Revalidation Delivery Board Scotland (RDBS) minutes: May 2019

Attendees and apologies

Present 

• Ian Finlay, SG (Chair)
• Frances Dow, Lay Member
• Alison Smith, Independent Healthcare Partners Scotland
• Sharon Baillie, HIS
• Willie Paxton, GMC
• Jenny Duncan, GMC
• Christiane Shrimpton, NES
• William Liu, NES
• Amjad Khan, NES
• Mike Winter, NSS
• Alison Graham, SAMD
• Iain Kennedy, BMA
• Simon Barker, BMA
• 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. A particular welcome was given to Christiane Shrimpton and Amjad Khan, both from NES who were attending RDBS for the first time. 

Apologies

Apologies were noted from Norman Gibb and it was confirmed that he has now stepped down from his role as patient representative.  IF recorded the gratitude of the Board for all Norman’s work and contribution over several years. IF will write to Norman. 

Minutes of the last meeting held on 29 October 2018

There were a number of matters arising from the last minutes:

• Simon Barker had requested a change to paragraph 6. The agreed change is “IF’s expectation was that the number of retirees over three years would be low and that dozens would not be exceptional or acceptable”
• in paragraph 7 the word appraisals was changed to appraisers
• there was further discussion in relation to paragraph 20. IF reaffirmed that it is unequivocally the RDBS position that appraisers in secondary care should undertake a minimum of 10 appraisals pa for reasons of quality and consistency (primary care appraisers undertake >20 appraisals per annum). SB suggested that if this was proving in reality to be “aspirational” then the guidance should reflect that. Frances Dow suggested that the wording might be “ an appraiser should normally undertake 10 appraisals  pa”. Mike Winter said that from an NSS point of view an appraiser needed enough activity to maintain skills, consistency and the confidence of appraisees. IF noted that BMA representatives in the past had been critical of appraisers undertaking too few appraisals. The following wording was agreed to be added at paragraph 20 – “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”
• at paragraph 25,  SB asked that the minutes be changed to reflect that he asked a question rather than made a statement.  The new wording will be “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”
• Iain Kennedy queried paragraph 5 of the last minutes which stated that it is not necessary for an appraiser to be in the same clinical role as an appraisee or indeed in any clinical role. IF stated that he was aware of only one instance in Scotland where for logistical reasons the appraiser was not a doctor. On the wider issue IF (supported by MW and FD) explained that there is a substantial body of scientific evidence that shows that appraisal by someone from a different clinical area can be superior to appraisal by a colleague from the same clinical area. IF noted however that as far as he was aware all GP’s in Scotland were being appraised by other GP’s

Board Performance – IF updated the Board  that remedial action had been undertaken by HIS, GMC and SG in this matter and it is anticipated that appraisal rates will be improved for 18/19.  This has been the subject of Cabinet Secretary briefing.  

Use of retired appraisers

Sally White confirmed that Boards had reported that 10 appraisers had been used who had been retired for between 3-5 years. Of those 10, three were no longer undertaking appraisals.  As of 1/4/19 the figure is now 7.   The Board accepted that this was exceptional and the matter was closed.  

SOAR security

William Liu confirmed that SOAR has now moved to the new TURAS platform and has the capability to provide a 2 factor log in process.  He emphasised that SOAR has been operational for 10 years ago and there have been no breaches of security. Further the system is regularly challenged and has been found to be robust.   

SB asked if the data held for doctors on SOAR is as secure as that is held for patients? WL said that he believed that it was within the constraints of the feedback from doctors themselves who are resistant to the imposition of requirements for more frequent changes of passwords.   SB and IK indicated that colleagues  from BMA would like to see a system developed that needed a second code sent to a mobile device before access was obtained. This however would exceed current security of patient NHS data.  IF concluded that the data was as secure as patient data with the exception that password changes were required less frequently and that this was specifically at the request of users.  Alison Smith commented making the password change  frequent and complex led to individuals writing it down which was counterproductive. 

