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
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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
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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?
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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
Select appraisers
List trained appraisers
Allocate appraisers
APPRAISAL
CD/AMD
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
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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
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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