RO Training Day

Organisational Structure for the Delivery of Enhanced Appraisal in

ScotlandIan G Finlay

Scottish Government Health Directorates

Regulation of Doctors

• Reserved power• Appointment of ROs• Revalidation will be a

UK process• Scottish Context• Remediation is a

devolved matter

Revalidation based on Enhanced Appraisal

• An annual enhanced appraisal over a 5 year cycle

• Patient and peer feedback (MSF)

• Based on evidence already present in the workplace for clinical governance

• Evidence – fulfil the framework of Good Medical Practice

Appraisal of Doctors in NHS Scotland

Primary Care

• Robust• Appraisers NES trained• Appraisers allocated• SOAR (e-system)

Secondary Care• Variable

National Appraisal Leads Group

• Leads - 14 Health Boards

• Developed an appraisal form- draft

• E-form SOAR• Appraisal Handbook -

draft

Basic Principles of the structure for Enhanced Appraisal

in 2011/2012

• Training of appraisers standardised to deliver enhanced appraisal

• All appraisers must be trained (NES)

• Appraisers allocated to appraisee

• Align appraisal in primary and secondary care

Appraiser selection and training

• NES have provided appraiser training for primary care since 2002

• NES funded by SGHD to deliver appraisal training for secondary care (circa 650) over two years (100 now trained)

• One day or two day courses• Consistent standard across Scotland• Board level- select appraisers for training

Allocation of an Appraiser

• The appraiser will be allocated to the appraisee• Local System to allocate appraisers• Primary care – Local appraisal adviser• Secondary care – ?Appraisal lead, ?CD/AMD• Appraiser from same specialty (not guaranteed)• Appraisee allowed one objection

Who should have an enhanced appraisal?

• All doctors who hold a licence to practice

• Consultants and SAS doctors

• Employed non standard doctors

• ?HR and the Pay Roll

• Compile a local list

Doctors who hold a national training number not included

Timing of the Appraisal

• Primary care – throughout the year

• Secondary care –

Align with job planning and pay progression

Help if throughout the year (10 appraisals/ appraiser)

Urgent tasks at Board level

• Compile a comprehensive list of all licensed doctors who will require to be appraised

• Compile a list of all “old style” trained appraisers• Select appraisers for NES enhanced appraisal

training program• Develop a structure to allocate the appraiser to

the appraisee• Ensure that every doctor has an appraisal and

form 4 in 2011

Delegation

NALG - Appraisal steering group

• Appraisal lead/Appraisal advisor• AMD/CD, HR, LNC,SAS doctors, Universities

and lay member• Allocate appraisers to appraisee• Minutes provide governance• Responsible for an annual report• AMD/CD free to deal with remediation issues

Structure for the delivery of enhanced appraisal in NHS Boards

RO Appraisal Steering GroupAppraisal Lead

CD/AMD

Select appraisersList trained appraisers

Allocate appraisers

APPRAISAL

Structure for the delivery of appraisal using CD/AMD

RO CD/AMD

Select appraisersList trained appraisers

Allocate appraisers

APPRAISAL

Supporting evidence for enhanced appraisal

Now• Proportionate• Meaningful• Cost effective• Deliver “fit to

practice”

Evidence of quality of practice for specialists

• Colleges and Faculties

• Menu of suggested suitable evidence

• Appraisee and appraiser discuss and agree nature of evidence

Provision of supporting evidence for enhanced appraisal at Board

level

Incremental process

• Description of practice

- patient numbers

• Provision of record of complaints

NALG -MSF Sub Groupproposals

• Single MSF Scotland – colleague feedback• Patient feedback will be separate and may be

specialty specific• Ideally should contain narrative• Feedback by a trained person• Focus on the administrative structure (cost

effective)

Proposed structure for MSF

Appraisee ( 15 Raters)

“Raters”

IT process

Appraiser

Appraisee

Outstanding issues relating to the organisational structure of MSF

• Should the appraisee see the unedited MSF before the appraisal?

• What happens if the comments are especially negative?

• What tool do we chose?

Output from appraisal

• Form 4 to CD/AMD• Analysis• SOAR – the final common pathway• Satisfactory list to RO• Unsatisfactory - MSF (colleague or patient) - Tacking concerns locally

Quality Assurance

• Feedback from selected appraisees

• Feedback from selected appraisers

• Annual report

• QIS Tool (pilots Tayside, Forth,Highland)

• GMC

Michaelangelo

Michaelangelo’s David

Actions in 2011

• Identify and list at local level all doctors in NHS Scotland who require an enhanced appraisal

• Ensure that they are all appraised in 2011• List all current appraisers - select for NES

training • Develop the local structure for allocation of

appraisers and organisation of enhanced appraisal