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National Clinical Assessment Service: A guide for health practitioners – frequently asked questions. 

This guide is aimed at healthcare practitioners whose employer or contracting body has made contact with NCAS for advice about an individual doctor, dentist or pharmacist about whom there are performance concerns. The guide is intended to provide clear and helpful information about our role and to address some of the most frequently asked questions about our services.  


Case management services - overview

These web pages are a guide to NCAS services but our ways of working are changing. Please talk to our advisory team about accessing our services:

 

 

Advice and support

All cases start with advice and support , a phone call from one of our advisers, which will usually be within a day of your first call to us, though we can also arrange to call you on a different date if this would be more convenient.   


You tell the adviser what the problem is, the adviser asks questions, and you work out together what the options are for addressing a performance concern. We may suggest follow-up action, including discussion of the specialist services described below. But advice and support is a service in its own right and the adviser and caseworker allocated to the case are your contacts for further work with us. 


With each episode of phone advice you will receive a confirmation letter shortly afterwards, and a further contact from us will be scheduled unless it has been agreed that the case can be closed. We are here so long as you need us. Each year, about 600 referrals are brought to resolution in this way.


Assessment services 

Since being set up in 2001, NCAS has developed and refined the design and delivery of leading edge models of performance assessment. Before offering these specialist services, our advisers and assessment experts will help you identify the intervention best suited to your needs. We carry out assessments mainly for NHS employing and contracting bodies but we can also undertake them for regulators or other organisations concerned with practitioner performance.  


All our assessments are designed to support the effective management of concerns about a practitioner’s work and to protect patients. We conduct 40-50 assessments each year and normally follow them up with PSR work. All our assessments are underpinned by a rigorous framework of quality assurance so that all parties can rely on the robustness and independence of the findings. Find out more about assessments.   


Professional Support and Remediation services 

NCAS offers a wide range of bespoke action plans to support practitioners in their return to safe and effective practice.  Action plans are developed following a review of the particular circumstances of each case, taking into account any development needs in areas such as leadership, patient or colleague interaction or other behavioural issues, in addition to supporting the development of knowledge and skills in the context of their clinical practice.  NCAS action plans include:

 

  • Remediation action plans - where evidence identifying performance concerns is available either following an NCAS assessment or local assessment

  • Return to work action plans - supporting a practitioner's reskilling and/or reintegration into clinical practice following a prolonged absence of time (with or without remediation of any pre-existing performance concerns)

  • Professional development action plans - to support practitioners in developing particular areas of their practice further.


NCAS has been working in this area since 2008; the 2011 Department of Health Report of the Steering Group on Remediation (pdf 530KB) advocated this type of service. 


Case conferences

Our advisers are independent, so they can bring the parties together without any baggage. Advisers start by talking to the referring manager, but we encourage managers to tell practitioners that we are involved and advisers can meet with practitioners and their representatives, as well as facilitating all party case conferences. When you refer a case to us, think about how the adviser can best be used. 

 
Support for investigations

 Requests for advice about how to investigate performance concerns are amongst the most common coming to us. We don’t investigate ourselves but we regularly advise on how investigation should be approached and our Good Practice Guide – How to conduct a local performance investigation - deals with this topic in detail. We also run regular workshops on conducting investigations.

 

Suspension or exclusion from work 

In England in 2012/13, approaching 200 practitioners were excluded or suspended from work using MHPS or Performers List Regulations. Both frameworks ask managers to discuss these measures with NCAS. Our aim is to ensure that exclusion and suspension are used only when necessary and that episodes last for the shortest time consistent with resolving the concern and protecting patients and services. By monitoring this area of casework, we have shown that exclusion episodes are getting steadily shorter, saving the NHS money and minimising loss of practitioner skills.

 

Assisted mediation

As part of the extensive experience NCAS brings to supporting the effective performance management of practitioners in resolving concerns we recognise that in some circumstances, the issues may impact on professional relationships. NCAS has identified that in over 50% of referrals, concerns are associated to some degree with conduct that may have a significant impact on the team and patient care.


In order to assist with the complex challenges that behavioural disruption can create; NCAS has developed an Assisted model of mediation which officially launched in April 2017.

 

Mediation Service is to bring together the parties concerned to help them find a mutually acceptable way to forward that enables a professional working relationship.


For further information please see our Assisted mediation service leaflet.

 

Supporting the development of local procedures

Good management of health professionals rests on good local governance, with clear procedures to manage concerns about performance. Every case brought to NCAS is an opportunity for our advisers to explore with managers how local procedures are working and whether any improvements might be made. The NCAS Education Programme also provides valuable opportunities for sharing ideas and good practice.

 

Re-validation and NCAS support for responsible officers

NCAS wants the focus of activity in professional governance to be at the front line of services so far as possible. We work to support local governance systems so that national regulatory systems are involved only where absolutely necessary. In relation to medical revalidation specifically, NCAS supports the work of responsible officers by providing:

 

  •  general and specialist advice on the handling performance concerns

  • a range of specialist assessment interventions

  • remediation support ranging from general advice to bespoke local structured programmes  
  • education programmes for ROs and senior clinicians to support them in their role, particularly in tackling performance concerns locally

 

See our 2011 position paper. 

 

telephone

NCAS advisers

NCAS has advisers in England, Northern Ireland and Wales.

 

In England, advisers are organised into north and south teams. Cases are allocated to minimise travelling times if meetings are required. 

 

You will find you get to know certain advisers and they will get to know you and your organisation. 


Meet our advisers here.