Revalidation Delivery Board Scotland (RDBS) minutes: October 2018

Attendees and apologies

Present 

• Ian Finlay, SG (Chair)
• Alison Smith, Scottish Independent Hospitals Association (SIHA)
• Jenny Duncan, GMC
• Willie Paxton, GMC
• Frances Dow, Lay member
• Leslie Marr, HIS
• Alison Graham, NHS A&A (by telecom)
• Iain Kennedy, BMA
• Simon Barker, BMA
• Rowan Parks, NES (for Stewart Irvine)
• Niall Cameron, NES
• Harry Peat, NES
• Elaine Green, NES
• Mike Winter, NSS
• Val Millie, SG
• Sally White, SG (Secretariat)
   

Items and actions

Welcome and introductions

Ian Finlay welcomed everyone to the meeting and round table introductions were made. 

Apologies

Apologies were noted Stewart Irvine, Norman Gibb, Andrew Buist and Sharon Baillie.  

Minutes of the last meeting held on 5 June 2018

The minutes were accepted as an accurate record. IF raised as a matter arising from the minutes the issue of the use of retired appraisers (paragraphs 13-22 of minutes of 5 June 2018 refer).  

Iain Kennedy advised that the BMA view remains that five years is too far from clinical practice and risks undermining the credibility of the process. The BMA view is that if this is necessary the service needs more appraisers. 

In response IF noted that the definition of retirement was becoming blurred. There are more portfolio careers, with doctors retiring from clinical work but undertaking other duties that require a license. There is also evidence that it is not necessary for an appraiser to be in the same clinical role as an appraisee or indeed any clinical role.

IF did, however support the premise of the BMA’s point. It was therefore decided to await the outcome of an audit of the numbers of retired appraisers that are currently being used and to present this at the next RDBS in Spring 2019. In doing so we would confirm whether this was an “exceptional circumstance” or not. IF’s expectation was that the number of retirees over three years would be low and that dozens would not be exceptional or acceptable. He concluded by saying that to have an inflexible moratorium on using any retired appraisers would cause difficulty, particularly in small and rural boards.  

Simon Barker said that his concern was that if we do not offer more support for appraisers in general the use of appraisers retired up to five years could become normal rather than exceptional. 

It was noted that Jill Vickerman had also spoken with Sean Neill, Deputy Director of Health Workforce, SG regarding this matter. He had agreed that officials would consider the matter further. 

Action points:

• SG officials to discuss the issue with Sean Neill and send considered response to Jill Vickerman
• SG to establish via RO’s how often they have used appraisers who have been retired for more than 3 years during the appraisal year 18/19 and report back at next meeting

Medical Revalidation in Scotland Annual Report 2017-18

Harry Peat explained that this was the first year that NES had prepared the report and thanked HIS for their role in the handover.  

HP advised that 2017-18 was year 5 of the first revalidation cycle and, as planned there were only 5% of doctors requiring to be revalidated in the year. This has often been called a “mop up year”. Of the 515 doctors identified for revalidation 432 received a positive recommendation, representing 84%. The review panel met on 24 July 2018 and reviewed all the returns. Seven designated bodies were sent follow up letters requesting further information or actions. Three designated bodies were approached to ask if their good practice could be shared.  

IF noted the headline figure of 92%  appraisal rate for Scotland.  

The deferral rate of 16% was noted and Willie Paxton advised that this is similar to the  RUK. He reminded the Board  that deferral can be for valid reasons and should not necessarily be viewed negatively.  

Frances Dow also noted the deferral rates and said that she and Norman Gibb always raise this at every panel meeting. She would like to see this figure examined and presented in more detail but in a non-judgemental way to understand the underlying reasons for deferral. 

IF asked if NES could include a more in depth analysis of deferral rates next year

Action point: 

• NES to consider additional questions for subsequent years to establish reasons behind deferrals

IK asked why, when we are revalidating only 5%, the referral rate is 16% - is there a reason it is high?  It was noted that this may be due to the fact that this was a “mop up year” that included doctors with unusual and difficult circumstances. Niall Cameron commented that in his experience there is a fairly consistent approach to deferral from the RO Network.  

Alison Graham commented that it was a good, well written report. She would like to have had more detail about what boards are doing to support doctors who have been deferred.  

Leslie Marr raised the issue of doctors in Scotland working full time here in private practise but being revalidated in England. It was noted that this had been raised before and there was an awareness that they were not included in the Scottish statistics which was not wholly satisfactory. However, at present they are very small in number and not easy to capture.  

It was noted if there was a very small number of doctors in DB only 1-2 doctors need to miss appraisal and reported rate would be in the “red” band. It was suggested that in the future it may helpful to have a footnote to this effect.

