CONSULTANT JOB INTERVIEW

HOW TO SUCCEED?

medicaljobinterview.org.uk

R. Sand MA Communication Consultant D. Ra !RCS "T# $ O#t%& !RCSI' (CH O#t%' (S O#t%' D O#t%' (BBS Consultant O#t%o)a*dic Su#+*on
!o#t% *dition

May 2011

0845 643959

!ontact" # $and %ddre&&" 'e&tcott (ittle)ort (ane $ib&ey (incoln&*ire +,22 0#$ -el no. 0845 643959 ,mail" contact.med&kill.co.uk 'eb&ite" medicaljobinterview.org.uk Medical/interview/book.co.uk Medical/!our&e.co.uk

!01-,1-$
Introduction Feedback

!*a)ter 2" # $and

2&&ue& be3ore t*e 2nterview Curriculum Vitae Seeking a Consultant job How to choose the correct hospital for you !he "ost # strategy to get your desired Consultant #ppointment #pplication Form How to answer a $uestion How to present yourself at the inter%iew Formatting an answer

!*a)ter 22" 4 #aj

!on&ultant 2nterview 5ue&tion&

!*a)ter 222" 4 #aj

2nterview &antra Inter%iew "anel &ock inter%iew

!*a)ter 26" # $and

+re&entation #ole )lay

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!*a)ter 6" 4 #aj

+er&onal and 7eneral i&&ue& Introduce yourself !eaching e(perience Communication skills )eadership skills *ood doctor Conflict Complaints Stress Criticism Confronting angry patient or relati%e Consent How do you take consent from a patient +runken colleague +ifficult nurse &ain weaknesses "ersonal de%elopment plan #ssessment, appraisal )icensing and re%alidation !eam leadership !raining -hy did you apply this job How can you ensure that you are ade$uately trained to be a consultant when you gain CC! Consultant contract .utcome

!*a)ter 6" 4 #aj

Management i&&ue& /usiness plan

+octor 1 manager relationship 2egotiation !ime management Coding

!*a)ter 622" 4 #aj

Moderni&ing Medical !areer&8 -raining8 ,'-4 and 4eanery &oderni3ing &edical Career Foundation "rograms Specialty and *" !raining #ssessment of !raining 4uropean -orking !ime +irecti%e Hospital at night +eanery How will you contribute to the +eanery !ooke5s report

!*a)ter 6222" 4 #aj

#e&earc*8 %udit8 ,t*ic& and !linical $cenario& 6esearch 6esearch Framework 6esearch *o%ernance )e%el of 4%idence for "rimary 6esearch 7uestion #udit 4thical Issues Clinical scenarios "rioriti3e your job

!*a)ter 29" 4 #aj

!linical 7overnance8 Multidi&ci)linary -eam and 1ational :ealt* $ervice Clinical *o%ernance &ultidisciplinary !eam !he Structure of 2HS -hite paper #uthorities and !rusts Strategic Health #uthorities 2ational Institute of Clinical 4(cellence Foundation Hospital "rimary Care !rusts 2HS )itigation #gency 6isk &anagement 2ational "atient Safety #gency 2ational !ariff and payment by results 9"b6: Independent Sector !reatment Centre 9IS!C: 2ational targets Heath Care Commission 9HCC; 7uality Care Commission 97CC: )ord +ar3i5s report

!*a)ter 9" %lok -ekriwal

$ummary

!*a)ter 92" # $and

$tandard 5ue&tion& ;seful )inks

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21-#04<!-201
Congratulations on completion of your training= >ou should ha%e a date in your mind when you are going to start applying for the post as it takes a few months to collect all the information which you would like to put in your CV? !he information below has been collated from a number of sources, our own personal e(perience and also e(periences of our colleagues? It is, in the main, applicable to any medical job inter%iew but concentrates on that potentially most important one @ !he Consultant Inter%iew, hopefully, your last inter%iew?

=,,4>%!?
-e would really appreciate feedback from you about this book? "lease send your positi%e and negati%e e(periences of the inter%iew as well as any opinions, criticism, and suggestions? If you ha%e any $ueries, we will be happy to answer them? If you find any factual error9s: in the book, please let us know? Contact detailsB 4@mailB -ebsiteB ContactCmedskills?co?uk medicaljobinter%iew?org?uk medical@course?co?uk medical@inter%iew@book?co?uk 6 Sand + 6aj

!:%+-,# 2 # $and 2$$<,$ >,=0#, -:, 21-,#62,'

!<##2!<(<M 62-%,
-hile applying for the post of Consultant you will clear all the hurdles and your CV is of paramount importance? 2owadays, you ha%e to fill the 2HS job websites but the information comes from your CV? !here are numerous websites pro%iding tips and hints from where you should gather all the information? It is absolutely important to do spell check and make sure e%erything you write in your CV is accurate? !he common errors made by the people in their CV are "oor formatting Incorrect or missing contact information Inaccurate dates or no dates Spelling errors 9!opographical and grammatical: )ong CVs with long paragraphs "ersonal information unrelated to job

It is difficult to do the proof reading on your own? >ou ha%e spell checkers these days e%erywhere but the commonest mistake is misspelling words which are still spelt like other words? If 4nglish is not your first language it is imperati%e to get someone to check your sentence structure and general synta(? It is essential to keep your CV updates on a regular basis? It is certainly a good practice to keep your CV updated regularly @ sometimes it is needed at fairly short notice 9research proposal, ethics committee, ">#:? #t inter%iew, you should be able to discuss each and e%ery aspect of your curriculum %itae 9CV:? .ften your CV or job application will be in front of each panel member? I recommend the following structure when writing your CVB 1? SummaryB Ha%e a one page summary of your CV? !his is important as it should co%er your $ualifications, current job, research, audit, presentations and future plan 9Short, Intermediate and )ong term:? 2? Current job '? "re%ious jobsB In chronological order 9starting from the immediate past:? )ist some of the consultants you ha%e worked with? 0? Clinical e(perienceB !ry to personalise your CV? >our personal e(perience should match the job you are applying for 9as much as possible:

1F

8? #ssessments and )earning agreements? In e%ery job, try to ha%e three learning agreements 9ocap?org?uk:, one at the beginning, and one in the middle and the last one at the end of the contract? <? 6esearch A? #udit D? "resentation 9)ocal, 6egional, 2ational and International: E? Courses attended 1F? Communication skills 11? I! skills 12? 6eferences G 6efereesB Select your referees carefully? !alk to them and take their consent before putting them down as your referee? #sk for ad%ice in preparing your CV?

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$,,?217 % !01$<(-%1- +0$Some tipsB 1? Choose the hospital carefully 2? &ake sure that the hospital which you are going for needs a consultant with your e(pertise, e(perience and training '? /e careful about an appointment to a hospital where you ha%e been at the end of your specialist registrar training? It is %ery flattering to be asked to join the consultant staff but you may always be the specialist registrar in the eyes of your consultant colleagues with all that entails?

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:0' -0 !:00$, -:, !0##,!:0$+2-%(@

#s a Consultant, you are going to be %ery important for the trust? !hey will depend on your ability to earn their income and reputation? >ou should therefore to be counted to join the hospital? It is useful to look at the information that was sent with the application? +oes it make you feel like I want to work thereH if it does not make you think like that or the description is rather dull then that might reflect the attitude of the hospital? In this day and era, hospital should be selling themH they do it to a primary care so they should do it for the prospecti%e consultants? Find out about the hospital whate%er you can, for an e(ampleB *rape%ine at the surgical meetings or medical meetings? )ook at the Healthcare commission website and there should be reports on the hospital as star ratings? Is the hospital ha%ing a foundation status -hat are the future plans How does the hospital do in terms of $uality of care and also utili3ation of resources Visit at a weekend and wander around to see what it feels like? *o to the postgraduate education centre to see what are teaching and training commitments in the hospital and specifically in the department? It is surprising how much you gain from first impressions? -ere they really welcoming and helpful If so, it is a good sign of happier staff and if not good, would you really want to work there )ook around the geographical area with your partnerH look at the facilities which are a%ailable in terms of recreation 9work@life balance:, schools, and connections to other parts of the countryGcities G houses and their costs? 6emember if you or your partner do not like things then you do not apply, you might get the job but be realistic though life is about compromise?

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-:, +0$In the application pack, you go through %ery carefully which should contain the followingB 1? Iob +escription which should include a model timetable 2? Information on the !rust '? !eaching commitments 0? "erson specification 8? Staffing and rele%ant Ser%ices <? !erms and conditions of Ser%ice If any information is missing ask for that? !hey might refer you to the +epartment of Health website for the terms and conditions which is acceptable? #ll Consultant posts should be suitable for those wishing to work less than full time? If not then the !rust should clarify why not? It should also outline how the post being ad%ertised fits in with the department and thus any sub@specialty interest that may be needed? If not #SJ @ the hospital may just be on a fishing trip to see who applies but this may lead to all kinds of problems?

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% $-#%-,7A -0 7,- A0<# 4,$2#,4 !01$<(-%1- %++021-M,1-hen I was looking for a Consultant "ost my then chief ad%ised meB Choose the hospital more carefully possibly than your partner sadly it is easier to separate from a partner and establish another relationship than it is to lea%e a hospital post and get another one ? /e %ery careful about an appointment to a hospital where you ha%e been at the end of your Sp6 training? It is %ery flattering to be asked to join the Consultant staff but you may always be the Sp6 in the eyes of your consultant colleagues with all that that entails #fter many years of obser%ing consultants and their progress I am sure these comments still hold true? +re)aratory 'ork" Visit the Hospital officially? >ou should try and meet the followingB "ossible Consultant Colleagues in the same specialty "ossible Consultant Colleagues in an allied specialty e(B #naesthesia, 6adiology, 2ephrology, *astroenterology etc to see what they feel about the new appointment "ossible colleagues in the support ser%ices e(B physiotherapy &edical +irector@ they may gi%e you a slightly different %iew from potential colleagues Chief 4(ecuti%e @ they should gi%e you the same %iew as the &edical +irector if not what is the relationship in management and where is the !rust heading 5ue&tion& to %&k" -hat is e(pected of the new appointment B Is it a replacement !hus all that is e(pected is to maintain the status $uo @ could be boring if you are not allowed to de%elop Is it to increase the capacity of the department !he department is busy good reputation etc and they want another pair of hands to complement e%eryone else Is it to increase the capability of the department >our chance to de%elop your sub@ specialty interest Is it to increase the portfolio of the !rust !his is to de%elop a completely new specialty doubtful in this day when specialties are contracting that this will be the situation !hese $uestions will gi%e you a fla%our of what will be e(pected of you in the post? 2o matter what, you need to establish that the !rust has thought about the implications of the appointment especially around costs forB

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,Bui)ment @ especially if you are replacing a retiring consultant, they will not necessarily be using modern techni$ues e( minimally in%asi%e kit? I doubt whether they will ha%e thought about this? $u))ort 4e)artment& #ny special in%estigati%e procedures that are now needed for you to pro%ide a modern ser%ice the hospital may not ha%e? $u))ort $ta33 If they are increasing the numbers are the support staff a%ailable e( junior medical staff, theatre sessions, anaesthetists, and physiotherapists to mention but a few? Medication& 2ot so much possibly for surgeons but there may be new non@operati%e treatments that re$uires a substantial in%estment in drugs? It is important to #SJ about the abo%e as if the !rust has not thought these matters through then you could spend the first few years of your consultant life fighting for what you consider the bare essentials of a modern ser%ice 2ot good? !hey may seem %ery recepti%e to new ideas but if you get the impression that there will be little support in the broadest sense for new ideas then is careful?

1<

%++(2!%-201 =0#M
4%eryone has the CC! so you ha%e to ensure that your application gets selected? &ake it interesting, try and tailor it to what the hospital wants e( if they want a hand surgeon make sure that your training in hand surgery is well presented and stands out? If in your spare time you do something different e( sailing across the oceans again makes sure it stands out? #ll this looks as if you are the correct person for the post and also you are someone who has that little bit e(tra to offer?

1A

:0' -0 %1$',# % 5<,$-201@

-hen you are asked a $uestion it could be an open@ended $uestion, 9e?g? tell me about >ourself: or it could be a closed one 9e?g? what is the role of genetics in rheumatoid arthritis :? -hen you are asked an open@ended $uestion you ha%e the opportunity to sell yourself? >our answer should be structured? I usually follow a rule of 2 minutes and 0F seconds? If you are asked an open@ended $uestion, format and try to complete your answer within two minutes? -atch the panel carefully@ if they seem to be bored then you should be in a position where you can finish off the answer within the ne(t ten to fifteen seconds, i?e? within forty seconds in total? -hen you are answering a $uestion, it is important to a%oid using jargon? >ou should try to use words used in day to day practice? If you are asked a $uestion about a topic you should not gi%e an answer taken from a te(t book? >ou need to use simple words? !his gi%es a better impression and the panel will ha%e a notion that this person thinks and hisGher answers are practical?

1D

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&ake eye contact with the inter%iewer before speaking #dopt a rela(ed posture sitting s$uarely in the chair Facial e(pressions and gestures should be natural +o not fidget or appear restless Jeep to the point #im to be precise *i%e a full answer and do not waffle Structure your answerH it should be logical and clearly understood #%oid using jargon Speak confidently so that you can he heard +o not speak too $uickly or slowly ;se your %oice to reflect the meaning of what you are saying +o not argue with the inter%iewer?

1E

=0#M%-217 %1 %1$',#
!here are so many different ways of formatting an answerH I follow the rule of three? -hen I am asked a $uestion I will think about it $uickly but logically and pick out three important points? If I ha%e the opportunity and time I will discuss each point in further three sub points and so on? !his structure has the benefit that you know what you are talking about and your answers are organised? #t the same time, if you find that during your answer the panel seem bored, at any time you can simply finish off with some other major heading?

Answer 1

Question

Answer 2

Answer 3

2F

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!:%+-,# 22 # $and 21-,#62,' 5<,$-201$

22

Mo&t commonly a&ked Take me through your CV highlight strong points Tell us about yourself Why do you want this job? Why should we choose you? What are your strengths? Your hobbies What do you think of 360 assessments? What are your views on specialist care in the community? Has the modernization programme worked? What is the importance of research personal and professional benefit? Importance of clinical governance What do you understand about audit cycle? Challenge to the NHS for providing anti-VEGF service %dmini&trative +o you ha%e any changes to make to your CV -hen are you a%ailable from +o you ha%e any courses booked How many jobs ha%e you pre%iously applied for +o you ha%e any other job applications in at present -hy didn5t you apply for our pre%ious post +o you ha%e a dri%ing license Ha%e you looked around Ha%e you met any of the panel members +o you ha%e any $uestions +er&onal -hy should we gi%e you this job -hy do you want this job -hat makes you good for this job -here do you see yourself in 1F years time -hy did you become a doctor -hen did you decide to become a geriatrician -hy did you want to concentrate on stroke medicine +o you want mainly to be a geriatrician -hat $ualities make a good consultant geriatrician

2'

-hat would you see as your role in this department -hat is your special interest in this department -hat can you offer this !rust How would you de%elop the stroke ser%ice -hat would you bring to this unit How would your appointment raise the profile of this !rust -hat are your strengthsGweaknesses -hat is your biggest fault -hat makes you angry -hat do you think of mo%ing area How do you feel about li%ing in -hat do you do in your free time !ell us of a recent triumphGdisappointment -raining How does your pre%ious training fit you for this job -hat training do you think you should ha%e to become a consultant geriatrician !ake me through your training so far -hy did you do a /Sc, &Sc How has it helped you in your working life +o you see any deficiencies in your training Is there any post you regret not doing as an SH. -hat courses ha%e you attended recently -as it useful -hat courses would you like to attend Should hospital consultants ha%e spent some time as *"s -ho should pro%ide management training In what way was the management course that you attended useful -hat do you think of Sp6 training with respect to general medicineGgeriatric medicine How would you impro%e the training of Sp6s How do we attract the best junior doctors to this trust gi%en the ad%ent of &&C +olitic& -hat is clinical go%ernance -hat is 2IC4 -as the 2SF for .lder "eople a helpful document How -hat is your opinion of our last Health Care Commission report -hat do you know about the recent 2HS -hite "aper -hat do you think of payment by results in geriatric medicine -hat is your opinion of the recent *&C publication -hat ha%e we learnt from the /ristol heart cases How has the #lder Hey scandal changed practice

