National Clinical Assessment Service

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National Clinical Assessment
Service Promoting Confidence in Doctors and
Dentists Professor Alastair Scotland FRCS FRCP
FFPH Director of NCAS
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Introduction

• What do we do and why?
• Services
• How can we help?
• Methods
• What have we seen and how have we done?
• Workload and performance

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What do we do and why? SERVICES
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The Challenge

• Medical scandals
• Was poor performance tolerated more than it
  should have been?
• Repeated common features in service and
  individual failures
• Was the NHS able to learn from its own mistakes?
• Systems for responding to these failures not fit
  for purpose
• Outdated, unwieldy and bureaucratic
• Excessively legalistic, adversarial and
  court-like
• Media response focused on blame
• Difficult or impossible to separate out
  individual failure, system failure and untoward
  incidents which were no-ones fault

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The Response

• Statutory duty of quality
• Placed on every health care organisation
• Underpinned by national quality standards (NICE /
  NSFs) and support to local governance frameworks
  (CGST)
• National regulatory framework for private and
  public sector health services (HCC)
• National initiative to build systems for learning
  lessons on patient safety (NPSA)
• National service supporting the resolution of
  concerns at practitioner performance (NCAA / NCAS)

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NCAS Coverage

• Geography
• NHS England (2001)
• NHS Cymru / Wales (2002)
• HPSS Northern Ireland (2004)
• NHS Scotland (2005?)
• Staff Groups
• Doctors (2001)
• Salaried and employed dentists (2003)
• General dental practitioners (2005)
• Other Sectors
• Prison Medical Service (2002)
• Defence Medical and Dental Services (2002)

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NCAS Services and Functions From 2001

• Case work
• Advice on local management of performance
  concerns
• Support expert help to resolve complex
  performance disputes
• Assessment full clinical performance assessment
  where detailed diagnostic work is needed
• Action planning and follow up
• Programme work
• RD assessment, support and advice methods
• Education and support to improve local
  expertise
• Evaluation individual cases and methods

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After 2001 New Work

• Suspensions and exclusions
• Restriction of Practice and Exclusion from Work
  Directions NHS bodies must contact us before
  formal exclusion
• Performers Lists Regulations PCTs advised to
  consult NCAS on suspensions (and GPs must give
  details of NCAS assessment)
• Supporting local resolution of long term
  suspensions
• Monitoring and reporting on suspensions and
  exclusions
• Directions on Disciplinary Procedures 2005
  extending our rôle on suspensions across the
  whole framework
• Alert letters developing and managing a web
  based alert system for practitioners about whom
  there is a significant concern

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2005 On the Horizon

• Other sectors private healthcare
• Other professions how our approach might be
  extended
• Other funding models self-funding for part or
  all of our work
• Impact of Inquiries and reports NAO and PAC,
  Shipman, Ayling, Neale, KerrHaslam
• Impact of Regulators work
• Contracting with GDC to provide its performance
  assessments
• Introduction of revalidation and relicensing

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How can we help? METHODS
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(No Transcript)
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The Performance Triangle
Work Context
Clinical Capability
Behaviour
Health
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What have we seen and how have we
done? WORKLOAD AND PERFORMANCE
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Requests for NCAS Help April 2001 June 2005
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HCHS Referrals April 2001 March 2005
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Referrals by Age April 2001 March 2005
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Factors that Impact on Performance

• Individual
• Clinical knowledge and skills
• Health and stress
• Psychological factors
• Leadership skills
• Organisational
• Education and training undergraduate and
  postgraduate
• Organisational culture and climate
• Team functioning
• Workload and sleep loss

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Number of Factors per Doctor 50 Cases
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Performance Two Key Objectives

• Supporting resolution of any concern at medical
  or dental performance
• Referrals continuing to rise c2 of the active
  profession
• At end of 2004/05 404 active cases, including 106
  (26) support, 25 (6) assessment cases and 42
  (10) assessment follow up cases
• Cases are being referred earlier and closed
  quicker
• 89 of trusts, 84 of foundation trusts and 82
  of PCTs have used our services since 2001 c70
  in 2004/2005 alone
• Helping health care staff not to need our
  service
• In person and hands-on our advisers
• On the web our toolkit
• Through group work our development programmes

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Performance Plus Two Key Outcomes

• Reducing inappropriate use of suspension or
  exclusion
• Alternative to exclusion offered in 85 of new
  cases
• Prevalent number of long term exclusions halved
• Two thirds of all established exclusions back to
  work or returning
• BUT one in five leave the employer before
  concern resolved
• Developing and using excellent assessment methods
• Individual cases followed up and reviewed after
  six months and one year
• Quality assurance, evaluation and further
  development of assessment framework using case
  experience

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National Clinical Assessment
Service Promoting Confidence in Doctors and
Dentists Professor Alastair Scotland FRCS FRCP
FFPH Director of NCAS