about the purpose of the ASR. The QIF refers to ASRs as providing an essential specialty perspective, a national overview by specialty and sub-specialty. This points to a report which should be focused on identifying trends and patterns across a specialty rather than identification of issues in a particular location which are better addressed through other mechanisms. If that is the case, there may be merit in the suggestion from one of the college representatives at the summer workshops that the GMC should prospectively identify a rolling programme of themes (perhaps over three years) for the colleges to report on against a defined set of data sources. 53. The ASRs also provide a counterpoint to deanery reports to the regulator and are an opportunity for colleges and faculties to share data they collect which may provide a different view of the quality of training within a deanery s programme/s. National exam results, attendance at training the trainer events and portfolio information can contribute. Colleges and faculties that undertake reviews of patient services may also be able to offer another view on the quality of training across the UK. Discussion point: What should be the purpose of the ASRs and how might this purpose be met? Post and programme approvals 54. PMETB and now the GMC, invites colleges and faculties to support deanery requests for new training posts and programmes. Feedback from colleges and faculties has indicated that they often feel that they no longer have the information needed to offer a view and/or that they are reluctant to raise concerns and be seen to obstruct deaneries. In some cases they are receiving requests for support from deaneries too late to investigate the information they hold and seek advice from regional networks. Discussion point: How can we ensure that colleges and faculties are able to raise concerns about new posts or programmes if they feel they will not meet the requirements of the curriculum and assessment systems or would 14

15 otherwise deliver poor training? What information would colleges and faculties need to provide an informed view? Identifying and sharing good practice 55. Quality assurance is about supporting quality improvement as well as maintaining minimum standards. Some colleges have been better able than others to identify and share good practice in their annual specialty reports. In what ways can we draw on college local and regional networks to identify and disseminate examples of good practice? Discussion point: How can colleges contribute to the better dissemination of good practice? Conclusions 56. This paper explores a number of ways in which college expertise and independence might be used to enhance the quality improvement framework. Although colleges have expressed a readiness to support that process, they will quite rightly be mindful of the potential costs of any interventions they make and how they interact with other parts of the system, such as the deaneries. We can explore what is feasible and affordable once we have identified what is desirable. In considering where colleges can best add value, we may also want to identify activities currently performed which should cease. We do not wish to increase the burden on the colleges or on the healthcare economy, but to make sure we use those resources to best effect. Next steps 57. We will write up a summary of our discussions at the workshop on 9 October 2012 and share these with you by . If you have any questions or further ideas please feel free to us on quality@gmc-uk.org 15