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+o you think the increased spending on the 2HS has been put to good use How does foundation status help patients -hy is acute medicine busier these days How should we measure consultant producti%ity -hat do you feel about the burden of proof shifting to that of ci%il courts for doctors -hat do you think of the mission statement of our trust How will the 2HS reforms affect you in your daily practice How would you ration healthcare Is there any limit to the demand for health care -hat is the future for geriatric medicine How can we ensure patients from ethnic minorities recei%e proper access to health care #re junior doctors5 hours now too short How will &&C impact upon geriatric medicine -hat do you think of the new consultant contract -hat is your opinion of the *&S contract for *"s -hat do you think about the super@speciali3ation of geriatrics -hat is the role of 2HS consultants in teaching hospitals +oes general medicine e(ist anymore -hat do you think about pri%ate practice How in%ol%ed should doctors be in management -hat do you think about the C4# awards system Management -hat are the main roles of a multidisciplinary team leader -hat is the role of a consultant geriatrician as a manager -hat do you know about resource management How should intermediate care ser%ices be organi3ed #re +ay Hospitals an e(pensi%e lu(ury -hat are the ad%antages of +ay Hospitals -hat is the biggest area of waste in the 2HS How would you deal with a 1FK cut in your budget How would you pay for a new piece of e$uipment if no new money was ob%iously a%ailable How would you spend a L2FFFF one off grant -hat are the components of a complaints procedure How would you assess user satisfaction with your ser%ice How would you define $uality in geriatrics -hat do you know of clinical go%ernance -hat is the difference between audit and go%ernance

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-hat clinical audits ha%e you done -ho should appraise you How should re%alidation be undertaken How would you reduce the number of acute admissions How might you cut waiting times in your clinic If you could change one thing in the 2HS what would it be -hat is your management style How would you persuade the "C! to continue to purchase your ser%ice How would you deal with an underperforming colleague How would you deal with a colleague who turned up for work drunk -hat would you do if you strongly disagreed with a colleague5s decision -eac*ing -hat did you last teach to nurses -hat5s wrong with undergraduate education -hat in geriatrics are the three main take home messages you would want to pass onto undergraduates How would you make clinical meetings more appealing -hat will you present on your first grand round -hat is the purpose of a College !utor -hat makes a good educational super%isor How should continuing education for consultants be arranged -hat is the role of a super%isor for an &+G"h+ How do you see your teaching role with respect to SH.s and Sp6s +o you find the presence of undergraduates in your clinic a hindrance #e&earc* +o you ha%e any current research interests How is research rele%ant to clinical medicine -hy did you do an &Sc 4(plain your &Sc in a few short sentences for the inter%iew panel? -hat ha%e you presented at an e(ternal meeting recently -hat journals do you read !ell us about a recent article that caught your eye -hat is the most important ad%ance in geriatric medicine in the last 1F years How would you pursue your research interests in this job Ha%e you been allocated enough sessions for research in your job plan If you ha%en5t got any research to show after a year should we reduce your salary by 2?8 S"#s +o you feel it is important to ha%e published research as a clinician

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-hy are you not the 1st author on more research 4(plain how research differs from audit !linical -o)ic& Can you gi%e an e(ample of where you ha%e encouraged good team working -hat are the current contro%ersies in your field -hat are the main recent de%elopments -hat constitutes an acceptable delay in diagnosis Should Mgeriatric5 patients be for resuscitation -hat is the place of palliati%e care in geriatric medicine In which areas do you need more e(perience -ho should manage a patient with a stroke !lo&ing 5ue&tion& +o you ha%e any $uestions for us If this job is offered, would you accept this job 0)*t*almology Explain what is diabetic retinopathy to a patient diabetes affects small

blood vessels of the eye. Retina is the film Explain cataract surgery to a patient Role as clinical lead interface between department and management and

other department, teamwork, leadership, motivational skills, morale boosters, negotiation skills, clarity of thought Take me through your CV highlight strong points Tell us about yourself Why do you want this job Why should we choose you What are your strengths Your hobbies What do you think of 360 assessment

2A

What are your views on specialist care in the community Has the modernisation programme worked What is the importance of research personal and professional benefit Importance of clinical governance What do you understand about audit cycle Challenge to the NHS for providing anti-VEGF service

2D

!:%+-,# 222 # $and Mantra& 2nterview +anel Mock interview

2E

M%1-#%$
+atient &a3ety +atient care !hese two aspects are %ery important >uCC word& Care pathway !eam work &ultidisciplinary approach Consensus approach "atient care "atient choice >ring t*em during your an&wer&. +ractice in your day to day work

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21-,#62,' +%1,(
2nterview"
Congratulations you ha%e been selected for the inter%iew? #s you ha%e not done one for a few years ask your chief if he would mind gi%ing you a mock inter%iew to see if you ha%e any bad habits which might make the panel not want you and to gi%e you some feedback as to how you come o%er? >ou ha%e one chance to impress the panel do not waste it= >ou may be asked to gi%e a presentation to staff? >ou will be informed of this in ad%ance and how long the presentation should be? Find out the audience to whom you will be presenting to and tailor it to that audience? Jeep it clear and succinct? !here will always be the standard inter%iew at which all the panel members will ha%e the chance to ask $uestions? /efore the inter%iew starts the $uestions that will be asked and by whom are agreed so that all candidates are asked the same $uestions? # few tips in generalB Short answers +o not meander !ry and look as if you want the post Jeep panel interested !ry and engage all panel members and watch their body language If one is yawning or looking away then you ha%e lost it= -atch your own body language

5ue&tion&"
!he $uestioning usually follows a set pattern and in the following orderB College 6epresentati%e ;ni%ersity 6epresentati%e Hospital Consultants 9usually 2: &edical +irector Chief 4(ecuti%e )ay Chair

!ollege #e)re&entative"
!here to see if you are appointable you should be as you ha%e CCS! so they could ask about your specific training for the post for which you are applying? >our chance to tell the panel you are just what they are looking for as your training in what they want is more than ade$uate and in addition you ha%e done other related things e?g? know how to gi%e chemotherapy for cancer and ha%e been in%ol%ed in trials?

<niver&ity #e)re&entative"
.nly present if there is a major teaching commitment so you will be asked about teaching and your e(perience and ways in which you know you are a good teacher e( feedback from students, pass rates at e(ams etc !ell the panel all this before they ask

'1

you and it has to be dragged out=

:o&)ital !on&ultant&"
!hey usually want to know what you ha%e done and why you want to join their department? !his is your chance to tell them why they should select you how your training fits into their department to strengthen it and make it a department to be proud of? /e positi%e it is surprising how few people can sell themsel%es?

-*e #e&t"
!his is where the $uestion can be difficult to forecast but in general the &edical +irector will want to know how you interact and the Chief 4(ec will want to be con%inced that you want to come to his hospital and that it is not just the ne(t in line? !he lay chair will want to know a bit about you outside medicine? So these following $uestions could be askedB

'2

'*at are your &trengt*& and weakne&&e&@

#ny management course or book can e(plain what this is about and what answers are e(pected? +o 2.! say I ha%e none when it comes to weaknesses? +o not say another does not want to do your paperwork might be true but not the best thing to say?

:ow do you deal wit* a di33icult colleague@

2ot an uncommon problem try to think how you dealt with a junior who was a problem and tell them how you dealt with it good practical stuff?

:ow do you deal wit* a 3ailing colleague@

.b%iously trying to pre%ent co%er ups you must deal with it positi%ely by in%ol%ing more senior people you are too ine(perienced in these matters? If they co%er it up then go higher and higher in the organi3ation? 6emember if you know about something and do nothing you are in just as much trouble if an en$uiry takes place?

'*y t*i& :o&)ital@

>ou must think of good reasons e( joining a good department and tell them how you know it is a good one, a hospital with a good reputation say how you know? -hat they need to know is that you ha%e positi%ely looked at the hospital and said >es !his is where I would want to be? &akes the C4. etc feel good about their hospital?

:ow do you relaD@

Its ama3ing what I ha%e heard reading medical a te(t is not the best answer how that rela(es you? -atching tele%ision @ what Coronation Street== !ry and be a bit more specific? If you play a sport for e(ample tell them who you play for or how often there are numerous ways in which to rela( so be specific about whate%er you do?

'*ere do you t*ink your $)ecialty will be in 5 Aear&@

!here ha%e been so many changes in the last few years ha%e you got any forward %ision as to how things may change and how you are going to adapt?

:ow would you get to know t*e 7+&@

;nder the new payments system you will ha%e to be able to sell yourself to the *"s preferably you do this by presentations, audit meetings etc? #rranging dinner parties is not the correct answer?

'*at would you want 3rom t*e :o&)ital@

>our chance to tell them what you would need to build up the department and for you to de%elop they should not want someone who thinks great I ha%e my Consultant "ost

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so that is it until I retire? !ry and think what you would like to do to de%elop yourself?

%re you a -eam +layer@

&ore and more we work in teams so the answer should be >es /ut gi%e e(amples as to how you know e?g? feedback from your boss at appraisal?

'*at %udit& *ave you been involved wit* and did t*ey c*ange )ractice@
!ell them what you ha%e done?

'*at i& your mo&t 3avourite )a)er you *ave written and w*y@
#gain tell them what you ha%e done?

23 2 wa& to )*one your Eunior $ta33 and &ay w*at are you really like w*at would t*ey &ay@
!ry and get in a bit about team player, approachable etc remember your references may say different?

'*y t*i& area o3 t*e country@

#part from the hospital and how great it is you can say that you ha%e looked around the area and like what you see? !ry and gi%e e(amples of good points e%en if it is good connections with major centres or good schools etc? If there is a recent article that affect the 2HS then try and get a feel for its implications to you e?g? /ristol 4n$uiry, Shipman 4n$uiry? It may also be worth %isiting the +epartment of Health website to see what is hot on the agenda www?doh?go%?uk !here may be numerous others but these are those that come up often? +o 2.! try and crack jokes they can go horribly wrong? !here seemed to be a %ogue a little while ago to start your answer by saying? !hat was a good $uestion !he panel knows it was a good $uestion that is why we are asking it? -e do 2.! wish to be complimented on our $uestion just answer it===

,nd o3 2nterview"
>ou will be asked if you ha%e any $uestions? >ou may want to clarify some points a bout funding of the post etc or you can say 2o !hank >ou, I ha%e had the chance to talk to e%eryone I wanted to? 2o one will be offended? >ou will be asked if you were offered the post would you accept? Could I suggest you answer in the affirmati%e saying no thanks is not a good mo%e wasting e%eryone5s

'0

time? 6emember if you do not want the post do not come for the inter%iew? !he panel do talk to others in the specialty and such an answer soon gets around?

$ucce&&3ul !andidate"
Congratulations you ha%e been called back and told you will be offered the job? +o 2.! sign any contract most hospitals will not ask you to do this but some will? It should be a standard contract but go away and read it to make sure?

+o&t 2nterview 1egotiation&"

!he job should lay down the number of "#s and there is nothing that you can do to increase these you may be able to negotiate them down if you wish to go less than full@time? -hat you could ask for is a pay increase abo%e the minimum but I doubt if you will be successful unless you are in a shortage specialty?

#e3erence&"
6emember there is a duty for your referees to tell the truth no longer can they gi%e a good reference to *et rid of you #sk them what they are going to say about you it may come as a shock and if there is a problem then you need to try and correct it? I ha%e seen references which say that a person is less that ade$uate for many reasonsH not much of a chance of getting a consultant post with that reference? #sk your referees for an idea of what they are going to say about you !he 6I!# assessments should gi%e you an idea?

'8

M0!? 21-,#62,'
F0rt*o)aedic )o&t; '*y &*ould we give t*e job to you@ I would like to talk about my clinical work, teaching, training, clinical effecti%eness and go%ernance? !linical work@ I would like to bring my e(perience and e(pertise in the lower limb ser%ice, specifically soft tissue knee reconstruction and uni@ compartment arthroplasty? In the trauma side, I feel that I can compliment the ser%ices in the field of soft tissue knee injury, comple( trauma around the knee, e(ternal fi(ator and frames 96econstructi%e surgery:? -eac*ing and training@ I would like to in%ol%e in undergraduate teaching, teaching ancillary team and post graduate trainees? !linical e33ectivene&&@ In the modern 2HS, we not only need to do high %olume of work but also need to show that the work we do is of highest standard? -e need to set up audits in%ol%ing outcome measures? It is essential that the he tools we use are simple, user@friendly, and reproducible? !he data of the audit we get should be widely publici3ed so that we can learn from it? I think that all these measures will help us in impro%ing the profile of the +epartment? -e need to ha%e care pathways for most common trauma and electi%e orthopaedics cases? #evalidation/'*o i& re&)on&ible8 you or t*e tru&t@ I think that it is my responsibility because I am the one who would like to be re%alidated? I ha%e to take the responsibility and I think this is the right way? '*y did you a))ly to t*i& *o&)ital@ +epartment of .rthopaedics in this hospital is growing? &y interest is lower limb arthroplasty, soft tissue knee reconstruction, anterior cruciate ligament work sports injury and uni@compartment arthroplastic surgery? !here is a great demand of this work in the !rust? I ha%e met all the Consultants in the department? !here is a great mi( of youth and e(perience? !here is a great scope of de%eloping soft tissue knee work? In trauma side, I would like to de%elop interest in the circular frame? !he trust has modern theatres and friendly staff? I am really enthusiastic about this? .rthopaedics, especially sports knee injury G surgery is my passion? I would like to put all my efforts to set up a sports knee ser%ice in the hospital? '*at do you t*ink about 2.5 $u))orting +ro3e&&ional %ctivitie& in t*e !on&ultant contract@ !his is %ery interesting and I think that as a Consultant it is not only just about doing the clinical work and going out? Supporting professional acti%ities are %ery important

'<

for teaching, training, audit and also clinical outcome? Clinical outcome is something %ery close to my heart and I want to de%elop it further? '*at do you do to make &ure t*at your clinical outcome& are good@ ;se most commonly used outcome measures *eneral health 7uestionnaire +isease specific $uestionnaire Ioint specific $uestionnaire 7uality of life measures #dministrati%e support .utcome assessment Implementation :ave you got any de3iciency in your training@ *eneral trauma and orthopaedics Special interest Fellowship 6esearch and audit 2eed help "el%ic trauma 1 definiti%e management Spinal trauma 1 definiti%e management Comple( hand trauma 1 definiti%e management '*y &*ould we a))oint you and w*at are t*e )er&onal Bualitie& you bring to t*e tru&t@ I think that I am an easy@going person? I like to go with the flow and do not create any confusion in the department and most importantly, as a Consultant when I work in a team I want to see that my team is %ery happy and I think by doing this we can get the best outcome? -hat your patients think about you I would like to think that my patients feel that I am a highly skilled surgeonH ha%e a caring attitude and abo%e all a good human being?

'A

!:%+-,# 26 # $and +#$,1-%-201 #0(, +(%A

'D

+#,$,1-%-201
;sually you will be asked to gi%e a presentation during the inter%iew? !his would be mentioned in your inter%iew letter? # topic will be gi%en? ;sually the topic will be related to your job? >ou need to know all about the hospital and the department prior to prepare your presentation? !he information can be ac$uired from 1? Hospital G? !rust websiteB #nnual report, future plan, HCCG7CC report, Chief e(ecuti%e report, Hospital news letter 2? "re hospital %isit '? Clinical +irector G )eadB #sk direct $uestions? Jnow what the need is? #ssess how you can fit in? Met*od& o3 )re&entation" 1? >ou might be asked to do a 8 minutes oral presentation? 2? >ou might be asked to do a 8 1 1F minutes presentation with the help of slides? Sometimes you will be gi%en a laptop where you can do a power point presentation? .n other occasion, they will gi%e you a projector where you can do a presentation on acetate papers? It is important to keep your presentations in a flash dri%e in a power point presentation mode? It5s a good idea to ha%e a C+ copy of your presentation and additionally ha%e it stored in your e@mail? !he idea is that when you are asked to do your presentation at the time of inter%iew, if one method of system fails on that computer another method can be used to perform your presentation? :ow to )re)are 3or t*e )re&entation@ "lan your presentation? ;sually the presentation will be related to your job or the department? *ather as much information as possible about the job, the department and the hospital? >ou need to know the duration of your presentation and how many minutes you are going to lea%e for the discussion at the end? I prefer the following formatB o Introduction o #ims and objecti%es o &aterials and methods o +iscussion o Summary and conclusion !ry to highlight only one or two ideas? "repare handouts of your presentation and distribute it to the panel prior to starting the presentation? #t the end of a presentation you can ask the panel whether there are any $uestions that they would like to discuss?

