Bruce Keogh explains why preparing the NHS for the introduction of medical revalidation is one of his main priorities as NHS Medical Director.
Since the Responsible Officer Regulations requiring designated organisations to appoint a responsible officer came into force on 1 January 2011, progress has been made, but we still have some way to go.
The role of the responsible officer is pivotal for ensuring strong and visible clinical leadership and for enhancing local clinical governance systems. It is also essential if we are to realise our ambition to radically improve clinical leadership, accountability and outcomes in the NHS.
A large number of medical directors are now in the role of responsible officer and a key responsibility is to ensure all their doctors are appraised annually. Appraisal underpins both clinical governance and revalidation. It is the key opportunity for organisations to talk to their doctors individually about how they can work together to improve the quality of care they offer. Appraisals should be objective, constructive and supportive.
The process is vital for engaging doctors with organisational ambition, promoting continuous professional development, clinical quality improvement and identifying early potential problems with clinical service delivery. It facilitates personal and organisational development.
Clinical governance incorporates clinical activity and quality in an organisation. It is an integral part of corporate governance and not a stand-alone function.
The Revalidation Support Team, part of Guys and St Thomas’ NHS Foundation Trust supports the implementation of revalidation. Earlier this year, the team worked with SHAs to complete an organisation readiness self-assessment (ORSA) – one of several initiatives taking place to prepare the health sector for the introduction of medical revalidation in late 2012. The ORSA assessment has provided a baseline against which progress can be measured to ensure appropriate maturity of clinical governance and appraisal systems for doctors.
While that assessment demonstrated that systems of clinical governance and appraisal have improved over the last two years, I have a sense, from the data drawn, that not all organisations have grasped the importance and benefits of this process, either for their staff or for the organisation. In particular, I note the low figures of appraisals taking place for hospital doctors (56 percent) and lower still for staff grade and associate specialist (SAS) doctors (31 percent).
This is all the more worrying given that many of the gaps identified with the ORSA assessment resonate with the Mid Staffs Inquiry (2010) findings, namely that the systems designed to improve performance, such as audit, appraisal and professional development, have been accorded a low priority. This cannot continue – we must build on creating an environment in the health care sector in which excellence in clinical care can flourish.
A more recent, interim six-month reassessment of several key areas since the full annual ORSA shows that progress is being made. Still, there is much to do in the collective effort to improve the systems supporting clinical governance and appraisal. The results are being analysed and I will provide a further update in due course.
Good clinical governance and appraisal are the bedrock of high-quality care and appraisal has been a requirement of all NHS organisations since 2001. The Responsible Officer Regulations addresses the gap and it is a statutory requirement that responsible officers should ensure all their doctors are appraised annually, irrespective of where they work.
As we move towards introducing revalidation, responsible officers should continue to support their doctors; clinical governance and outcome data should be collected, shared and used in a way that supports continuous improvement.
In doing so, responsible officers will provide the framework to support clinicians to improve the quality of care they provide and ensure they are fit to practise; while providing that much needed assurance to patients and the public.