This page describes in more detail the case management services outlined in the overview. The NCAS adviser can provide more information and advise on access to the appropriate service.
Case conferences and advice on local investigation
Suspension or exclusion
Health Professionals Alert Notices
Mediation
Assessment services
Back on Track services
Team review
Local review
Supporting the development of local procedures
Education services
Medical revalidation and NCAS support for responsible officers
For some cases we offer to help plan or facilitate case conferences with the employer/contracting body and practitioner. Requests for advice about how to investigate performance concerns are amongst the most common coming to us. NCAS does not investigate but we regularly advise on how investigations should be approached.
NCAS offers advice on the use of suspension and exclusion of practitioners. We aim to ensure that these measures are used only when absolutely necessary and for the shortest time consistent with understanding and resolving the concern. NCAS also monitors the number of episodes, how
they arise and how they are resolved.
If you are considering excluding an employed doctor or dentist who is subject to the Maintaining High Professional Standards framework, you should contact NCAS to discuss the situation before any move to formal exclusion is made. Primary care organisations are required to notify NCAS where they have suspended a practitioner on the Performers List.
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NCAS is developing, at the request of the Department of Health (England), a Health Professionals Alert Notices database (HPAN). HPAN will enable health care employers and contracting bodies to access information about current alert notices about any health care professional in an effective and timely manner. It will also facilitate the local management of alert notices to ensure that the information available is always up to date.
NCAS employs several trained and accredited mediators who can help resolve conflict in the work environment and resolve employment disputes. Mediation is a formal process governed by accepted rules and procedures and so it is important that both parties understand and agree to the process.
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We now provide a range of assessment services:
1. Performance assessment: An NCAS assessment offers a way forward in cases where an independent view on the practitioner’s performance may be helpful. The purpose of an NCAS assessment is to clarify concerns and to identify factors that may be contributing to the difficulties, in order that they may be effectively addressed and resolved. NCAS assessment includes assessment of the practitioner’s health, behaviour, clinical skills and context of practice. We produce a report with recommendations for improvement and resolution of the case. More
2. Assessment of health: Where concerns about a practitioner include some health component, NCAS may advise the employing/contracting body to consider an assessment of their health. We can provide this or we can offer advice to referring bodies who may wish to commission their own occupational health assessment.
3. Assessment of behavioural concerns: Where there are concerns about an individual’s behaviour we can offer an assessment to provide an independent view on whether there are behavioural factors that are causing concern and make recommendations for addressing any difficulties identified.
4. Assessment of communicative competence: An NCAS performance assessment may also include, where appropriate, an assessment of the practitioner’s communicative competence. The purpose of this assessment component is to review, in the clinical context, a practitioner’s
ability to communicate effectively with patients and colleagues. In some circumstances, NCAS may be able to offer an assessment of communicative competence as a stand-alone assessment component.
5. Regulatory assessment: NCAS may carry out performance assessments on behalf of health profession regulators with a specification agreed between NCAS and the regulator. The assessment will include some or all of the components of the NCAS performance assessment.
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NCAS can help referring bodies and practitioners to develop, implement and monitor a further training action plan to address concerns identified through local processes or by NCAS assessment. We can also provide action planning advice and guidance for practitioners who are returning to practice after a significant period of absence. See our NCAS Good
Practice Guide - Back on Track and its supporting templates, which provide a clear framework for helping practitioners return to safe practice.
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To help deal with concerns about the service provided by a clinical team NCAS has developed a specification for team reviews and established a panel of preferred providers. We can advise on whether a team review may be appropriate in a particular case and provide access to the list of preferred providers. The referring body will then contract directly with the providers and
will need to pay for the review. More
This service is still under development and should be available later in 2011.
The purpose of a local review will be to provide information about an individual’s practice to enable the referring body to decide whether there is a problem that needs further investigation or assessment. It will be useful in identifying concerns at an early stage, ensuring that practitioners can be supported as necessary. However, it will not be suitable, in itself, for making a decision on an individual’s fitness for purpose.
Local review will include a record review and an interview with the practitioner to explore issues arising from the record review. NCAS will train reviewers and will maintain a list of accredited reviewers whom referring bodies can commission directly to undertake a local review.
NCAS can advise on developing good local clinical governance procedures, including procedures to manage concerns about performance. Our Toolkit provides useful information. We may also direct people towards our education programme.
Our programme of workshops and conferences aims to share good practice and learning from our casework with all those who deal first-hand with concerns about performance. Workshops are interactive, often using case studies. We provide events at national, regional and local level and for audiences defined by specialty and sector interests as well as for multidisciplinary groups. In particular, we are currently involved in supporting the development of training for Responsible Officers in handling concerns about the performance of doctors.
We work with organisations to tailor-make workshops and provide facilitators and speakers for workshops or conferences. Our annual national conferences have a highly interactive format but with the broader aim of bringing colleagues up to date with our work and sharing the learning from new initiatives and policy developments. If you would like to be added to our mailing list for details about forthcoming events please send your contact details to ncas.education@ncas.npsa.nhs.uk. More
NCAS believes that the focus of activity in professional governance should be at the front line of services so far as possible. We are therefore providing specialist expertise to support local activity so that local governance systems involve national systems only where absolutely necessary.
In relation to medical revalidation specifically, NCAS will support the work of responsible officers by providing:
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general and specialist advice on the handling performance concerns
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a method for local review of areas of an individual practitioner’s performance to clarify concerns. This new form of assessment is currently under development and will be provided by a panel of NCAS-trained and accredited local reviewers
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remediation support ranging from general advice to bespoke local structured programmes
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education programmes for ROs and senior clinicians to support them in their role, particularly in tackling performance concerns locally
This position paper describes our approach in more detail.
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