+ower )oint )re&entation&"

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o Font si3eB 20 o ;se bullet points, not more than ' lines in one power point presentation? o +on5t o%er do it? o +on5t make the presentation make %ery flashy? -hene%er you are doing a presentation Jeep notes ready with you? +o lots of practice prior to the inter%iew? It always helps? <ltimately8 t*e )re&entation i& about" >our communication skills? >our presentation skills? >our confidence and body language? How well you are able to get your message across

#emember8 )ractice make& )er3ect.

0F

#0(, +(%A
Here it is about looking at your approach rather than knowledge? !he scenarios you are going to do are straightforward? !ry to keep it simple? /efore you start think and try to work out what it is you need to get across? Ha%e a structure in your mind? 4(amplesB complaintGerror, difficult colleagues, taking bad news, taking consent "ositi%e signs 1? >ou ha%e a clear structure in your mind and are able to demonstrate it? 2? #ctions are natural and not rehearsed? '? #re able to communicate well, show empathy, honesty and are clear? 0? >ou show that you understand the problem? 8? >ou ha%e a follow@up arrangement and information etc? <? >ou summarise at the end? 2egati%e signs 1? #rrogant 2? +ismissi%e '? Candidate does not understand the problem 0? Jeeping things %ague 8? 2ot summarising and making a follow@up plan

01

!:%+-,# 6 4 #aj +,#$01%( %14 7,1,#%( 2$$<,$

02

21-#04<!, A0<#$,(= -,(( M, %>0<- A0<$,(=

"lease introduce yourself?

%>0<- A0<#$,(=
Introduction /ackground@ 4(perience @ clinical, audit, research, teaching 7ualifications 7uality @ )eadership skills, Communication skills

Family G Interests GSports G others

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-,%!:217 ,9+,#2,1!,
-hat is your teaching e(perience

-eac*ing eD)erience
NInformal /edside "/) Formal )ectures *roup discussions open closed $el3 im)rovement Motivation -eam &)irit >etter )atient care
simulators, Heading

"atient education )eaflets Consenting

Important role

use of robotic tech, hand eye co@ordination assessment to wards ser%ices into two categories

!rainers 2on@trainers pro%iding ser%ices -raining t*e trainer& cour&e M$c in medical education (earner G =acilitator G -rainer

00

!0MM<12!%-201 $?2(($
How do you rate your communication skills

!0MM<12!%-201 $?2(($
N 6ate yourself @ *ood N "atient and relati%es 1 Co mp le( issues in simple way
*ain patient trust 4mpathy 9a process of putting yourself in others shoes: /reaking bad news

N Colleagues

#ble to co mmunicate at all le%els #pproachable Jeep others informed 1

Senior 9precise information: Iuniors 9In%ol%e them:

N 2ursing and other health professionals 1 )iaise with nurse and *"? *ood record
keeping and communicat ion

08

(,%4,#$:2+ $?2(($
-hat are the $ualities of a leader Ha%e you got any leadership skills

(,%4,#$:2+ $?2(($
N #im should be clear N Self moti%ation@ self starter 9i?e? #uditGresearch project: N *ood management skills@ !ime management &oney management &an management N &oti%ate others Feedback Identify need for training In%ol%e people +elegation *ood leader is a good manager and a moti%ator?

0<

-,%M (,%4,#$:2+
If you lead a team, you must ensure thatB N N &edical team members meet the standards of conduct and care set in the guidelines #ny problems that might pre%ent colleagues from other professions following guidance from their own regulatory bodies are brought to your attention and addressed N #ll team members understand their personal and collecti%e responsibilities for the safety of patients, and for openly and honestly recording and discussing problems N N N N 4ach patient5s care is properly coordinated and managed and that patients know who to contact if they ha%e $uestions and concerns #rrangements are in place to pro%ide co%er at all times 6egular re%iews and audit of the standards and performance of the team are undertaken and any deficiencies are addressed Systems are in place for dealing supporti%ely with problems in the performance, conduct or health of team members

0A

7004 40!-0#
#re you a good doctor

7004 40!-0#
N N N N N N &ain strengths *ood clinical care *ood medical practice !eaching, training, appraisal and assessing 6elationship with patients "robity 9information, reports, documents, research: N Health

N N N N

7ood clinical care "ro%iding a good standard of practice, decision making, !reatment in emergencies Maintaining good medical )ractice up to date, performance -eac*ing and training8 a))rai&ing and a&&e&&ing #elation&*i) wit* )atient& .btaining consent, 6especting confidentiality, &aintaining trust, good communication, 4nding professional relationship with patients

N N

4ealing wit* )roblem& in )ro3e&&ional )ractice@ conductG performance of colleagues, Complaints and formal en$uiries 'orking wit* colleague& !reating colleagues fairly, working in a team, )eading teams, #rranging co%er, sharing information from colleagues, +elegation and referrals

N N

+robity "ro%iding info about your ser%ices, -riting reports, gi%ing e%idence, signing documents, 6esearch, Conflict of interest :ealt*

0D

!01=(2!If there is a conflict, how do you resol%e it *i%e an e(ample of a conflict you were in%ol%ed in?

Conflict is difference of opinion

It goes back to the who, what and why sort of $uestions? .nce an issue has been raised we need to get to the bottom of it and define what the problem is -hen you know the problem the ne(t $uestion is how are we to resol%e it Can we resol%e it at a local le%el .r do we need to in%ol%e the management, the hospital In a rare situation you might need to in%ol%e the &edical +efence ;nion 9&+;: or *eneral &edical Council 9*&C:? &ost of the issues arise because of the lack of communication and poor information to the patients? .nce the issue has been resol%ed, we will look back and see how this could ha%e been pre%ented -hat did I learn from the conflict I had with someone or some organi3ation How did I implement that e(perience into my practice and what benefits did it yield

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!0M+(%21How will you deal with a complaint against you

C.&")#I2!
N N N N N N "rompt, open, constructi%e and honest response Should co@operate How -hen -hy "#)S #pology "atient care should not be prejudiced

"rompt, open, constructi%e and an honest response is mandatory by a doctor when there is a complaint against him? "lease read 7M! guideline 3or com)laint? It is the responsibility of the doctor to co@operate? How, when and what should be addressed? .nce you know the issue you need to resol%e it? In%ol%e e%erybody including the patient, relati%e, nursing staff and other colleagues? If needed, in%ol%e the patient ad%isory liaison ser%ice 9"#)S:? .ne should not hesitate to apologise? 4%en if it is not your fault you can apologi3e for the patient5s e(perience? If it is your fault, there is no harm in apologi3ing and trying to resol%e the issue? #t the end of the day, patient care should not be compromised? -hat did you learn from it How are you going to change your practice if it was your fault I will look back and do an audit to find out if the change of practice has made a difference?

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!here are many types of complaints? /ad food 6ude staff Complication of treatment 2egligence

!he *&C re$uires doctors to gi%e a patient who complains Oa prompt, open, constructi%e and honest response? !his will include an e(planation of what has happened and where appropriate, an apology?O *4246#) "6I2CI")4SB +onPt forget patient confidentiality? # competent adult must gi%e a fully informed, e(pressed consent before you can disclose clinical information to a third party who is not in%ol%ed in their clinical care? It can be a comple( matter, so donPt hesitate to seek e(pert ad%ice from the &+; on this issue? !here is a 1F day time limit for pro%iding a response at the )ocal 6esolution stage 9the first stage: of the 2HS patient complaints procedure? !he time limit is fle(ible pro%ided you keep the complainant informed of progress? #%oid the urge to gi%e an instant reaction? Some complainants may be distressed, but the tone of your response needs to be professional, measured and sympathetic? CH6.2.).*> .F 4V42!SB *i%e a factual description of the chronology of e%ents as you saw them, using the clinical notes as a framework? 6efer to the clinical records whene%er you can? +escribe each and e%ery consultation or telephone contact in turn and this description should include your working diagnosis or your differential diagnoses? State if you saw the patient alone or accompanied by another person? *i%e the name and status of the other person, e?g? spouse, mother etc? &o%e on to respond to each and e%ery concern raised by the complainant as far as you can, including your opinion on what happened? Sometimes you can combine this with the chronology of e%ents, but often it is better to deal with one and then the other? &any complaints arise from a misunderstanding and a detailed description of

81

the patho@physiology in%ol%ed can be helpful, and in some cases this might include references to journal articles or standard medical te(tbooks? !he complaint may in%ol%e more than one clinician? It is hardly e%er appropriate to e(press an opinion on the acts Q omissions of a colleague, unless they are under your direct super%ision, e%en if it is with their consent? .n some occasions a joint response, for e(ample by the complaints officer, may be appropriate? Howe%er, it will usually gi%e a better impression, and help speed resolution, for each clinician to pro%ide their own response? !hese may be sent with a co%ering letter from the complaints officer? &any complaints arise because there has been a breakdown in communication and percei%ed rudeness is common? If it is appropriate, you may wish to apologise, and you are encouraged to do so? 2o doctor can get it right e%ery time? &edicine is a life@long learning e(perience and e%ery doctor can learn something from e%ery complaint? Complainants often want an assurance that what happened to them will not happen to anyone else? !he practice should consider analysing each complaint as part of its ad%erse incident reporting procedure? In that way the practice can see what can be learned from the e%ent and take steps to pre%ent or reduce the risk of the problem happening again? For complaints that are more comple(, perhaps in%ol%ing more than one member of the practice team, for e(ample you could hold a significant e%ent meeting? !his will allow the practice to discuss the case in detail, analyse what went wrong, if anything, and make necessary changes? >our response to the patient can then include details of the action taken by the practice to remedy the situation and to ensure the problem is not repeated? !his process also encourages the practice as a whole to adopt a positi%e approach if things go wrong? C)I2IC#) 2.!4SB It is usually helpful to enclose a photocopy of the contemporaneous clinical notes and where appropriate it might e%en be necessary for you to pro%ide a word@for@word, line@by@line, typewritten transcript plus abbre%iations written out in full?

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$tyle o3 writing #%oid the use of any medical abbre%iations in your response? &any lay people understand something like O/"O, but few will know OS./O 9shortness of breath:, for e(ample, so all medical abbre%iations are best written in full? If you mention a drug, gi%e an idea what type of drug it is 9e?g? antidepressant, antihypertensi%e:? *i%e the full generic name, dosage and route of administration of it as well 9e?g? capsules, inhaler, intra@muscular injection, suppository etc?:? !his will pro%ide any independent medical ad%iser who may read your response with a complete picture? -rite in the first person? It is %ery tempting to write in the passi%e tense because that is the accepted format in a clinical report? !he reader should ha%e a good idea who did what, why, when, to whom, and how you know this occurred? In other words, rather than, O!he patient was e(amined again later in the day????O, it is far more helpful to say, OI remember asking my registrar, +r? Iim /rown, to e(amine the patient again later on the same day, and according to the notes, he did so?O C)4#6 +4SC6I"!I.2SB >our description of both the history and the e(amination should enable a medically@ $ualified third person to put themsel%es in your shoes? It is important to say not only what you found, but also what you looked for, but failed to find? In the course of a clinical report, the positi%e findings alone may be sufficient? It may be reasonable to assume that where important symptoms and signs are not mentioned, they were looked for, but found to be negati%e? In a medico@legal response this assumption cannot be relied upon? If your e%idence is to be challenged, it may be on the basis that you failed to put yourself in a position to make an ade$uate assessment? If your response at the outset clearly describes the full e(tent of the patientPs history Q your e(amination, the patient is likely to be satisfied with the thoroughness of your approach and is less likely to pursue the matter to an Independent 6e%iew, for e(ample? >our notes are not likely, in many cases, to contain the Onegati%eO information described abo%e? 2o one e(pects you to make copious clinical notes of

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e%ery last detail, nor will you be e(pected to remember e%ery detail of a consultation which at the time appeared to be routine, and which may ha%e been one of se%eral thousand similar cases you ha%e dealt with during the inter%ening time? It is perfectly acceptable to $uote from memory, but if you cannot recall the details of a case, then it is acceptable to state what you5re OusualO or OnormalO practice would ha%e been in the circumstances of the case? In your response you should specify which details are based onB 1? 2? '? >our memory !he contemporaneous notes and >our OusualO or OnormalO practice?

Complainants sometimes say, O!he doctor ne%er e(amined meO? !his normally means the doctor did not touch the patient, but that is not the same thing? If you saw the patient, then you will ha%e seen or been aware of many features without the need to touch him? 4(amples include emotional distress, breathlessness, cyanosis, jaundice, sweating and many other things, which if present, you as a doctor would ha%e noticed? !01!(<$201" # good )ocal 6esolution response takes time and careful thought? It is worth the effort? 6emember, o%er EAK are successful? !he prime purpose of the 2HS complaints procedure is to address the concerns of the complainant and to help you identify changes that may be needed to impro%e your practice? It is not a disciplinary process? # thorough and detailed first response should help to minimise the risk ofB 1? Further correspondence from the complainant asking for clarification and 2? Further medico@legal complications?

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$-#,$$
How do you manage stress

H.- +. >.; &#2#*4 S!64SS

N 6ecognitionGIn%ol%ement of teamGFeedbackGmanagementGpre%entionGfamily
N N N N N N N N N N N N "re%ention "roacti%e organi3ation of time and demands Ser%ice configuration 6ecognition Identify the stress? Is the stress good or bad & anage the cause of the stress Identify the cause of the stress and then try to recogni3e which components of the cause you can manage on your own and which need help from colleaguesGmanagement & anage the symptoms of the stress +iscuss with colleagues, spouse, friends Ha%e $uality time away from work to recharge your batteries Ha%e hobbies and interests which are important to you 4(ercise

88

!#2-2!2$M
How will you deal with a criticism

C6I!ICIS&
N !o be taken positi%ely towards making patient care better N )isten N Identify N !ake on board N #ny change N Importance of feedback

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!01=#01-217 %1 %17#A +%-2,1- 0# % #,(%-26,

How to confront an angry patient or a relati%e

!on3ronting an angry )atient or a relative

N*ood communication N"roblem addressed N#ction N6esults NSummary

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!01$,1!he 2HS "lan promised a re%iew of consent procedures to ensure that good practice in seeking consent for both treatment and research is in place throughout the 2HS? !his work is being taken forward through the O*ood practice in consent initiati%eO, supported by an #d%isory *roup made up of representati%es of patients and carers, clinicians, academics and 2HS managers? !he "lan recognised that a change of culture would be re$uired to ensure that patients become informed partners in their own care? )egally, the same principles apply to consent in research practice as in clinical practice? -y)e& o3 con&ent 3orm" !on&ent 3orm 1 @ "atient agreement to in%estigation or treatment !on&ent 3orm 2 @ "arental agreement to in%estigation or treatment for a child or young person !on&ent 3orm 3 @ "atientGparental agreement to in%estigation or treatment 9procedures where consciousness not impaired: !on&ent 3orm 4@ Form for adults who are unable to consent to in%estigation or treatment !on&ent 3orm 5 @ Consent to surgical treatment by patients who refuse to ha%e a blood transfusion 9PIeho%ah5s witness formP:?

httpBGGwww?dh?go%?ukGenG"olicyandguidanceGHealthandsocialcaretopicsGConsentGinde (?htm

