Policy responses and statements
- Name of organisation:
- Department of Health
- Name of policy document:
- Responsible officers and their duties relating to the medical profession
- Deadline for response:
- 24 October 2008
Background: The White Paper 'Trust, Assurance and Safety' set out an ambitious programme for the reform of professional regulation including the creation of responsible officers. These will be senior doctors with personal responsibility for evaluating the conduct and performance of doctors and making recommendations on their fitness to practise as part of revalidation. The Health and Social Care Act 2008 sets out the legal basis for responsible officers enabling secondary legislation to set out the detail.
This consultation sought views on what should be included in that secondary legislation. An expert group representing a wide range of interests including patient, NHS and professional organisations developed the proposals in the document.
The consultation was held on a UK wide basis, although regulations may be different in different parts of the UK. This is explained in the consultation document.
COMMENTS ON
DEPARTMENT OF HEALTH
RESPONSIBLE OFFICERS AND THEIR DUTIES RELATING TO THE MEDICAL PROFESSION
The Royal College of Physicians of Edinburgh is pleased to respond to the Department of Health on its consultation on Responsible officers and their duties relating to the medical profession. Our responses to the questions are as follows.
Question 2.1: Which bodies should we designate as organisations required to appoint a responsible officer?
All organisations employing or contracting with doctors should be required to appoint a responsible officer either in–house where clinical governance systems are appropriate or through an alternate provider with appropriate clinical governance systems. None should be exempt from ensuring a responsible officer is available for their doctors.
Question 2.2: Should locum agencies be offered the opportunity to appoint a responsible officer subject to demonstrating good clinical governance systems?
Locum agencies should be offered the opportunity to establish effective clinical governance systems and then to appoint their own responsible officers.
Question 2.3: To the extent that some form of quality assurance of clinical governance systems in some or all designated bodies is desirable, who should this be carried out by?
The agencies responsible for quality assuring local clinical governance systems should include:
- the regulators (ie GMC, Healthcare Commission/Care Quality Commission)
- standard setting bodies including the Royal Colleges and (in Scotland) NHS QIS
- accreditation bodies for various services
- Strategic Health Authorities, Primary Care Trusts and Health Boards
It is important that organisations understand the boundaries of their contributions to overall QA to avoid confusion and minimise duplication.
Question 2.4: In determining the way in which individual doctors should be linked to a responsible officer, which options do you prefer?
For the majority of doctors their responsible officer will be appointed by their main employer, failing that, their locum agency or a responsible officer working in a mainstream organisation in the same geographical area. The regulations should determine who acts as responsible officer for academic doctors and how the two elements of appraisal interface.
Although there is no real support for allowing doctors to select their own responsible officer freely, there should be some flexibility to support doctors who find it difficult to identify an appropriate responsible officer. Doctors working outside managed clinical environments need support to confirm their continuing fitness to practice in what may be seen as higher risk areas.
Question 2.5: Do you agree that in the last resort, doctors in non-mainstream medical work are responsible for finding an appropriate responsible officer?
Doctors working outside mainstream areas should be responsible for finding and linking with an approved responsible officer. Local responsible officers should be receptive to their approach. As stated above, there should be a safety net for doctors experiencing difficulties. There is also the issue of who acts as the responsible officer for designated responsible officers if they retain clinical responsibilities?
Question 2.6: Do you agree that where a doctor relates to a responsible officer in an organisation for which he or she is not contracted to provide clinical services, the organisation may recover the costs incurred?
Where organisations are providing responsible officer services for doctors other than their own employees they should be able to recover reasonable costs, either directly from a self- employed doctor or from smaller healthcare organisations.
Question 2.7: In which circumstances should the appropriate authority be able to appoint or nominate a responsible officer?
The appropriate authority (in England, Scotland and Wales this is the Secretary for State after consultation with devolved Ministers) should be given the power in the regulations to appoint a responsible officer for an organisation where:
- they have failed to do so
- they have appointed inappropriately
- they have failed to address serious performance deficiencies in a responsible officer
Question 2.8: Should the ability for a designated organisation to appoint or nominate more than one responsible officer be available?
The College considers it appropriate for the ultimate responsibility for clinical governance to be vested in a single board level appointment, although clearly the implementation of the clinical governance systems will be delegated throughout the organisation and involve a number of associates. In Scotland, it is likely that Medical Directors of Health Boards will take on this responsibility.
Question 2.9: Should the ability to appoint or nominate more than one responsible officer be subject to approval by another body?
The College cannot foresee circumstances when this would be either necessary or desirable. Deputising arrangements would be required for all board level appointments and the responsible officer is no different. The consultation is silent on the issue of appointment procedures and the College assumes this would be in line with local board procedures.
Question 3.1: Should the responsible officers be licensed not just registered medical practitioners?
Responsible officers should themselves be both registered and licensed with the GMC – for credibility with the profession.
Question 3.2: To ensure the appropriate seniority, do you think a responsible officer should be responsible at board level.
In Scotland it is likely that Medical Directors of Health Boards will assume the role of responsible officer and this is a board level post. The College agrees that all responsible officers should be at board level.