WL concluded that NES would consider a clear proposal that outlined in detail the specific  security update that the Board required. NES however believe that for all practical purposes SOAR is as secure as it requires to be.  SB agreed to take this back to BMA colleagues.  

NES update

WL confirmed that the MARQA forms had been sent out.  The  review panel will meet on 22/7/19 to discuss responses.  

IF noted that Mike Winter who had previously chaired the panel was  retiring .  IF thanked Mike for the work he had undertaken for both the panel and the RDBS.     

IF informed the board that Frances Dow has agreed to chair the panel this year and highlighted that fact that she had many years’ experience of appraisal and revalidation and is the lay rep on RDBS.  

IF reaffirmed that the MARQA is commissioned by RDBS and the document will be presented to our next Board meeting.  He also noted that any actions arising from the process are normally dealt with by the CMO in a formal letter to Designated Bodies and Health Boards.  

Action point:

SG to agree with NES  the process for dealing with the MARQA report

Governance arrangements between HIS andNES

Val Millie stated that this was a tripartite process between SG, HIS and NES working on an informal/internal document which would allow all to be in a position where everyone involved knew where the lines of responsibility were.    It became clear at the panel meeting last year that it was necessary to know what NES was responsible for and at what point HIS stepped in.  The process document will highlight triggers for HIS and limits of roles and responsibilities.   Sharon Baillie stated that if an issue was raised at the panel it would go through the HIS assessment process to decide what action was required.  

Action point:

• copy of draft process document to be sent to Frances Dow

GMC update

Consultation on patient feedback and revalidation  - Jenny Duncan confirmed that this consultation was open and GMC were encouraging as many responses as possible. A brief discussion about the role of patient feedback followed.

The overall view of the meeting was that patient feedback was welcome but the question remained as to how to collect meaningful information in a practical and pragmatic way.

Possible changes to RO Regulations -  IF noted that the RO Regulations are a reserved function so overall responsibility is with DH, England.  There are a number of proposed changes that are mostly technical/drafting issues.  The main issue that would affect Scotland is the proposal  that all doctors must have an RO.   At present there are a number of doctors who are unable to connect for whatever reason and they revalidate through a rigorous GMC process. IF advised that officials in SG were having regular meetings with colleagues in DH to discuss the regulatory changes that will be taken forward. 

Training for new RO’s and updates for RO’s

Training for new RO’s – IF noted that almost half of the RO’s in Scotland had changed in the last 12 months and supported the suggestion that a training day should be offered for new RO’s.  The GMC, NES and SG will collaborate in providing the course later this year.  

Updates for RO’s – IF noted that traditionally an update day is held for established ROs but that this did not occur in 2018. It is proposed that the next event will be in 2020 to include a range of topics such as new RO Regulations, Fitness to Practice, Managing Concerns, thresholds for referral to GMC, RO role, SOAR etc.

Christiane Shrimpton having had experience of the English system was invited to comment on appraisal in Scotland. She thought that having a national system was an advantage and that the process for appraisal  was well embedded. The next step might be to look at quality of appraisal.    

IF suggested that the Scottish appraisal guide “A Guide to Appraisal for Medical Revalidation” published in March 2014 should be updated.  It was suggested that a small group of key stakeholders might be convened for this purpose.  

Action point:

• SG to organise a small working group to review Scottish appraisal guidance

MW asked whether the membership of the RDBS should be reviewed given that there had been several retirals. In particular he suggested that another RO might positively contribute to the work of the Board.  IF agreed that the membership should be reviewed. 

Action point:

• SG to review the membership of the RDBS with a view to ensuring that all appropriate groups are adequately represented

AOCB

IF noted that this was the last meeting of the Board that MW would attend due to retiral. He formally thanked Mike for his work for the Board over several years and recognised his substantial contribution to the development of appraisal and revalidation processes in Scotland. His advice had been invaluable.

Next meeting

The next meeting of RDBS is to be held on Tuesday 29 October 2019, 2-4pm in St Andrew’s House, Edinburgh in Room 1E.09.