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httpBGGwww?nhs?ukGconditionsGConsent@to@treatmentG"agesGIntroduction?asp( Consent is the principle that a person must gi%e their permission before they recei%e any type of medical treatment? Consent is re$uired from a patient regardless of the type of treatment being undertaken, from a blood test to an organ donation? !he principle of consent is one of the cornerstones of medical ethics? It is also enshrined 9held sacred: in international human rights law? -hat constitutes consent For consent to be %alid, it must be %oluntary and informed, and the person consenting must ha%e the capacity to make the decision? !hese terms are e(plained below? 6oluntary" the decision to consent or not consent to treatment must be made alone, and must not be due to pressure by medical staff, friends or family? 2n3ormed" the person must be gi%en full information about what the treatment in%ol%es, including the benefits and risks, whether there are reasonable alternati%e treatments, and what will happen if treatment does not go ahead? !a)acity" the person must be capable of gi%ing consent, which means that they understand the information gi%en to them, and they can use it to make an informed decision? !here are a few e(ceptions when treatment can go ahead without consent 9see Consent to treatment @ how it works:? .ne main e(ception is if a person does not ha%e the mental capacity 9the ability to understand and use information: to make a decision about their treatment? In this case, the healthcare professionals can go ahead and gi%e treatment if they belie%e that it is in the person5s best interests? )egal terms !his article mentions se%eral legal terms and acts of parliament, which are e(plained below? -*e Mental :ealt* %ct F1983; sets out %arious legal rights that apply to people with se%ere mental health problems? !he act also contains the powers which, in e(treme cases, enable some people with mental health problems to be compulsorily detained in hospital? -*e Mental !a)acity %ct F2005; is designed to protect people who cannot make decisions for themsel%es? !he act e(plains when a person is considered to be lacking capacity, and how decisions should be made in their best interests? -*e !ourt o3 +rotection is the legal body that o%ersees the operation of the &ental Capacity #ct 92FF8:? %n advance deci&ion 9pre%iously called an ad%ance directi%e: is a legally binding document that sets out in ad%ance the treatments and procedures that someone does or does not consent to? :ow con&enting to treatment work& httpBGGwww?nhs?ukGConditionsGConsent@to@treatmentG"agesGHow@does@it@work?asp( !he seeking and gi%ing of consent should not be a one@off e%ent? It should be a continual process of communication between yourself and your healthcare pro%iders? If you are going to ha%e major medical inter%ention, such as an operation, your consent should be obtained well in ad%ance so that you ha%e plenty of time to study any information about the procedure? >ou should also ha%e the chance to ask as many $uestions as you want? #dditional procedures

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!here may be some circumstances when, during an operation, it becomes ob%ious that you would benefit from an additional procedure that was not included in your original consent? For e(ample, you may be ha%ing abdominal surgery when your surgeon notices that your appendi( is infected, dangerously close to bursting and needs to be remo%ed? If is felt that it would be too dangerous to delay the additional procedure and wake you up to get your consent, the additional procedure can go ahead if it is considered to be in your best interest? Howe%er, e(tra procedures cannot be done just because it would be con%enient for the healthcare professionals treating you? !here has to be a clear medical reason why it would be unsafe to wait to obtain your consent? 4mergency treatment If you re$uire emergency treatment to sa%e your life, and you are unable to gi%e consent as a result of being physically or mentally incapacitated 9for e(ample, you are unconscious:, treatment will be carried out? .nce you ha%e reco%ered, the reasons why treatment was necessary will be fully e(plained to you? *i%ing consent Consent should be obtained from the healthcare professional who is directly responsible for your current treatment? !his could beB a nurse who is arranging a blood test a *" who is prescribing new medication for you a surgeon who is planning your operation Consent can be gi%enB %erbally non@%erbally 1 for e(ample, you may raise your hand to indicate that you are happy for a nurse to take a blood sample in writing 1 by signing a consent form # signed consent form by itself does not constitute consentH it simply ser%es as e%idence of consent? !he consent form will not be %alid if your consent isB not %oluntary not informed, or you do not ha%e enough mental capacity 9the ability to use and understand information to make a decision: to gi%e consent See Consent to treatment @ capacity for more information about capacity and situations that can affect your capacity? 6efusing treatment If you ha%e enough capacity and make a %oluntary and informed decision to refuse a particular treatment, your decision must be respected? !his is still true e%en if your decision would result in your death, or the death of your unborn child? >ou are still entitled to recei%e any other appropriate medical treatment and care that is felt would be in your best interest? Howe%er, if you ask for a course of treatment that healthcare professionals belie%e would not be in your best interest, they ha%e no obligation to pro%ide it? Children and teenagers !eenagers who are 1< and 1A years old are entitled to consent to their own treatment, and this consent cannot be o%erruled by their parents? Children who are under 1< years old can consent to their own treatment if it is thought that they ha%e enough intelligence, competence and understanding to fully appreciate what is in%ol%ed in their treatment? If a child who is under 1<, or a teenager who is 1< or 1A years old, refuses treatment and by doing so this may lead to their death or a se%ere permanent injury, their

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decision can be o%erruled by the courts? !he court used is the Court of "rotection, which is the legal body that o%ersees the operation of the &ental Capacity #ct 92FF8:? In some cases, the parents of a child who has refused treatment ha%e been allowed to consent for them? Howe%er, it may be best to go through the courts in such situations? "arental responsibility If a child who is under 1< does not ha%e the capacity to consent, someone with parental responsibility can consent for them? See the bo( 9left: for a list of people who can hold parental responsibility? !he person with parental responsibility must ha%e the capacity to gi%e consent? If a parent refuses to gi%e consent to a particular treatment, this decision can be o%erruled by the courts if treatment is thought to be in the best interests of the child? If one person with parental responsibility gi%es consent and another does not, the healthcare professionals can accept the consent and perform the treatment? If the people with parental responsibility disagree about what is in the child5s best interests, the courts can make a decision? In an emergency, where treatment is %ital and waiting to obtain parental consent would place the child at risk, treatment can proceed without consent? 4(ceptions !here are a number of e(ceptions where a capable person can be treated without first obtaining their consent? !hese e(ceptions are listed below? <nder t*e +ublic :ealt* F!ontrol o3 4i&ea&e; %ct F1984;8 a magistrate can order that a person is detained in hospital if they ha%e an infectious disease that presents a risk to public health 1 such as rabies, cholera and anthra(? <nder t*e 1ational %&&i&tance %ct F1948;8 a person who is se%erely ill or infirm and is li%ing in unsanitary 9unclean: conditions can be taken to a place of care without their consent? <nder t*e Mental :ealt* %ct F1983;8 people with certain mental health conditions, such as schi3ophrenia, bipolar disorder or dementia can be compulsorily detained at a hospital or psychiatric clinic without their consent? "risoners !he legal rights of prisoners are unaffected when it comes to the issue of consent? 2o capable prisoner can be treated without consent e%en if that means their life will be at risk? !his includes a prisoner who is refusing to eat food? +arental re&)on&ibility # person with parental responsibility for a child who is under 1< years of age could beB t*e c*ildH& mot*er t*e c*ildH& 3at*er if he was married to the mother when the child was born 3or c*ildren born be3ore 4ecember 18 2003" t*e c*ildH& 3at*er, if he marries the mother, obtains a parental responsibility order from the court or registers a parental responsibility agreement with the court 3or c*ildren born on or a3ter 4ecember 18 2003" t*e c*ildH& 3at*er, if he registered the child5s birth with the mother at the time of the birth, or if he re@registers the birth 9if he is the natural father:, marries the mother, obtains a parental responsibility order from the court, or registers a parental responsibility agreement with the court t*e c*ildH& legally a))ointed guardian a )er&on wit* a re&idence order concerning the child a local aut*ority that is designated to care for the child a local aut*ority or )er&on wit* an emergency )rotection order for the child

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!he process starts in the out patient department? .nce a diagnosis has been made and the treatment options ha%e been e(plained, a decision can be made between the patient and the surgeon on the best way forward for that indi%idual? #t this point the patient would ha%e a full description of the intended procedure, possible complications that may occur, and the likely time spent in hospital and the length of the reco%ery? !he patient would then ha%e an information sheetGleaflet which would ha%e all this information down into the plain language? !he patient is ad%ised to discuss the prospecti%e treatment with family and friends, and to write down any $uestions that arise, and ask these when they ne(t see the team? -hen the patient attends for surgery the whole process is repeated, to ensure that the patient fully understands what is going to happen? !his would be done by the operating surgeon, or someone who is capable of performing the operation? Clearly check and mark the limb with a permanent marker? e?g? for !H6 risks stated would include dislocation, infection, +eep Venous !hrombosis 9+V!: or "ulmonary 4mbolism 9"4:, stiffness, leg length discrepancy and wear 9aseptic loosening: httpBGGwww?dh?go%?ukGenG"olicyandguidanceGHealthandsocialcaretopicsGConsentGinde (?htm

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21!0M+,-,1- !0((,%7<,
How are you going to deal with an incompetent colleague

H.- #64 >.; *.I2* !. +4#) -I!H #2 I2C.&"4!42! C.))4*;4

N N N N N N N N N "atientGColleagueG"ublic safety HearGsayGconfirm +irect communication 2e(t chain of command Hospital protocol )ocalG6egional bodies@ /&#,&+; &anagement "re%ention Counselling

Firstly, O#ct $uickly to protect patients from risk if you ha%e good reason to belie%e you or a colleague my not be fit to practiceO? !his places a clear professional responsibility on each indi%idual to take action where they ha%e serious concerns? # first step would be to discuss concerns informally with a senior colleague such as the consultant, the Clinical +irector, &edical +irector, Chairman of the &edical Staff Committee, or a colleague in the specialty from another hospital? In doing so, it may be helpful to consider whether the use of locally a%ailable informal procedures 9counselling ser%ices, O!hree -ise &enO or e$ui%alent: would be appropriate? !he local /&# office is a possible source of ad%ice on the range of informal procedures in the locality? +iscuss it with &+;?

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4#<1?,1 !0((,%7<,
How will you deal with a drunken colleague

4runken colleague

"atient safety +octor5s safety +irect communication@ inform that C+ will be informed Chain of commands 1 whistle blowing Hospital policy Gguidelines /&#G &+;

It is a %ery sensiti%e situation? #cknowledge it? # difficult doctor is the doctor in difficulty? "atient safety comes first? !ry to communicate with the doctor directly? If you are a junior doctor, you can discuss the matter with your anaesthetist or other colleague i?e? a senior sister in charge or a senior manager? If you are still unable to handle it, you can ring another consultant colleague or the Clinical +irector 9C+: if it is possible? -hate%er happens, heGshe should not be allowed to go and deal with the patient? +octor5s safety is important? How will heGshe go home -ill heGshe dri%e on hisGher own If this is the case, you should find out a ta(i or some other alternati%e measure should be taken so that heGshe goes home safely as the doctor5s and public safety is at stake? CH#I2 .F C.&&#2+SB # senior person who is in charge of the team should be informed? 2ow, Rwas it a one off incident or is it a regular happening S +o you need to record it !here is hospital policy and guidelines for each trust and this should be followed? In%ol%ement of the

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/ritish medical association 9/&#: and &edical +efence ;nion 9&+;: may also be needed? 6emember, if it is a clinical go%ernance issue or a criminal issue you ha%e to take appropriate action?

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42==2!<(- 1<#$,
If you are a new consultant G S! and the nurse keeps on saying in the .perating !heatre that you are useless and is constantly criticising you, how are you going to deal with him or her

>ou ha%e to go to the basic $uestionsH when, where, what and whom +iscuss the situation with him or her when the theatre is o%er? If needed, you should in%ol%e the in@charge nurse and e(plain to the nurse that there are different ways to do the same thing? !hat you are fully trained and you are competent in doing this? If the situation is not resol%ed by direct con%ersation, you might need to in%ol%e the clinical director? If the criticiser is correct, there is no harm in apologi3ing and thus resol%ing the issue? If he or she is wrong, appropriate action has to be taken after discussing the situation with the clinical and the &edical +irector? >ou might need to take ad%ice from the &+;?

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-hat is your main weakness Ha%e you got any weaknesses

Main weakne&&
!oo serious about clinical commitments !ry to do too much, must keep a realistic goal #ffects family life !ime management @ course

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-hat is your personal de%elopment plan How do you want to de%elop yourself

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N N N N N Clinical 6esearchG#udit !eaching C"+ &anagement waiting list targetG+ay care centerG+ay surgery unitG4arly discharge N "ersonal

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%$$,$$M,1- %14 %++#%2$%(

-hat do you think of an assessment and an appraisal -hat difference is there between an assessment and appraisal

+IFF4642C4 /4!-442 #SS4SS&42! #2+ #""6#IS#)

N #ssessment B "erformance %Gs Standard N #ppraisalB #ssessment T setting target for further progression N !he difference between #ssessment and #ppraisal has been summarised thusB N R!icking bo(es set by othersS 9#ssessment: N R!icking bo(es that I ha%e helped to set myselfS 9#ppraisal: N !he purpose behind appraisal for medical staff under training is to set goal is for training? In this conte(t, it is ine%itable that career options will be discussed?

#SS4SS&42! #2+ #""6#IS#)B #n assessment is essentially performance %ersus standard? #n #ppraisal is an assessment while additionally setting targets for others5 progress? !he difference between an assessment and an appraisal has can be summarised as ticking the bo(es set by others, an assessment, and appraisal when ticking bo(es that I ha%e helped to set for myself? It is essential to enable both doctors and patients to see that there are mechanisms by which good practice is acknowledged by peers and ultimately re%alidation and bad practice is identified and then addressed? !he go%ernment is trying to de%elop a plan for re%alidation of doctors under the *&C? *tt)"GGwww.a))rai&al&u))ort.n*&.ukG3ile&2G<?I%))rai&alIandI#evalidationI$u ))ortI%ug0 .)d3

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*tt)"GGwww.)d)toolkit.co.ukG=ile&Ga))rai&al&Gg)Ia))rai&al&IandIrevalidation.*t m #ppraisal for *"s was introduced in #pril 2FF2, following full and detailed consultation with the *eneral "ractitionersP Committee of the /&#? 6esponsibility for appraisals rests with "C!s? ;pdated guidance was published on 2' #ugust 2FF0?

%))rai&al 3or 1:$ clinical con&ultant&

In 2FF1 clinical consultants became the first group of 2HS doctors to undertake annual appraisal? !his was intended to support the learning and personal de%elopment needs for consultants? It also de%eloped models of best practice that featured in the introduction of appraisal for other 2HS doctors? *tt)"GGwww.a))rai&al&u))ort.n*&.ukG

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(2!,1!217
httpBGGwww?gmc@uk?orgGdoctorsGlicensing?asp
To practise medicine in the UK all doctors are required by law to be both registered and hold a licence to practise. Doctors work in many different environments. Those who treat patients must be registered with a licence to practise. This applies to all doctors irrespective of whether they practise full time, part time, as a locum, privately or in the NHS, or whether they are employed or selfemployed. Only doctors who are registered with a licence to practise can, for example: Work as a doctor in the NHS Write prescriptions Sign death or cremation certificates

Licensing is the first step towards the introduction of revalidation. This new approach to medical regulation will give patients and employers regular assurance that their doctors are up to date and fit to practise. Licences will require periodic renewal by revalidation. When revalidation begins licensed doctors will be required to demonstrate to the GMC that they are practising in accordance with the generic standards of practice set by the GMC (as described in Good Medical Practice). This section contains the following information: Regulations and guidance Information for employers and other organisations Information for patients

Overseas medical regulators can also download a briefing on licensing (PDF, 1MB), which explains the changes that were made to the registration arrangements for UK doctors on 16 November 2009.

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REVALIDATION
httpBGGwww?gmc@uk?orgGdoctorsGre%alidation?asp

Over the next few years, the General Medical Council will be changing the way doctors within the UK are regulated to practise medicine. Revalidation is the process by which licensed doctors will demonstrate to the GMC that they remain up to date and fit to practise. Revalidation is expected to start from late 2012, according to a joint statement published in October 2010 by the General Medical Council and the health departments of England, Northern Ireland, Scotland and Wales. Revalidation: A Statement of Intent (pdf) sets out the key milestones that employers will need to meet before revalidation is introduced.

