National Responsible Officer Conference - 4th June 2 01 4

1. National Responsible OfficerConference - 4th June 2014 Hilton Dixon Responsible Officer Fiona Thomson – Templars Revalidation Manager Durham, Darlington and Tees Area Team

2. Structure and working arrangements • 2800 GPs across 2 area teams • 200 appraisers • 2 band 4 admin staff full time • 1 appraisal lead • 2 performance managers • 2 ROs • 2 Deputy MDs • Electronic matching system for appraisers and appraisees • Fortnightly operational group meeting

3. Confusion and complexity and clarity - NHS | Presentation GMC, 6th May 2014

4. Confusion • Some locum agencies not DBs • Who investigates performance concerns? • NHS England is the default DB for locum doctors with no DB • Do locums understand the appraisal and revalidation processes? • Who pays for the appraisal? • Are the fees consistent? • Who does the appraisal?

5. Complexity • Locum medical consultant approaches the Area Team • NHS England is not their employer and they are not a GP • Locum Agency not a DB therefore no RO but offers to appraise/pay • The doctor lives nearest DDT Area Team and is the Designated Body • Performance concerns arise on discussion with RO where the doctor works.

6. Collaborative approach • AT confirmed they were the DB and RO • FT to investigate concerns • FT to appraise as a locum • AT to undertake formal whole of practice appraisal as DB • Requested past appraisal documents • Discussion with ELA

7. How to get clarity? • ELA advice? • Are GMC decisions appropriate? • NCAS advice? • RO to RO communication? • Why are some locum agencies are DBs some are not? • What are the implications • Processes for complaints/SUI investigations • Information sharing • Risk assessment as DBs and ROs? • Need for locum agency RO forum?

8. Issues for Locum Doctors • Difficult to obtain feedback particularly for short term locums • Appraisers difficult to find • Appraisers may be selected on commercial basis alone • May not get sufficient support from Agency • Pressure to work through agencies in return for support • Easy to blame – unfairly discriminated NHS | Presentation to [XXXX Company] | [Type Date]

9. Issues for overseas Locums Doctors • CPD carried out overseas • May have overseas appraisal which doesn’t meet the UK requirements • Difficulty in securing adequate UK locums to make UK appraisal appropriate or obtain 360 and patient feedback • Many specialists come to the UK for a few weeks a year but may not return due to revalidation difficulties NHS | Presentation to [XXXX Company] | [Type Date]

10. Issues for Locum Agencies • Validating overseas evidence • Cost • Locums move designated bodies • Inappropriate connections • Inability to support certain doctors • No remediation • Communication with NHS Trusts/health Boards • Loss of supply – many take retirement option • Need for communication with NHS Trust/Health Boards. NHS | Presentation to [XXXX Company] | [Type Date]

11. Concerns Around Locum Agencies • Agency has no knowledge of previous history/complaints when supplying a locum not connected to the Agency • NHS Issues disregarded and locums moved to alternative NHS post • No means of monitoring performance/ identifying trends • Information may not be passed to NHS body • Insufficient recruitment checks • Conflict of Interest when revalidating locums NHS | Presentation to [XXXX Company] | [Type Date]

12. What are the key issues to address • For patients • For the doctor • For the service provider • For the regulator • For the Designated Body and RO

13. Thank you