National Responsible Officer
Conference - 4th June 2014
Hilton Dixon
Responsible Officer
Fiona Thomson – Templars
Revalidation Manager
Durham, Darlington and Tees
Area Team
Structure and working arrangements
• 2800 GPs across 2 area teams
• 200 appraisers
• 2 band 4 admin staff full time
• 1 appraisal lead
• 2 performance managers
• 2 ROs
• 2 Deputy MDs
• Electronic matching system for appraisers and
appraisees
• Fortnightly operational group meeting
Confusion and complexity
and clarity
-
3 NHS | Presentation GMC, 6th May 2014
Confusion
• Some locum agencies not DBs
• Who investigates performance concerns?
• NHS England is the default DB for locum doctors
with no DB
• Do locums understand the appraisal and
revalidation processes?
• Who pays for the appraisal?
• Are the fees consistent?
• Who does the appraisal?
Complexity
• Locum medical consultant approaches the Area
Team
• NHS England is not their employer and they are
not a GP
• Locum Agency not a DB therefore no RO but
offers to appraise/pay
• The doctor lives nearest DDT Area Team and is
the Designated Body
• Performance concerns arise on discussion with
RO where the doctor works.
Collaborative approach
• AT confirmed they were the DB and RO
• FT to investigate concerns
• FT to appraise as a locum
• AT to undertake formal whole of practice appraisal
as DB
• Requested past appraisal documents
• Discussion with ELA
How to get clarity?
• ELA advice?
• Are GMC decisions appropriate?
• NCAS advice?
• RO to RO communication?
• Why are some locum agencies are DBs some are
not?
• What are the implications
• Processes for complaints/SUI investigations
• Information sharing
• Risk assessment as DBs and ROs?
• Need for locum agency RO forum?
Issues for Locum Doctors
• Difficult to obtain feedback particularly for short
term locums
• Appraisers difficult to find
• Appraisers may be selected on commercial basis
alone
• May not get sufficient support from Agency
• Pressure to work through agencies in return for
support
• Easy to blame – unfairly discriminated
8 NHS | Presentation to [XXXX Company] | [Type Date]
Issues for overseas Locums Doctors
• CPD carried out overseas
• May have overseas appraisal which doesn’t meet
the UK requirements
• Difficulty in securing adequate UK locums to
make UK appraisal appropriate or obtain 360 and
patient feedback
• Many specialists come to the UK for a few weeks
a year but may not return due to revalidation
difficulties
9 NHS | Presentation to [XXXX Company] | [Type Date]
Issues for Locum Agencies
• Validating overseas evidence
• Cost
• Locums move designated bodies
• Inappropriate connections
• Inability to support certain doctors
• No remediation
• Communication with NHS Trusts/health Boards
10 NHS | Presentation to [XXXX Company] | [Type Date]
Concerns Around Locum Agencies
• Agency has no knowledge of previous
history/complaints when supplying a locum not
connected to the Agency
• NHS Issues disregarded and locums moved to
alternative NHS post
• No means of monitoring performance/ identifying
trends
• Information may not be passed to NHS body
• Insufficient recruitment checks
• Conflict of Interest when revalidating locums
11 NHS | Presentation to [XXXX Company] | [Type Date]
What are the key issues to address
• For patients
• For the doctor
• For the service provider
• For the regulator
• For the Designated Body and RO
Thank you