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+epartment ;nit Colleagues "lace Family

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# safe and competent consultant @ Is able to manage his ser%ices well along with the training responsibilities in the defined clinical team @ understands his limitations @ and knows when to ask for help and where N Skill impro%ement B clinicalG +ecision makingG.peratingG InterpersonalG CommunicationG )eadershipG&anagementG!eachingG 6esearchG#udit N )earning G!raining agreement N +irect super%ision N #ssessmentB "rogress at each le%el of training N N N N N N N 6I!# assessment <monthsG 1 year and annually thereafter )og book '<F degrees feedback Intercollegiate specialty e(amination )ast 2 years will be dedicated to de%eloping subspecialty interestG Fellowship #t this stage I will go through the process of CCS! .nus B myself #t the end of the day I should feel that I ha%e completed my training and am ready for the job

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!01$<(-%1- !01-#%!!on&ultant contract In the year 2FF' the current consultant contract came into effect in 4ngland, Scotland and 2orthern Ireland? !he aims of the new contract 1? 6educe e(cessi%e working hours 2? Strengthen job planning '? increase consultant producti%ity It has introduced a number of principles that fundamentally change the way consultants work? +iscussion pointsB 1? "erformance related pay 2? Increases management control of how consultants relate to their patients and employers '? Imposes a strict working timetable !he key principles of the contract are 2o consultant can be compelled to work more than 0F hours a week? Consultants wishing to work in the pri%ate sector may be asked to work an additional four hours a week or forfeit a pay progression if this re$uest is declined? !he working week is made up of program acti%ities 9"#s: four hours each? !ypically A?8 "#s 9'F hours: are set aside for direct clinical acti%ity including patient administration and 2?8 "#s 91F hours: set aside as for supporting acti%ities? !he allocation of time necessary to undertake supporting acti%ities has been a contentious issue of the contract and is discussed further? In 4ngland, Scotland and 2orthern Ireland the annual increment has been replaced with entitlement to pay progression, subject to the trusts chief e(ecuti%e being satisfied that the consultant has achie%ed his or her objecti%es as identified in the agreed job plan? .n@call work is recognised by the payment of a percentage of salaryH depending on the fre$uency of the rota and the allowance in the job plan by the time typically spend returning to work whilst on@call? 2o consultant may be re$uired to undertake non@emergency work in weekends between the hours of A "& and A #&? #dditional "#s may be offered and accepted were additional capacity is needed? It reinforces the need for consultants to maintain an accurate diary of all the acti%ities? If there is a conflict between one trust and the consultant any mediation or formal appeal will re$uire e%idence to be produced as opposed to the anecdotal considerations? Iob "lanning >ou should ha%e a job plan that is well defined in the job description when you apply for consultant post? !he consultants will be in%ited by their employers to undertake no more than 1F "# contracts?

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!his is entirely consistent with contract at may mean a reduction in salary for those currently working in e(cess of 1F "#s? If the trust is proposing that you reduce your "#s you need to be satisfied that there is a reduction in acti%ity so that any work your employer re$uires of you can be done within the 0F hours en%elope? If there is any disagreement about whether this can be achie%ed you should post to this through the mediation and appeal process to reach a mutually acceptable agreement? >ou should establish clearly with your employer the scope of the role that is in%ol%ed? >ou should raise any issue of ambiguity or uncertainty about responsibilities in a multidisciplinary team in order to clarifyB 1? )ines of accountability for the care pro%ided to indi%idual patients? 2? -e should take on leadership roles or line management responsibilities? '? -here does the responsibility lie for the $uality and standard of care pro%ided by the team

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Int#oduction
It is essential to ha%e a realistic, working business plan when youPre starting up a business? # business plan is a written document that describes a business, its objecti%es, its strategies, the market it is in and its financial forecasts? It has many functions, from securing e(ternal funding to measuring success within your business?

T%* audi*nc* ,o# -ou# .usin*ss )lan

!here are many benefits to creating and managing a realistic business plan? 4%en if you just use it in@house, it canB

help you spot potential pitfalls before they happen structure the financial side of your business efficiently focus your de%elopment efforts work as a measure of your success

&any people think of a business plan as a document used to secure e(ternal funding? !his is important because potential in%estors, including banks, may in%est in your idea, work with you or lend you money as a result of the strength of your plan? !he following people or institutions may re$uest to see your business plan at some stageB

Finance department grant pro%iders anyone interested in buying your business potential partners

>ou should also bear in mind that a business plan is a li%ing document that will need updating and changing as your business grows? 6egardless of whether you intend to use your plan internally, or as a document for e(ternal people, it should still take an objecti%e and honest look at your business? Failing to do this could mean that you and others ha%e unrealistic e(pectations of what can be achie%ed and when?

W%at t%* )lan s%ould includ*

>our business plan should pro%ide details of how you are going to de%elop your business, when you are going to do it, whoPs going to play a part and how you will manage the money?

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Clarity on these issues is particularly important if youPre looking for finance or in%estment? !he process of building your plan will also focus your mind on how your new business will need to operate to gi%e it the best chance of success? >our plan should includeB

%n eDecutive &ummary @ this is an o%er%iew of the business you want to start? ItPs %ital? &any lenders and in%estors make judgments about your business based on this section of the plan alone? % &*ort de&cri)tion o3 t*e bu&ine&& o))ortunity @ who you are, what you plan to sell or offer, why and to whom? Aour marketing and &ale& &trategy @ why you think people will buy what you want to sell and how you plan to sell to them? Aour management team and )er&onnel @ your credentials and the people you plan to recruit to work with you? Aour o)eration& @ your premises, production facilities, your management information systems and I!? =inancial 3oreca&t& @ this section translates e%erything you ha%e said in the pre%ious sections into numbers? !he e(ecuti%e summary

!he e(ecuti%e summary is often the most important part of your business plan? "ositioned at the front of the document, it is the first part to be read? Howe%er, as a summary it makes sense to write it last? It may be the only part that will be read? Faced with a large pile of funding re$uests, %enture capitalists and banks ha%e been known to separate business plans into Pworth consideringP and PdiscardP piles based on this section alone?

W%at is it?
!he e(ecuti%e summary is a synopsis of the key )oint& of your entire plan? It should include highlights from each section of the rest of the document @ from the key features of the business opportunity through to the elements of the financial forecasts? Its purpose is to e(plain the basics of your business in a way that both informs and interests the reader? If, after reading the e(ecuti%e summary, an in%estor or manager understands what the business is about and is keen to know more, it has done its job? It should be concise @ no longer than two pages at most @ and interesting? ItPs ad%isable to write this section of your plan after you ha%e completed the rest?

W%at is it not?

# brief description of the business and its products? ItPs a synopsis of the entire plan? #n e(tended table of contents? !his makes for %ery dull reading? >ou should ensure it shows the highlights of the plan, rather than restating the details the plan contains? Hype? -hile the e(ecuti%e summary should e(cite the reader enough to read the entire plan, an e(perienced in%estor or businessperson will recognise hype and this will undermine the planPs credibility?

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/ou# .usin*ss' its )#oducts and s*#0ic*s

If you want other people to in%est in your business or if youPre writing your plan to focus your e(isting business acti%ities, you must be able to clearly con%ey what your business does? !his part of the plan sets out your vi&ion for your new business and includes who you are, what you do, what you ha%e to offer and the market you want to address? Start with an o%er%iew of your businessB

when you started or intend to start trading and the progress you ha%e made to date the type of business and the sector it is in any rele%ant history @ for e(ample, if you ac$uired the business, who owned it originally and what they achie%ed with it the current legal structure your %ision for the future

!hen describe your products or ser%ices as simply as possible, definingB

what makes it different what benefits it offers why customers would buy it how you plan to de%elop your products or ser%ices whether you hold any patents, trade marks or design rights the key features of your industry or sector

6emember that the person reading the plan may not understand your business and its products, ser%ices or processes as well as you do, so try to a%oid jargon? ItPs a good idea to get someone who isnPt in%ol%ed in the business @ a friend or family member perhaps @ to read this section of your plan and make sure they can understand it?

/ou# ma#1*ts and com)*tito#s

In this section you should define your market, your position in it and outline who your competitors are? In order to do this you should refer to any market research you ha%e carried out? >ou need to demonstrate that youPre fully aware of the marketplace youPre planning to operate in and that you understand any important trends and dri%ers? >ou should also be able to show that your business will be able to attract customers in a growing market despite the competition?

2*- a#*as to co0*# includ*3

your market @ its si3e, historical data about its de%elopment and key current issues your target cu&tomer ba&e @ who they are and how you know they will be interested in your products or ser%ices

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your com)etitor& @ who they are, how they work and the share of the market they hold t*e 3uture @ anticipated changes in the market and how you e(pect your business and your competitors to react to them

(a#1*tin+ and sal*s

!his section should describe the specific acti%ities you intend to use to promote and sell your products and ser%ices? ItPs often the weak link in business plans so itPs worth spending time on it to make sure itPs both realistic and achie%able? # strong sales and marketing section means you ha%e a clear idea of how you will get your products and ser%ices to market? >our plan will need to pro%ide answers to these $uestionsB

How do you plan to )o&ition your product or ser%ice in the market place -ho are your cu&tomer& Include details of customers who ha%e shown an interest in your product or ser%ice and e(plain how you plan to go about attracting new customers? -hat is your )ricing policy How much will you charge for different customer segments, $uantities, etc How will you )romote your product or ser%ice Identify your sales methods, e?g? direct marketing, ad%ertising, "6, email, e@sales? How will you reac* your customers -hat channels will you use -hich partners will be needed in your distribution channels How will you do your &elling +o you ha%e a sales plan Ha%e you considered which sales method will be the most effecti%e and most appropriate for your market, such as selling by phone, o%er the internet, face@to@face or through retail outlets #re your proposed sales methods consistent with your marketing plan #nd do you ha%e the right skills to secure the sales you need

/ou# t*am4s s1ills

>our business plan needs to set out your own background and skills and the structure and key skills of both your management team and your staff? It should identify the strengths in your team and your plans to deal with any ob%ious weaknesses?

T%* mana+*m*nt t*am

If youPre looking for e(ternal funding, your management team can be a decisi%e factor? 4(plain who is in%ol%ed, their role and how it fits into the organisation? Include a CV or paragraph on each indi%idual, outlining their background, rele%ant e(perience and $ualifications? Include any ad%isers you might ha%e such as accountants or lawyers?

D1

If youPre looking to satisfy your bank manager or other in%estors, you need to demonstrate that your management team has the right balance of skills, dri%e and e(perience to enable your business to succeed? Jey skills include sales, marketing and financial management as well as production, operational and market e(perience? >our in%estors will also want to be con%inced that you and your team are fully committed? !herefore itPs a good idea to set out how much time and money each person will contribute to the business and the salaries and benefits you plan to draw?

/ou# o)*#ations
>our business plan also needs to outline your operational capabilities and any planned impro%ements? !here are certain areas you should focus on?

Location

+o you ha%e any business property -hat are your long@term commitments to the property +o you own or rent it -hat are the ad%antages and disad%antages of your current location

5#oduction ,aciliti*s

+o you need your own production facilities or would it be cheaper to outsource any manufacturing processes If you do ha%e your own facilities, how modern are they -hat is the capacity compared with e(isting and forecasted demand -ill any in%estment be needed

(ana+*m*nt6in,o#mation s-st*ms

Ha%e you got established procedures for stock control, management accounts and $uality control Can they cope with any proposed e(pansion

In,o#mation t*c%nolo+- "IT&

I! is a key factor in most businesses, so include your strengths and weaknesses in this area? .utline the reliability and the planned de%elopment of your systems?

!inancial ,o#*casts
#s part of your plan you will need to pro%ide a set of financial projections which translate what you ha%e said about your business into numbers? >ou will need to look carefully atB

how much capital you need if you are seeking e(ternal funding D2

the security you can offer lenders how you plan to repay any borrowings sources of re%enue and income

>ou may also want to include your personal finances as part of the plan at this stage?

!inancial )lannin+
>our forecasts should run for the ne(t three 9or e%en fi%e: years and their le%el of sophistication should reflect the sophistication of your business? Howe%er, the first 12 monthsP forecasts should ha%e the most detail associated with them? Include the assumptions behind your projection with your figures, both in terms of costs and re%enues so in%estors can clearly see the thinking behind the numbers?

5#*s*ntin+ -ou# .usin*ss )lan

!o make sure your business plan has ma(imum impact, there are a number of points to obser%e? Jeep the plan &*ort @ itPs more likely to be read if itPs a manageable length? !hink about the )re&entation and keep it professional @ e%en if you only intend to use the plan in@house? 6emember, a well presented plan will reinforce the positi%e impression you want to create of your business?

Ti)s ,o# )#*s*ntin+ -ou# )lan

Include a co%er or binding and a contents page with page and section numbering? Start with the e(ecuti%e summary? 4nsure itPs legible @ make sure the type is ten point or abo%e? >ou may want to email it, so ensure you use email@friendly formatting? 4%en if itPs for internal use only, write the plan as if itPs intended for an e(ternal audience? 4dit the plan carefully @ get at least two people to read it and check that it makes sense? Show the plan to e(pert ad%isers @ such as your accountant @ and ask for feedback? 6edraft sections they say are difficult to understand? #%oid jargon and put detailed information @ such as market research data or balance sheets @ in an appendi( at the back?

&ake sure your plan is reali&tic? .nce you ha%e prepared your plan, use it? If you update it regularly, it will help you keep track of your businessP de%elopment?

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40!-0#/M%1%7,# #,(%-201$:2+
-*e 4octor !rained to emphasise the scientific approach Has face to face contact with patients and their families -ill ne%er be primarily concerned with costs Focuses on indi%idual patient -*e Manager Has to remember political factors and human moti%ation 6arely meets patients or family

Focused on treatment efficiency deli%ered within the allocated resources Focused on populationGgroup and go%ernment agenda 4(pected to sol%e all presenting problems &ust to choose which problem to tackle Has learnt to be independent and 4(pects to share responsibilities with competiti%e others 4(pects problems to ha%e solutions 4(pects to tolerate many insoluble problems 4(pects to stay with the same trust for Has to mo%e to gain promotion or due to whole career and has job security redundancy High social status and professional &edium social status and public freedom pressures 9From *arelicka and Faginl the +octor manager relationship ad%ances in psychiatric treatment 11: 92FF8:

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1,70-2%-201
2ntroduction 2egotiation is something that we do all the time and is not only used for business purposes? For e(ample, we use it in our social li%es perhaps for deciding a time to meet, or where to go on a rainy day? 2egotiation is usually considered as a compromise to settle an argument or issue to benefit oursel%es as much as possible? Communication is always the link that will be used to negotiate the issueGargument whether it is face@to@face, on the telephone or in writing? 6emember, negotiation is not always between two peopleB it can in%ol%e se%eral members from two parties? !here are many reasons why you may want to negotiate and there are se%eral ways to approach it? !he following is a few things that you may want to consider? '*y 1egotiate@ If your reason for negotiation is seen as PbeatingP the opposition, it is known as P+istributi%e negotiationP? !his way, you must be prepared to use persuasi%e tactics and you may not end up with ma(imum benefit? !his is because your agreement is not being directed to a certain compromise and both parties are looking for a different outcome? Should you feel your negotiation is much more PfriendlyP with both parties aiming to reach agreement, it is known as PIntegrati%e negotiationP? !his way usually brings an outcome where you will both benefit highly? 2egotiation, in a business conte(t, can be used for selling, purchasing, staff 9e?g? contracts:, borrowing 9e?g? loans: and transactions, along with anything else that you feel are applicable for your business?

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-2M, M%17,M,1Central to good time management is the ability to prioritise tasks and there are different ways of going about this? 1? >ou should try to handle a piece of paper once? i?e? when you read you post you should aim to deal with each item in the same way? +eal it, delegate it or act upon it? 2? &ake good use of your waste paperG recycling bin? If you ha%e a tendency to procrastinate on certain tasks doing them first to get them out of the way? '? +elegate as much as you can? 0? Jeep a list of things to do? 8? )et people know there are times you don5t want to be interrupted, unless there is an emergency? <? Jeep and use a diary or an electronic organiser? A? 4nter all commitments as they are met? D? -hen planning time to carry out a project, estimate the time it will take you and then double it? E? )earn to say no? !o re$uest that you don5t ha%e the time or inclination for? 1F? !ry to keep your desk tidy?

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httpBGGwww?mmc?nhs?ukG !he &odernising &edical Careers team is working with colleagues around the country to de%elop a better way of training doctors through the implementation of the Foundation "rogramme and the reform of specialty and general practice training programmes?

