RO Training Day Organisational Structure for the Delivery of Enhanced Appraisal in Scotland Ian 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 Group Appraisal Lead CD/AMD Select appraisers List trained appraisers Allocate appraisers APPRAISAL

Structure for the delivery of appraisal using CD/AMD RO CD/AMD Select appraisers List 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 Group proposals 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