RO Training Day Organisational Structure for the Delivery of Enhanced Appraisal in Scotland

1. RO Training DayOrganisational Structure for the Delivery of Enhanced Appraisal in Scotland Ian G Finlay Scottish Government Health Directorates

2. Regulation of Doctors • Reserved power • Appointment of ROs • Revalidation will be a UK process • Scottish Context • Remediation is a devolved matter

3. 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

4. Appraisal of Doctors in NHS Scotland Primary Care • Robust • Appraisers NES trained • Appraisers allocated • SOAR (e-system) Secondary Care • Variable

5. National Appraisal Leads Group • Leads - 14 Health Boards • Developed an appraisal form- draft • E-form SOAR • Appraisal Handbook -draft

6. Basic Principles of the structure for Enhanced Appraisalin 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

7. 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

8. 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

9. 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

10. 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)

11. 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

12. Delegation

13. 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

14. Structure for the delivery of enhanced appraisal in NHS Boards RO Appraisal Steering Group Appraisal Lead Select appraisers List trained appraisers Allocate appraisers APPRAISAL CD/AMD

15. Structure for the delivery of appraisal using CD/AMD CD/AMD RO Select appraisers List trained appraisers Allocate appraisers APPRAISAL

16. Supporting evidence for enhanced appraisal Now • Proportionate • Meaningful • Cost effective • Deliver “fit to practice”

17. Evidence of quality of practice for specialists • Colleges and Faculties • Menu of suggested suitable evidence • Appraisee and appraiser discuss and agree nature of evidence

18. Provision of supporting evidence for enhanced appraisal at Board level Incremental process • Description of practice - patient numbers • Provision of record of complaints

19. 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)

20. Proposed structure for MSF Appraisee ( 15 Raters) “Raters” IT process Appraiser Appraisee

21. 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?

22. 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

23. Quality Assurance • Feedback from selected appraisees • Feedback from selected appraisers • Annual report • QIS Tool (pilots Tayside, Forth,Highland) • GMC

24. Michaelangelo

25. Michaelangelo’s David

26. 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