-hat is &&C
&oderni3ing &edical Careers 9&&C: aims to impro%e patient care by deli%ering a moderni3ed and focused career structure for doctors through a major reform of postgraduate medical education? It aims to de%elop demonstrably competent doctors who are skilled at communicating and working as effecti%e members of a team? #s training and education are central to the work of doctors and their role in deli%ering patient care, &&C will also bring about significant changes to career structures, pro%iding $ualified staffs that are able to meet the needs of patients?

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=0<14%-201 +#07#%M$
*tt)"GGwww.3oundation)rogramme.n*&.ukG)age&G*ome !he Foundation "rogramme is a two@year training programme that forms the bridge between medical school and specialty G general practice training? #ll graduates of ;J medical schools are re$uired to complete the Foundation "rogramme before applying for specialty training? +uring the Foundation "rogramme, trainees will ha%e the opportunity to gain e(perience in a series of placements in a %ariety of specialties and healthcare settings? Foundation >ear 1 9F1: !he first year of the Foundation "rogramme builds upon the knowledge, skills and competences ac$uired in undergraduate training? Foundation >ear 2 9F2: !he second year Foundation "rogramme builds on the first year of training? In F2, the focus is on training in the assessment and management of the acutely ill patient? !raining also encompasses the generic professional skills applicable to all areas of medicine 1 teamwork, time management, communication and I! skills? *tt)"GGwww.3oundation)rogramme.n*&.ukG

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=0<14%-201 +#07#%M$" -raining and %&&e&&ment

*tt)"GGwww.3oundation)rogramme.n*&.ukG)age&G*omeGtraining/and/a&&e&&ment >our training will be supported by the Foundation "rogramme Curriculum and you must gain all of the competences detailed in the curriculum before you can complete the Foundation "rogramme? !his section e(plains more about your education and training, assessments and your Foundation )earning "ortfolio?

Rou+% 7uid* to t%* !oundation 5#o+#amm*

!he 6ough *uide will gi%e you an o%er%iew of the programme and tell you what to e(pect in your induction, placements, study lea%e, etc? !he guide also contains case studies from foundation doctors which may help gi%e you an insight into what actually happens during your first two years as a doctor? It is best if you can read this before you look at the curriculum or the portfolio?

!oundation 5#o+#amm* Cu##iculum

>ou will be assessed against the competences in the curriculum and you should keep all of your assessments 9not just the good ones: in your Foundation )earning "ortfolio?

!oundation L*a#nin+ 5o#t,olio

!he portfolio may either be paper@based or electronic, depending on which %ersion your foundation school has decided to use? !he paper@based portfolio can be downloaded and printed off from this website? If you are going to use the electronic portfolio, your foundation school will pro%ide you with your login details and password, and the website address? 9Scotland uses a different web address to the rest of the ;J, but the portfolios ha%e the same content:?

Ass*ssm*nt and ass*ssm*nt tools

-orkplace@based assessment and feedback are central to the philosophy of foundation training? 6egular assessment ensures you are progressing, pro%ides documentary e%idence of your achie%ements and can be used to identify any problems you are ha%ing early on? !he goal is to help you pro%ide better care to patientsH and to help you strengthen any areas of weakness that are identified? >ou will be assessed against the standard of competence that is e(pected of a doctor completing the F1 year? !his means that, in your first days as a foundation doctor, you

E1

may not reach the standard re$uired? +on5t worry, this is to be e(pected and is 2.! a failure? !he assessments are designed to measure your progress through the year? #t the end of F1, you will be e(pected to ha%e progressed to a satisfactory le%el? !here are three types of assessment commonly usedB

&ulti@Source Feedback 9&SF: pro%ides an opportunity for a number of your colleagues to rate your abilities and offer comments? !he three tools currently in use areB o &ini "eer #ssessment !ool 9mini@"#!:, o !eam #ssessment of /eha%iours 9!#/: o &ulti@source feedback tool 9used in Scotland:? -ith all of these tools, you will be asked to submit a list of colleagues 9including non@clinical members of your healthcare team: as possible ratersGassessors? #n administrator will contact these raters and will compile the results once sufficient responses are recei%ed? !he report is sent to your educational super%isor, who will discuss the results and comments with you?

+irect obser%ation of doctorGpatient encounters are obser%ed clinical interactions which pro%ide the opportunity for immediate feedback to the junior doctor? !he two most commonly used tools areB o +irect .bser%ation of "rocedural Skills 9+."S: o &ini Clinical 4%aluation 4(ercise 9&ini@C4U:? +uring your placements, you should ask e(perienced colleagues 9including Sp6s, consultants, *" principals, plus e(perienced nurses and allied health professionals in the case of +."S: to obser%e you performing a particular procedure 9+."S: or clinical consultation 9mini@C4U:, rate your le%el of competence and pro%ide feedback? It is your responsibility to arrange the assessments and submit copies of the reports?

Case@/ased +iscussion 9C/+: 1 this is a structured re%iew of cases you ha%e been in%ol%ed in? It allows you to discuss your decision@making and clinical reasoning in a safe, non@judgemental en%ironment with a senior clinician?

!he assessments may sound intimidating, but they all come with instructions and training material for you and the assessors?

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$+,!2%(-A -#%21217
httpBGGwww?mmc?nhs?ukGspecialtyVtrainingV2F1F?asp(

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7+ -#%21217
*tt)"GGwww.g)recruitment.org.ukG !he 2ational 6ecruitment .ffice co@ordinates recruitment to general practice training schemes throughout 4ngland, -ales, Scotland and 2orthern Ireland? !his website is designed to help doctors who want to train for general practice identify the a%ailable opportunities, make informed judgments about where they wish to train and guide them through the application system? 4ligibility re$uirements, +eanery information plus the answers to your most fre$uently asked $uestions are a%ailable on this site which also ser%es as a gateway to indi%idual deanery sites?

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,<#0+,%1 '0#?217 -2M, 42#,!-26, ,<#0+,%1 '0#?217 -2M, 42#,!-26,

*tt)"GGwww.d*.gov.ukGenGManagingyourorgani&ationG:umanre&ource&andtraini ngGModerni&ingwork3orce)lanning*omeG,uro)eanworkingtimedirectiveG4:I41 5 !his is a still a hot topic? "lease go to the +epartment of health website to update yourself?

'*at i& t*e ,uro)ean 'orking -ime 4irective@

!he 4-!+ is a directi%e from the Council of 4urope 9E'G1F0G4C: to protect the health and safety of workers in the 4uropean ;nion? It lays down minimum re$uirements in relation to working hours, rest periods, annual lea%e and working arrangements for night workers? !he +irecti%e was enacted into ;J law as the -orking !ime 6egulations, which took effect from 1.ctober 1EED? !he *o%ernment negotiated an e(tension of up to twel%e years to prepare for full implementation for doctors in training?

'*at i& t*e &ituation at t*e moment@

Since 1EE1, doctors in training ha%e been co%ered by the 2ew +eal, a package of measures to impro%e the conditions under which they work? .ne of the key features of the 2ew +eal is limits on the working hours of junior doctors? From #ugust 2FF' all junior doctors are limited by contract to 8< hours of acti%e work?

-*e legal de3inition o3 working time

O-orking time shall mean any period during which the worker is working, at the employerPs disposal and carrying out his or her acti%ity or duties, in accordance with national laws andGor practice?O !he 4uropean Court made a judgement in .ctober 2FFF, in answer to a claim by doctors in Spain, that time spent resident on call be defined as workB

!he Si&ap ruling

'*at i& t*e timetable 3or im)lementation o3 t*e '-4@

%ugu&t 200
Interim 8<@hour ma(imum working week? 96est break re$uirements became legally enforceable in 2FF0:

E8

%ugu&t 2009
+eadline for 0D@hour ma(imum working week? !his may e(ceptionally be e(tended by another three years at 82 hours, with 0D hours then being implemented in 2F12?

'*at are t*e re&t and break reBuirement&@

# minimum daily consecuti%e rest period of 11 hours # minimum rest break of 2F minutes when the working day e(ceeds si( hours # minimum rest period of 20 hours in each se%en day period 9or 0D hours in 10 days: # minimum of four weeksP paid annual lea%e # ma(imum of eight hoursP work in any 20 hours for night workers in stressful job

'*at 3leDibility will 1:$ em)loyer& *ave in giving re&t entitlement&@

# derogation is an agreement to introduce fle(ibility in some of the rest re$uirements, allowing doctors, for e(ample, to take compensatory rest in lieu of the rest they should be getting while working? -e ha%e derogated from rest re$uirements for doctors in training 9subject to immediate compensatory rest: under the -orking !ime 6egulations 2FF', thereby gi%ing 2HS employers some fle(ibility as to when rest is taken? !his will help the 2HS to plan ser%ices around patient needs? ?

-raining and &ta33

$*orter *our& will mean le&& training@ !he -!+ will indeed challenge us to look at the way we deli%er training? !hat is why the *o%ernment launched its &oderni3ing &edical Careers strategy in February this year? !his heralds a thoroughgoing re%iew of training systems and methods as well as looking at the end product of training? !he better@managed, better structured and more robust training arrangements we en%isage will lead to more meaningful and focused training? !his is e(actly what is re$uired in addressing the -!+? :ow are we going to get everyt*ing done K u&ing ot*er &ta33@ Changes to ser%ice deli%ery to bring doctors in training hours into compliance with the -!+ pro%ide an opportunity for all members of the health care team 9not just nurses:, to re%iew their contribution to patient care, and to de%elop their roles? -e are in%estigating inno%ati%e ways to share work amongst all professions, and aim to

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de%elop other employees to take on work traditionally undertaken by doctors in training? Inno%ations include the modeling of different working patterns 9with li%e pilots:, skill mi( solutions etc? &any nurses are e(tending their roles to run clinics, perform minor surgery, admit and discharge patients, and re$uest tests and in%estigations?

!o&t& and 3inance

'*ere i& t*e money 3or im)lementing t*e ,'-4@ 2HS funding is e(pected to increase by an a%erage of A?0 K in 4ngland o%er each of the ne(t fi%e years? !his includes pro%ision for the impact of -!+? 2&nHt it too eD)en&ive to im)lement@ Changes to working practices need not cost more, and can actually lead to impro%ed care for patients? Solutions re$uire more fle(ible use of new and e(isting staff, so !rusts must assess what skills are needed, when they are needed and who has those skills?

EA

:0$+2-%( %- 127:!he Hospital at 2ight project aims to redefine how medical co%er is pro%ided in hospitals during the out@of@hours period? !he project re$uires a mo%e from co%er re$uirements defined by professional demarcation and grade, to co%er defined by competency? -e belie%e the project pro%ides the best possible care for patients gi%en the changes in permitted working hours of doctors in training? It offers the most efficient method of preser%ing, and e%en enhancing, doctors5 training in the reduced hours a%ailable? !he Hospital at 2ight model consists of a multidisciplinary night team, which has the competencies to co%er a wide range of inter%entions but has the capacity to call in specialist e(pertise when necessary? !his contrasts the traditional model of junior doctors working in relati%e isolation, and in specialty@based silos? !he project also ad%ocates Super%ised multi@specialty hando%er in the e%enings .ther staff taking on some of the work traditionally done by junior doctors &o%ing a significant proportion of non@urgent work from the night to the e%ening or daytime 6educing the unnecessary duplication of work by better coordination and reducing the multiple clerking and re%iews? !he project has used the Ioint Consultants Committee as its steering group and the model is endorsed by them, as well as the 6oyal College of 2ursing and the /ritish &edical #ssociation?

ED

,valuation )ubli&*ed 3or L:o&)ital at 1ig*tL )roject Hospital at 2ight, a model of shift patterns and staffing mi( for the 2HS to use in response to the 4uropean -orking !ime +irecti%e has deli%ered impro%ements to patient care, according to a new report published today? !he report details e%aluations from four acute hospital sites across 4ngland that piloted the scheme in 2FF'? !he report concludes that Hospital at 2ightB

:el)ed im)rove )atient care during the night by prioritising acutely ill patients, and ensures that patients are treated more $uickly and are seen by doctors who are more alert Had no negative im)act on doctor& training Has not affected the achie%ement of national performance targets in the areas of #Q4 waiting times, cancelled operations and inpatient waiting times?

!he Hospital at 2ight project redefined how medical co%er is pro%ided in hospitals during the out@of@hours period? !he project re$uires a mo%e from co%er re$uirements defined by professional demarcation and grade, to co%er defined by competency? Jey elements of Hospital at 2ight include multi@disciplinary teams, multi@specialist hando%ers, bleep filtering, e(tended nursing roles, and mo%ing non@urgent work from the nighttime? !he project is a partnership between the +epartment of Health, the 2HS &odernisation #gency, the /ritish &edical #ssociation and the 6oyal Colleges? "ublic Health &inister Caroline Flint saidB PImplementation of the -orking !ime +irecti%e for doctors in training in #ugust 2FF0 was not easy, but it is testament to the hard work and dedication of staff that we ha%e managed to come this far? PHospital at 2ight played a key part role in helping trusts formulate new ways of working, achie%e -orking !ime +irecti%e compliance, impro%e patient care and encouraged a better workGlife balance between doctors? P#s the report shows, the successful implementation of Hospital at 2ight prioritises acutely ill patients, and ensures that patients are treated more $uickly and are seen by doctors who are more alert? P!he in%ol%ement and ad%ice from professional organisations and colleagues in the wider 2HS has been critical to the successful implementation of Hospital at 2ight? P!he -orking !ime +irecti%e was a great opportunity for us to modernise the way we work to pro%ide faster treatment for patients, a better patient e(perience and a better working en%ironment for staff?

EE

PHospital at 2ight was a key element of this strategy? -e need to build on this success? -e must keep up the momentum in reducing doctorsP hours @ the job is not fully done but the principles underpinning Hospital at 2ight will be a key solution to the 2FFE 0D@hour 4uropean -orking !ime +irecti%e?P "atrick Chu, Clinical +irector of Haematology at the 6oyal )i%erpool 2HS !rust, one of the pilot schemes, saidB O!he Hospital at 2ight model is a %ery good working model to help pa%e the way for the full implementation of the 4uropean -orking !ime +irecti%e in 2FFE? It also has much wider benefits including training more highly skilled nurses, ,impro%ing communications, team building and time management? !he hospital at night model can be impro%ed further by applying the concept across the 20 hours of the working day?O !he report also highlightsB -eam working @ #t all !rusts for the pilots the multidisciplinary team comprised highly trained nurses and doctors from a range of specialties? +octors felt that team working reduced the intensity of their workload and allowed them to concentrate on specific patients without interruption? :andover @ #ll staff felt that the more formal hando%er that is a key re$uirement of Hospital at 2ight guidance impro%ed patient care? +octors felt that they were picking up the most acutely ill patients and it was easier to get cross speciality referrals? 1ig*t !oordinator role @ !he importance of the 2ight Coordinator role @ a senior nurse at each of the pilot sites @ was a critical part of the implementation and working of Hospital at 2ight teams? 2urses in particular reported that they felt more willing to bring problems to the attention of the 2ight Coordinator, which led to impro%ements in patient care? >lee) 3iltering @ !he inappropriate bleeping of doctors helped doctors to see patients more $uickly, carry out patient consultations without constant interruption? It also contributed to impro%ing the workGlife balance of doctors by helping them finish their shifts on time?

1FF

-00?, #,+0#httpBGGwww?mmcin$uiry?org?ukGdraft?htm

W%- an in8ui#-?
!he former Secretary of State for Health, "atricia Hewitt, in%ited Sir Iohn !ooke to lead an Independent In$uiry into &odernising &edical Careers 9&&C: in the wake of the debacle surrounding &!#S, the process used for selecting trainee doctors for specialist training? Seldom in my professional career has an issue pro%oked such an outcry from the profession and e(pressions of concern for the future of trainee doctors and the deli%ery of medical care and health ser%ice de%elopments to which we hope they will contribute?