IF suggested that there was more concern that there are Boards with a high number of doctors who are in the red category. One in particular caused concern and had been the subject of a  cabinet secretary briefing. LM confirmed that HIS was involved in that case and had met with senior members of the board and had agreed a remedial plan. The matter is now a standing matter at Board meetings.

Simon Barker noted that there was an assumption that appraisers were undertaking a minimum of 10 appraisals per annum in secondary case when this was not the case. NC confirmed that 10 per annum was seen as the ideal but calculations of the number of trained appraisers were based on an assumption that appraisers would undertake only six per annum. This allowed for some “slack in the system”. IF confirmed that the policy position under the guidance was that normally 10 appraisals per annum were needed to maintain confidence and consistency in the process. He recognised that for practical reasons in reality some appraisers undertake less than 10 appraisals per annum.

HIS involvement 

There were questions raised about the level of HIS involvement in the annual reporting process and Leslie Marr advised that her view was that NES would send out the self-assessment forms, prepare the report, hold the panels and arrange sending out the letters from the panel. She advised that she felt that HIS would only get involved if the response to the letters was unsatisfactory.  

Frances Dow asked what would happen in the event that agreement could not be reached about relevant roles. It was agreed this was a valid concern since there would inevitably be “grey areas”. It was agreed that SG should organise a meeting to include  SG, HIS and NES to discuss their respective roles in the process.  

Action point:

• SG to organise a meeting to include SG, HIS and NES to discuss their respective roles in the Medical Revalidation annual reporting process. This date was subsequently set for 11 December 2018

Willie Paxton asked LM to confirm whether the HIS framework included questions about revalidation and appraisal. She responded that it did. LM also stated that revalidation often features in the intelligence sharing meetings.  

Alison Graham emphasised that the annual report should be submitted to senior members of Boards and to be available to non-executive directors and others.  

SOAR security

IF referred to the statement provided by Christopher Wroath, Director of Digital at NES and asked for comments. Simon Barker raised the question of whether the level of security for doctors health information is less than that for patients and asked that this is considered. Niall Cameron stated that the system was secure as it could be with information only available to the appraiser and appraisee and even then it is time limited for the appraiser.  

IK supported SB’s comments and whilst he noted that SOAR has a two factor authentication, the password changing is not enforced. He noted that BMA also remained concerned about the level of encryption within the system. NC went on to say that passwords and authentication factors should be strong and not easily identifiable and it is incumbent upon each doctor to ensure that this is the case in order to protect their own data.   

Action point:

• NES to check that the level of security offered for doctors health data within SOAR is equal to that provided for NHS patient data and that this will be reported to the next meeting of RDBS

Taking revalidation forward

End of programme report

The end of programme report was tabled and noted. 

PPI – consultation spring 2019

Jenny Duncan reported that a pre consultation engagement exercise was being undertaken until the end of the year. Board members were encouraged to comment. 

IF recognised that there was concern that PPI could become disproportionate, expensive and difficult to deliver within the current systems. SB agreed and noted that whilst keen to get patients views he is unsure how this will be achieved with current staffing. 

NC did make the point that whilst there is some dissatisfaction with the current process he feels it is important to remember that we have come a significant way in that all doctors now do PPI at least once every five years.  

Alison Smith noted that moving to an electronic system may not provide solutions. When her organisation moved to an electronic system for PPI they were criticised that it did not include those who did not have IT skills. Further if a nurse assisted in the process it was criticised for influencing what the patient wants to say.  

There was broad agreement with FD who noted that the current system tends to appeal to complainers rather than prompt compliments or constructive comment.  

LM reminded the members of the statistic that 25% of the population has literacy problems; another consideration in planning a PPI system. 

Rowan Parks said it was important to remember that it was patient and public feedback and observed that all the focus was on patient rather than the public feedback.  

Revalidation Oversight Group (ROG)

Val Millie tabled the embargoed paper Taking Revalidation Forward: Working with others to improve revalidation which ROG had allowed her to share with the Board. She asked members to note the headline measures and directed them to the GMC links dealing with the impact of revalidation. 

AOCB

IF expressed his personal and the Board’s gratitude to Niall Cameron who is leaving NES and this was his last Board meeting. He noted it had been a personal delight to work with Niall but more importantly he wished to recognise his enormous contribution to appraisal and revalidation not just in Scotland but beyond. He specifically noted Niall’s work in developing primary care appraisal, the development of SOAR and the  development of appraiser training schemes. IF wished Niall well in the next phase of his career.  

Next meeting

The next meeting has been scheduled for Tuesday 14 May 2018, 2 – 4pm in Conference Room D, St Andrew’s House, Edinburgh.