Question 3.3: Please check those competences that you think should be a requirement for appointment as a responsible officer.
Responsible officers will require all the following competences (as offered in the consultation document):
- communication skills
- mediation and arbitration skills
- evidence handling skills
- awareness of the principles and investigation and legal processes
- equality and diversity knowledge and skills
The requirements and personal aptitudes of a responsible officer are divided into essential and desirable (Table 3) and the College lay advisers were interested in understanding why integrity, good judgement, objectivity, respect of professional peers, and sensitivity to interpersonal differences are included as desirable rather than essential personal aptitudes of a responsible officer.
Question 3.4: What other measures could we take in relation to the responsible officer promoting equality in treatment for individual doctors?
There should be a forum for responsible officers to learn from each other and ensure consistency across Trusts and Health Boards.
Question 3.5: Should the requirements on the responsible officer to be set out in detail in guidance or in regulations?
The requirements of responsible officers should be laid out in guidance rather than regulations.
Question 4.1: Should the responsible officer be given specific responsibilities in relation to referral of doctors to the GMC fitness to practice processes and to the oversight of local arrangements for compliance with conditions on practice?
Responsible officers should be given specific responsibility relating to referral of local doctors to GMC fitness to practice systems and the oversight of local arrangements for compliance with GMC conditions of practice.
Question 4.2: Is there a need for any additional safeguards in cases involving a history of personal conflict between the responsible officer and an individual doctor?
Delegated responsibility for implementation in larger organisations and external QA should limit the potential for direct conflict between a responsible officer and individual doctor. However, this may be an issue for smaller organisations and safeguards may be required where an individual doctor feels there is a lack of objectivity or actual prejudice. There should be an appeals component within any system of local investigation and smaller organisations may require external support in this regard.
Question 4.3: The proposed regulations require designated bodies and responsible bodies to have regard to guidance from certain specified organisations in relation to the regulation of doctors, which organisations should be specified in regulations for this purpose?
The regulations should list those organisations with a formal role to provide advice on the regulation of doctors. These include the GMC, NCAS and NPSA (in England only). The UK Academy of Medical Royal Colleges and the individual Royal Colleges have a role here, particularly for specialist recertification.
Question 5.1: For which of the following specific tasks in relation to doctors seeking contracts of employment or admission to the performance list, should the responsible officer be held accountable?
Responsible officers should have responsibility for ensuring the following specific (HR) tasks are undertaken in relation to a contract of employment or the “performers list” (England only).
- ensuring appropriate references are received
- checking references for consistency and accuracy
- checking the relevance of clinical qualification
- identity checks
- maintaining records of checks
- alerting other employers through the alert letter system
Where appropriate this list should include CRB police checks.
It may be appropriate (but challenging) for responsible officers to collect all official complaints against individual doctors, irrespective of the source of the complaint.
Question 5.2: Which of the following specific responsibilities should be given to the responsible officers following the identification of a concern over the conduct or performance of a doctor?
Responsible officers should be given the following responsibilities (in addition to referral to the GMC) following identification of a local cause for concern:
- initiating appropriate investigation
- arranging for further monitoring
- considering the need to share information with other healthcare organisations directly and through alert systems
- considering the need for suspension or restrictions on practice
- considering the potential for remediation or re-skilling
- initiating actions in relation to wider systems issues
- referral to the police
Question 6.1: Which of the following types of resources required by responsible officers should be specified in regulations?
Respondents agreed that resources were necessary for staff time, training and remediation and also for accessing external advice and support (for example, from Royal Colleges) and for which there may be a financial charge. It would be helpful to include this within regulations to ensure appropriate resources are set aside.
Question 7.1: Which of the following offences should be created in regulations?
The regulations should create an offence in the following situations:
- failure to appoint a responsible officer
- failure to provide a responsible officer with the required resources to function effectively
- preventing a responsible officer from performing his/her duties ie by requiring other duties as a priority
- preventing responsible officer from taking responsibility for doctors linked to but not employed by the organisation
Question 7.2: Which individuals and organisations should be required to give relevant information when requested by a responsible officer?
Information from a wide range of external organisations should be released to the responsible officer on request. This would include information from:
- current and previous employers
- other clinicians or organisations with direct experience of the work of the doctor under investigation
- Primary Care Trusts/Health Boards
- other responsible officers
- Accountable Officers for controlled drugs
Data protection arrangements may require review to deliver this level of data exchange.
Question 7.3: Should the regulations state in broad terms the information to be provided to the responsible officers or set out specific items of information and documents?
The regulations should set out in broad terms only the range of information to be provided to the responsible officer (ie for revalidation or conduct/performance issues).
Other Comments:
Clinical governance systems focus on the efforts of teams and the responsible officer focus on individual performance within a team will need careful consideration.
Will the addition of this onerous but essential responsibility change the nature and/or numbers of doctors seeking appointment as medical directors?
This major innovation may carry unintended consequences and regulations should retain some flexibility to cope with these as they arise.
Although largely welcome, the introduction of the responsible officer would not necessarily have prevented the Shipman tragedy, which is widely believed to have been the stimulus for the initiative.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[8 October 2008]
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