$ummary 1? &anagement of "ostgraduate !raining in 4ngland )ack of cohesion Suboptimal relationships with ser%ice and academia 2? "ostgraduate +eaneries should be re%iewed to ensure they deli%er against guiding principles 9fle(ibility, aspiration to e(cellence: and 2HS priority of e$uity of access '? "&4!/ merged within *&C offeringB 4conomy of scale # common approach )inkage of accreditation with registration Sharing of $uality enhancement e(pertise 6eporting direct to "arliament, rather than through monopoly employer 0? !he structure of "ostgraduate !raining should be modified to pro%ide a broad based platform for subse$uent higher specialist training, increased fle(ibility, the %aluing of e(perience and the promotion of e(cellence 8?&!#S was criticised

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Several Core Specialt! stems 3 !ears + , + month positions Ma! interrupt training $or up to 12 months -ntegrated "Masters# programmes availa.le / )esearch / 0ducation / Management / Glo.al health 3 stems include $or e,ample Medicine4 Surger!4 Diagnostic4 "5!.rid# and G* training6 71 the term "specialt!# has no $ormal legal signi$icance in these e,amples

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-hat is research +efine it? Visit your hospital5s and 2HS 6Q+ website? httpBGGwww?dh?go%?ukGenG"olicyandguidanceG6esearchandde%elopmentGinde(?htm -hat is the importance of research in our practice 6eliable research based information is fundamental to the successful implementation of clinical go%ernance? +eli%ery of patient care, planning, organisation and management of ser%ices and education of those who pro%ide that care should be based on well researched practice? #d%ances boundaries of scientific knowledge Helps in de%eloping logical thought, critical analysis and self reliance 4nables interpretation and e%aluation of research undertaken by others Impro%es job prospects Helps in pursuing an academic career How to implement in the clinical practice

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-hat is a research framework

64S4#6CH F6#&4-.6J
#im, objecti%es and hypothesis? 6esources, ethics, communication and access Construction of instrument and e$uipment "ilot study +ata collection +ata preparation and analysis "resentation of findings 4%aluation +issemination of findings

# research framework is about how you implement a project in an organi3ed way? !here has to be clear aims and objecti%es? >ou should ha%e a hypothesis? 4nough resources should be there in terms of the money, man power and time? If the research has not been done before, you need to do a pilot study to see if the research is feasible? +ata collection, data analysis and in%ol%ement of a statistician at the beginning of the project is %ery important? So, it is %ery important to in%ol%e e%erybody in the research framework at the beginning and at the hypothesis stage?

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-hat is the role of research go%ernance

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N 6esearch go%ernance framework sets out standards , deli%ery mechanisms and monitoring arrangements for all research which relates to the responsibility of secretary of state for health? N It is for all who participate in research, host, fund, manage and undertake research? N It impro%es research $uality and safeguards public by N 4nhancing ethical and scientific $uality N "romoting good medical practice N 6educing ad%erse incidents and ensuring lessons all learnt N "re%enting poor performance and misconduct

httpBGGwww?dh?go%?ukGenG"olicyandguidanceG6esearchandde%elopmentG#@ WG6esearchgo%ernanceGinde(?htm

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LEVEL

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5RI(AR/

RESEARCH <UESTION
T-)*s o, Studi*s 5#o+nostic Studi*s= In0*sti+atin+ t%* E,,*ct o, a 5ati*nt C%a#act*#istic on t%* Outcom* o, Dis*as* Economic and D*cision Anal-s*s =D*0*lo)in+ an Economic o# D*cision (od*l

T%*#a)*utic Studi*s= In0*sti+atin+ t%* R*sults o, T#*atm*nt 'evel -

Dia+nostic Studi*s= In0*sti+atin+ a Dia+nostic T*st

5igh/8ualit! randomi9ed controlled trial with statisticall! signi$icant di$$erence or no statisticall! signi$icant di$$erence .ut narrow con$idence intervals

5igh/8ualit! prospective stud!< :all patients were enrolled at the same point in their disease with =>?@ $ollow/ up o$ enrolled patients;

Testing o$ previousl! developed diagnostic criteria in series o$ consecutive patients :with universall! applied re$erence AgoldA standard;

Sensi.le costs and alternativesB values o.tained $rom man! studiesB multiwa! sensitivit! anal!ses

S!stematic review2 o$ 'evel/- randomi9ed controlled trials :and stud! results were homogeneous3; 'evel --

S!stematic review2 o$ 'evel/- studies

S!stematic review2 o$ 'evel/- studies

S!stematic review2 o$ 'evel/studies

'esser/8ualit! randomi9ed controlled trial :e6g64 C>?@ $ollow/up4 no .linding4 or improper randomi9ation;

X X X

)etrospective+ stud!

%ntreated controls $rom a randomi9ed controlled trial 'esser/8ualit! prospective stud! :e6g64 patients enrolled at di$$erent points in their disease or C>?@ $ollow/ up;

Development o$ diagnostic criteria on .asis o$ consecutive patients :with universall! applied re$erence AgoldA standard;

X X

*rospective< comparative stud!D S!stematic review2 o$ 'evel/-- studies or 'evel/studies with inconsistent results

S!stematic review2 o$ 'evel/-- studies

Sensi.le costs and alternativesB values o.tained $rom limited studiesB multiwa! sensitivit! anal!ses

S!stematic review2 o$ 'evel/-studies

X X

S!stematic review2 o$ 'evel/-- studies

'evel ---

X X X

Case/control stud!E
+

Case/control stud!E

)etrospective comparative stud!D S!stematic review2 o$ 'evel/--- studies

Stud! o$ nonconsecutive patients :without consistentl! applied re$erence AgoldA standard;

X X

Anal!ses .ased on limited alternatives and costsB poor estimates S!stematic review2 o$ 'evel/--studies

X
Case series

S!stematic review2 o$ 'evel/--- studies

'evel -F

Case series>

X X

Case/control stud! *oor re$erence standard

7o sensitivit! anal!ses

'evel F 16 26 36 <6 D6 +6 E6 >6

0,pert opinion

0,pert opinion

0,pert opinion

0,pert opinion

A complete assessment o$ the 8ualit! o$ individual studies re8uires critical appraisal o$ all aspects o$ the stud! design6 A com.ination o$ results $rom two or more prior studies6 Studies provided consistent results6 Stud! was started .e$ore the $irst patient enrolled6 *atients treated one wa! :e6g64 with cemented hip arthroplast!; compared with patients treated another wa! :e6g64 with cementless hip arthroplast!; at the same institution6 Stud! was started a$ter the $irst patient enrolled6 *atients identi$ied $or the stud! on the .asis o$ their outcome :e6g64 $ailed total hip arthroplast!;4 called Acases4A are compared with those who did not have the outcome :e6g64 had a success$ul total hip arthroplast!;4 called Acontrols6A *atients treated one wa! with no comparison group o$ patients treated another wa!6

This chart was adapted $rom material pu.lished .! the Centre $or 0vidence/1ased Medicine4 2,$ord4 %&6 For more in$ormation4 please see www6ce.m6net6

1FA

httpBGGwww2?ejbjs?orgGmiscGinstru(?shtml 9scroll down, you will see the le%el of e%idence:

1FD

%<42-hat is an audit How does an audit help you in your clinical practice

#;+I!
#udit is a dynamic, cyclical process 9audit loop: in which &tandard& are defined and data collected and monitored against these standards 9 +ractice v&. $tandard; +efine standards

&akes changes

&onitor against standards

#nalyse results "lan changes

#n audit is to make sure that the clinical practice is meeting the standard? It is a dynamic and cyclical process? >ou define their standards and monitor it? !here should be a monitoring process, e%entually you analyse the result and match it again to the set standards? If the standard is poor then you ha%e to find out what is the cause of it and re@do the audit again? It is %ery important that once you ha%e started the audit the audit loop is closed? It might not be possible in one audit, and till the audit loop is closed it has to be done again and again? It has got a great role in maintaining the highest standard practice and it is one of the most important pillars of the clinical go%ernance?

httpBGGen?wikipedia?orgGwikiGClinicalVaudit

1FE

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N2o discrimination for age N2on committal N!eam decisionB most important %utonomy 1 indi%idual dignity >ene3icence 1 balance risk and benefit 1on/ mal e33icience 1 minimising harm Eu&tice 1 fairness Fnon;+rejudice

4thical issues are common $uestions in inter%iews? >ou will be gi%en scenarios and will be asked to discuss the problem? 4(ampleB Case 1B # A8@year@old gentleman presents with a carcinoma of prostrate and ad%anced metastases? He has got se%ere internal bleeding? Case 2B # 0F@year@old lady presents with carcinoma of breast and ad%anced metastasis? She is in a se%ere internal bleeding situation? Case 'B # 28 years old was in%ol%ed in a 6oad !raffic accident 96!#:? He is bleeding hea%ily? He is in a haemorrhagic shock? #t a small cottage hospital you ha%e resources to deal with one patient only? How will you deal with the situation -ho will you treat first 11F

!here is no right or wrong answer? >ou ha%e to discuss this situation? !he decision has to be taken as a team? If I work in a small hospital and I don5t ha%e any doctor colleagues, I will discuss it with the senior sister in charge, senior manager and the whole team? I should use phone and discuss with my colleague at the tertiary care centre? I will re%iew the situation retrospecti%ely? I will get feedback from the team and the tertiary referral centre? !here should not be any discrimination of age? Indi%idual dignity is important? .ne should balance risk %Gs benefit? -hate%er you do, you should minimise loss? .ne should be fair and there should not be any prejudice? #ll the actions you discussed should be recorded for further reference?

111

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112

!(212!%( 706,#1%1!,
-hat is a Clinical *o%ernance How does it help in your clinical practice

!(212!%( 706,#1%1!,
+efin itionB # framework through which 2HS organisations are accountable for continuously impro%ing the $uality of their ser%ices and safeguarding high standards of care by creating an en%ironment in wh ich e(cellence in clin ical care will flourish? N N N N N N N Clin ical audit 6isk management Continuous professional de%elopment #ccreditation of health care pro%iders 6esearch and de%elopment Staff management "atient feedback

Clinical go%ernance is a frame work to make sure that the 2HS is pro%iding the highest le%el of patient care? !here are se%eral features of clinical go%ernance 1? Clinical audit? 2? 6isk management? '? Continuous professional de%elopment 0? #ccreditation of health care pro%iders 8? 6esearch and de%elopment <? Staff management A? "atient feed back? >ou should be able to discuss all these issues at length? 'eb&ite" httpBGGwww?clinicalgo%ernance?scot?nhs?ukG

11'

2M+(,M,1-%-201 0= !(212!%( 706,#1%1!,

How will you implement Clinical go%ernance How you make sure that in your ;nit G+epartment good Clinical *o%ernance is practiced

!(212!%( 706,#1%1!,
2m)lementation reBuire&" !ransformation of culture -ays of working #ttitude System in local 2HS organisations #cti%e leadership #eBuire& c*ange& at 3 level& N Indi%idual health care professions@ need to embrace change, adopting reflecti%e practice, which places patient at the centre of their thinking N !eam@ multidisciplinary groups, where understanding about roles, sharing of information and knowledge about support for each other becomes p art of e%eryday practice N .rganisation@ needs to put in place systems and local arrangements to support such teams and assure the $uality of care pro%ided? Commitment and leadership from board and throughout organisations is clearly crucial? N N N N N

Implementation of clinical go%ernance re$uires transformation of culture, ways of working, attitude, and systems in the local 2HS organi3ation? It was introduced in 1EEE? It is practiced in all trusts of the 2ational Health Ser%ice? Some hospitals are running slightly better than the other hospitals? I think it is again about the change of cultures, ways of working and attitude? How are you going to assist in impro%ing clinical go%ernance Here is an e(ample? -e ha%e clinical go%ernance running in our hospital? -e reali3ed that fracture neck of femur patients in our hospital are waiting for a longer period before they are operated? -e felt that they needed to be dealt with $uickly? -e de%eloped a trauma nurse coordinator whose job was to look after only the fracture neck of femur patients? Her job description was carefully designed? She will liaise with the surgeon, ward, anaesthetist, operating theatre and the care of the elderly doctors? #n audit done after one year showed that this system was working? !he one year morbidity and mortality had reduced significantly 9" %alue YF?F8:? !his is an e(ample of good clinical go%ernance?

110

M<(-2/42$!2+(21%#A -,%M
Healthcare is increasingly pro%ided by multidisciplinary teams? -orking in a team does not change your personal accountability for your professional conduct and the care you pro%ide? -hen working as a team, you mustB 6espect the skills and contribution of your colleagues &aintain professional relationship with patients Communicate effecti%ely with colleagues within and outside trust &ake sure that your patients and colleagues understand your professional status and specialty, your role and responsibilities in the team and who is responsible for each aspect of patient5s care "articipate in regular re%iew and audit of standards and performance of the team, taking steps to remedy any deficienciesH /e willing to deal openly and supporti%ely with problems in the performance, conduct or health of team members

118

-:, $-#<!-<#, 0= -:, 1:$

Hospitals in the 2HS are managed by 2HS trusts 9sometimes called acute trusts: and are run by a trust board? !hese trusts make sure that hospitals pro%ide high $uality health care, and that they spend their money efficiently? &ental health trusts and ambulance trusts ha%e a similar structure but tend to co%er wider areas? !here are almost 'FF hospital, mental health and ambulance trusts, and 182 primary care trusts in 4ngland? "rimary care is pro%ided in your local community %ia your local *", 2HS walk@in centre, dentist, pharmacist and optician? 2HS +irect is also responsible for pro%iding healthcare ad%ice and information 20 hours a day %ia the internet and o%er the telephone? #ll hospital and mental health trusts are dependent on primary care trusts 9"C!s: commissioning ser%ices such as electi%e surgery, outpatient %isits and other treatments from them, but "C!s also run community@based hospitals and pro%ide ser%ices such as district nursing and health promotion? "C!s still tend to commission many ser%ices from their local hospital? Howe%er, under the patient choice initiati%e, anyone needing electi%e hospital treatment will be offered a choice of where it is carried out, including independent sector treatment centres 9IS!Cs: run by pri%ate companies? Strategic health authorities 9SH#s: co%er large areas 1 typically neighbouring counties or large city areas 1 and are responsible for o%erseeing other 2HS organisations in their area and leading on issues such as workforce de%elopment and capacity?

#s per 2HS -hite paper lots of changes are going to take place in the structure of 2HS? "lease read the 2HS -hite paper and make yourself aware of the current changes taking place? !he "C!s will terminate in2F1' and will be replaced by *" consortia? SH#s also will change and new structure will take place which is still taking a shape? httpBGGwww?dh?go%?ukGenG"ublicationsandstatisticsG"ublicationsG"ublications"olicy#n d*uidanceG+HV11A'8'

11<

':2-, +%+,#
,Buity and eDcellence" (iberating t*e 1:$ !he 2HS -hite "aper, 4$uity and e(cellenceB )iberating the 2HS, sets out the *o%ernmentPs long@term %ision for the future of the 2HS? !he %ision builds on the core %alues and principles of the 2HS @ a comprehensi%e ser%ice, a%ailable to all, free at the point of use, based on need, not ability to pay? It sets out how we willB put patients at the heart of e%erything the 2HS doesH focus on continuously impro%ing those things that really matter to empower and liberate clinicians to inno%ate, with the freedom to focus patients @ the outcome of their healthcareH and on impro%ing healthcare ser%ices Salient features *" consortium will replace "C! 9 "C! will cease to function in 2F1': SH# will be replaced by some other similar organisation

"lease go to the following website and download the document and go through it? Jeep yourself updated httpBGGwww?dh?go%?ukGenG"ublicationsandstatisticsG"ublicationsG"ublications"olicy#n d*uidanceG+HV11A'8' httpBGGwww?dh?go%?ukGprodVconsumVdhGgroupsGdhVdigitalassetsGCdhGCenGCpsGdocu mentsGdigitalassetGdhV11AAE0?pdf

11A

-*e 3ollowing i& t*e )ro)o&ed &tructure o3 t*e 1:$

11D

%<-:0#2-2,$ %14 -#<$-$

#uthorities and !rusts are the different types of organisations that run the 2HS at a local le%el? !he whole of 4ngland is split into 1F Strategic Health #uthorities 9SH#s:? !hese organisations were set up in 2FF2 to de%elop plans for impro%ing health ser%ices in their local area and to make sure their local 2HS organisations were performing well? -ithin each SH#, the 2HS is split into %arious types of !rusts that take responsibility for running the different 2HS ser%ices in your local area? !he different !rust types areB

#cute !rusts #mbulance !rusts Care !rusts &ental Health !rusts "rimary Care !rusts 9"C!s:

11E

$-#%-,72! :,%(-: %<-:0#2-2,$

Created by the *o%ernment in 2FF2 to manage the local 2HS on behalf of the Secretary of State, there were originally 2D Strategic Health #uthorities 9SH#s:? .n 1 Iuly 2FF<, this number was reduced to 1F? Fewer, more strategic organisations will deli%er stronger commissioning functions, leading to impro%ed ser%ices for patients and better %alue for money for the ta(payer? Strategic Health #uthorities are responsible forB

+e%eloping plans for impro%ing health ser%ices in their local area &aking sure local health ser%ices are of a high $uality and are performing well Increasing the capacity of local health ser%ices @ so they can pro%ide more ser%ices &aking sure national priorities @ for e(ample, programmes for impro%ing cancer ser%ices @ are integrated into local health ser%ice plans

Strategic Health #uthorities manage the 2HS locally and are a key link between the +epartment of Health and the 2HS?

#s per 1:$ '*ite )a)er lots of changes are going to take place in the structure of 2HS? "lease read the 2HS -hite paper and make yourself aware of the current changes taking place? SH#s will terminate in 2F1'? # new structure will replace them? It is still taking shape? httpBGGwww?dh?go%?ukGenG"ublicationsandstatisticsG"ublicationsG"ublications"olicy#n d*uidanceG+HV11A'8'

12F

12!, F1ational 2n&titute o3 !linical ,Dcellence;

*tt)"GGwww.nice.org.ukG It is a part of the 2ational Health Ser%ice 92HS:, and its role is to pro%ide patients, health professionals and the public with authoritati%e, robust and reliable guidance on current Rbest practiceS? It was set up as a Special Health #uthority for 4ngland and -ales on 1 #pril 1EEE? !echnology appraisals @ guidance on the use of new and e(isting medicines and treatments within the 2HS in 4ngland and -ales? Clinical guidelines @ guidance on the appropriate treatment and care of people with specific diseases and conditions within the 2HS in 4ngland and -ales? Inter%entional procedures @ guidance on whether inter%entional procedures used for diagnosis or treatment are safe enough and work well enough for routine use in 4ngland, -ales and Scotland. *uidelines ColorectalG /reastG Vascular .rthopaedic !echnology appraisals @ guidance on the use of new and e(isting medicines and treatments within the 2HS in 4ngland and -ales? Clinical guidelines @ guidance on the appropriate treatment and care of people with specific diseases and conditions within the 2HS in 4ngland and -ales? Inter%entional procedures @ guidance on whether inter%entional procedures used for diagnosis or treatment are safe enough and work well enough for routine use in 4ngland, -ales and Scotland? 6ele%ant *uidelines in progress

For eac* &)ecialty there are some guidelines? >ou need to know thes guidelines?

121

=0<14%-201 :0$+2-%(
'*at are t*e 1:$ 3oundation tru&t&@ !he Health and Social Care #ct 2FF' establishes 2HS foundation trusts as independent public benefit corporations and will be modelled on co@operati%e and mutual traditions? 1? !hey are controlled and run locally, not nationally? )ocal public accountability will replace central state control, 2? !hey ha%e increased freedoms to retain any operating surpluses and access a wider range of options for capital funding to in%est in deli%ery of new ser%ices, recruit and employ their own staff, '? !hey ha%e to deli%er on national targets and standards like the rest of the 2HS, but 2HS foundation trusts will be free to decide how they achie%e this, 0? !hey are not subject to directions from the Secretary of State for Health, are not subject to performance management by strategic health authorities and the +epartment of Health? %im& o3 1:$ 3oundation tru&t& 2HS foundation trusts form part of a major programme of in%estment, e(pansion and reform of the 2HS o%er a ten year period? !his programme will deli%er the %ision of the 2HS "lan for prompt, con%enient and high $uality ser%ices, with patients treated as partners and staff fairly treated and properly rewarded? -ithin a framework of clear national standards, subject to independent inspection, power is being de%ol%ed to locally run ser%ices with the freedom to inno%ate and impro%e care for patients? !he programme builds on the %alues of the 2HSH ser%ices will be centred around the needs of patients so that where%er 2HS patients are treated they recei%e high $uality care, free at the point of use and based on clinical need, not ability to pay? 2HS foundation trusts are at the cutting edge of the programme? !hey are part of the 2HS, pro%iding care for 2HS patients but with the freedom to impro%e ser%ices for patients without interference from -hitehall? !he *o%ernment belie%es that securing sustained impro%ements in 2HS performance can only happen when staff ha%e more control and local communities ha%e a bigger say o%er how hospitals are run? !he aim is to harness the creati%e energy and e(pertise of managers and clinical staff, recogni3ing the skills and knowledge that they ha%e?

122

+ur)o&e o3 1:$ 3oundation tru&t&" !he Health and Social Care 9Community Health and Standards: #ct establishes 2HS foundation trusts as independent public benefit corporations? "ublic benefit corporations are a new type of organisation, specially de%eloped to reflect the uni$ue aims and responsibilities of 2HS foundation trusts? !he purpose of 2HS foundation trusts is to pro%ide and de%elop ser%ices for 2HS patients? !hey are part of the 2HS, and subject to 2HS systems of inspection? !hey treat 2HS patients according to 2HS principles and 2HS standards, but they are controlled and run locally, not nationally? !ransferring ownership and accountability from -hitehall to the local community means that 2HS foundation trusts are able to tailor their ser%ices to best meet the needs of the local population, and to tackle health ine$ualities, whilst working within a framework of national standards?

12'

+#2M%#A !%#, -#<$-$

"rimary Care !rusts bring together the primary care ser%ices 9eg? *" "ractices and Community 2ursing Ser%ices: in a particular area and work to de%elop these ser%ices in response to the needs of the local community? !he main roles of a "C! are toB Impro%e the health of local people and reduce ine$ualities in health? "ro%ide effecti%e and responsi%e local health ser%ices? Commission the best possible ser%ices for local people from 2HS hospitals 92HS !rusts:? "C!s act as sub@committees of Health #uthorities? "C!s ha%e a duty to work in partnership with other local organisations and neighbourhood ser%ices 9 e?g? social ser%ices, housing, ser%ice user and community groups, other "C*G!s, 2HS !rusts:? "C! will control DFK of the health budget by 2FF0?

%& )er 1:$ '*ite )a)er lot& o3 c*ange& are going to take )lace in t*e &tructure o3 1:$. +lea&e read t*e 1:$ '*ite )a)er and make your&el3 aware o3 t*e current c*ange& taking )lace? !he "C!s will cease functioning by 2F1''? !heir role will be taken o%er by *" consortium? httpBGGwww?dh?go%?ukGenG"ublicationsandstatisticsG"ublicationsG"ublications"olic y#nd*uidanceG+HV11A'8'

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1:$ (2-27%-201 %7,1!A F1:$(%;

!he 2HS)# handles negligence claims and works to impro%e risk management practices in the 2HS? !hey are also responsible for resol%ing disputes between practitioners and primary care trusts, gi%ing ad%ice to the 2HS on human rights case law and handling e$ual pay claims on behalf of the 2HS?

httpBGGwww?nhsla?comGhome?htm

128

#2$? M%1%7,M,1-

6ISJ &#2#*4&42!
N Formal and systematic process to identify and analyse risk and take remedial action to reduce or eliminate risk of harm to patients, staff and organisation N Critical incident reporting N Clinical audit N Confidential en$uiry N Complaints procedures N .bser%ation of staff N In%estigation Committee5s report N #ccreditation %isit reports N "atient satisfaction sur%eys

*tt)"GGwww.n*&la.comG#i&kManagementG 6isk management was introduced by the department of health to make sure that we analyse the problem, learn from it and practice it so that it does not reoccur leading to an impro%ed health care ser%ice? !his is about critical incident reporting, audit, confidential en$uiry, and so on? !his is not howe%er about blaming somebody and loosing a job? !his is about studying why something happened, defining the situation, analysing the cause, learning from it, re@practicing it, and re@auditing it to make sure that a change has taken place for a better patient care? 2HS)# 1 6isk assessment *tt)"GGwww.n*&la.comG#i&kManagementG
# key function for the 2HS)#, as set out in their Framework +ocument, is to Rcontribute to the incenti%es for reducing the number of negligent or pre%entable incidentsS? !hey aim to achie%e this through an e(tensi%e risk management programme?

12<

1:$(% &tandard& and a&&e&&ment& !he core of their risk management programme is pro%ided by a range of 2HS)# standards and assessments? &ost Healthcare organisations are regularly assessed against these risk management standards which ha%e been specifically de%eloped to reflect issues which arise in the negligence claims reported to the 2HS)#? !here is a set of risk management standards for each type of healthcare organisation incorporating organisational, clinical, and health Q safety risksB 2HS)# #cute, Community, &ental Health Q )earning +isability and Independent Sector Standards @ 2F11G12 2HS)# #mbulance Standards @ 2F11G12 In addition, there is a separate set of clinical risk management standards for 2HS maternity ser%ices?

2HS organisations which pro%ide labour ward ser%ices are subject to assessment against both the 2HS)# #cute 9or Community: Standards and C2S! &aternity Standards?
#ll the 2HS)# Standards are di%ided into three Rle%elsSB one, two and three? 2HS organisations which achie%e success at le%el one in the rele%ant standards recei%e a 1FK discount on their C2S! and 6"S! contributions, with discounts of 2FK and 'FK a%ailable to those passing the higher le%els? !he C2S! &aternity Standards are also di%ided into three le%els and organisations successful at assessment recei%e a discount of 1FK, 2FK or 'FK from the maternity portion of their C2S! contribution? .rganisations at le%el 1 are assessed against the rele%ant standard9s: once e%ery two years and those at le%els 2 and ' at least once in any three year period, although organisations may re$uest an earlier assessment if they wish to mo%e up a le%el? .rganisations that drop to )e%el F or fail to attain )e%el 1 will be placed under impro%ement measures and must undertake a )e%el 1 assessment within si( months of the date of their unsuccessful assessment? .rganisations which fail an assessment and fall to )e%el 1 or 2 are re$uired to be assessed at the le%el assigned in the following financial year? #ll assessments take place o%er two days and are carried out on behalf of the 2HS)# by +et 2orske Veritas )td?, who are responsible for much of the day@to@day administration of our risk management programmes? +etails of the assessment le%els achie%ed by healthcare organisations are updated monthly in our Factsheet 0?

C2S! &aternity Standards @ 2F11G12

12A

1%-201%( +%-2,1- $%=,-A %7,1!A F1+$%;

*tt)"GGwww.n)&a.n*&.ukG !hey lead and contribute to impro%ed, safe patient care by in3orming, &u))orting and in3luencing organisations and people working in the health sector? !hey are an #rm5s )ength /ody of the +epartment of Health and through their three di%isions co%er the ;J health ser%ice? 1ational #e)orting and (earning $ervice #ims to reduce risks to patients recei%ing 2HS care and impro%e safety? 1ational !linical %&&e&&ment $ervice Supports the resolution of concerns about the performance of indi%idual clinical practitioners to help ensure their practice is safe and %alued? 1ational #e&earc* ,t*ic& $ervice "rotects the rights, safety, dignity and well@being of research participants that are part of clinical trials and other research within the 2HS? !hey also commission and monitorB 2ational Confidential In$uiry into Suicide and Homicide by "eople with &ental Illness Confidential 4n$uiry into &aternal and Child Health 2ational Confidential 4n$uiry into "atient .utcome and +eath

12D

1%-201%( -%##2== %14 +%AM,1- >A #,$<(- F+b#;

+ayment by re&ult&
httpBGGwww?dh?go%?ukGenG&anagingyourorganisationG2HSFinancial6eformsGinde(?ht m !he aim of "ayment by 6esults 9"b6: is to pro%ide a transparent, rules@based system for paying trusts? It will reward efficiency, support patient choice and di%ersity and encourage acti%ity for sustainable waiting time reductions? "ayment will be linked to acti%ity and adjusted for case mi(? Importantly, this system will ensure a fair and consistent basis for hospital funding rather than being reliant principally on historic budgets and the negotiating skills of indi%idual managers?

>ackground
!he 2HS "lan 9Iuly 2FFF: introduced the *o%ernment5s intention to link the allocation of funds to hospitals to the acti%ity they undertake? It stated that in order to get the best from e(tra resources there would be major changes to the way money flows around the 2HS and differentiation between incenti%es for routine surgery and those for emergency admissions? Hospitals would be paid for the electi%e acti%ity they undertake and this is a system of payment by results? !his reformed financial system offers the right incenti%es to reward good performance, to support sustainable reductions in waiting times for patients and to make the best use of a%ailable capacity? Historically, hospitals were paid according to Rblock contractsS 1 a fi(ed sum of money for a broadly specified ser%ice 1 or Rcost and %olumeS contracts which attempted to specify in more detail the acti%ity and payment? /ut there was no incenti%e for pro%iders to increase throughput, since they got no additional funding? !he +epartment of Health consulted on its plans for introducing "b6 in M2HS Financial 6eformsB Introducing "ayment by 6esults5 on 18 .ctober 2FF2 and published its response on 1F February 2FF'?

6esponse to 6eforming 2HS Financial FlowsB Introducing "ayment by 6esultsB 6esponse issued 1F February 2FF'

!he +epartment of Health undertook a further consultation on A #ugust 2FF' @ "ayment by 6esultsB "reparing for 2FF8?

"ayment by 6esults "reparing for 2FF8 B consultation outcome

"ayment by 6esults is being implemented incrementally both in terms of scope and financial impact? In terms of scope, the system began in a small way in 2FF'@F0, was e(tended in 2FF0@F8, and, for the majority of trusts, included only electi%e care in 2FF8GF<? In 2FF<GFA the scope of payment by results was e(tended to include non@ electi%e, accident Q emergency, out@patient and emergency admissions for all trusts?

12E

2FFAGFD marked a year of consolidation with no significant changes to the tariff? !he financial impact of "b6 has also been introduced gradually with a four year transition path which comes to an end in 2FFD@FE? .n 1A &arch 2FF< Sir Ian Carruthers, the acting Chief 4(ecuti%e of the 2HS, announced that he had asked Iohn )awlor, the Chief 4(ecuti%e of Harrogate and +istrict 2HS Foundation !rust, to lead an independent re%iew of the process followed by the +epartment of Health to set the national tariff for ser%ices within the scope of "ayment by 6esults for 2FF<GFA?

Independent re%iew results

-e are working with a range of stakeholders to de%elop the tariff, in particular to support wider healthcare policy to pro%ide care closer to home? -e ha%e published indicati%e tariffs for unbundling aspects of the tariff embedded in acute care, including rehabilitation and some diagnostics to support the 2HS in de%eloping local tariffs to deli%er ser%ices that meet the needs and choice of patients? In the longer term, we are looking to continually refine the tariff and e(tend the scope of payment by results where clinically appropriate and economically sensible? !he +epartment of Health published the .ptions for the Future of "ayment by 6esultsB 2FFDGFE 1 2F1FG11 consultation on 18 &arch 2FFA?

.ptions for the Future of "ayment by 6esultsB 2FFDGFE to 2F1FG11

!he consultation document outlined proposals to strengthen the e(isting building blocks of payment by results policy including classification, currency and costing as well as ideas about how the policy can be de%eloped and administered o%er the ne(t few years? -e will report the findings of the consultation later in 2FFA?

!on3irmation o3 +ayment by #e&ult& F+b#; arrangement& 3or 2011/12

From the links below you will be able to access information and guidance in support of "ayment by 6esults in 2F11@12? !he road@testing of the 2F11@12 tariff and draft guidance concluded on 21 Ianuary 2F11? +etails of the small number of changes that ha%e been made to some of the prices and e(clusions lists that we released at road@test are contained in the letter from +a%id Flory? !he 2F11@12 "b6 guidance has been clarified and e(panded in a number of areas, in response to feedback recei%ed at road@test?

>,$- +#%!-2!, -%#2==

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httpBGGwww?dh?go%?ukGenG&anagingyourorganisationG2HSFinancial6eformsG+HV1F8 FDF O/est practice tariffs represent one of the enablers for the 2HS to impro%e $uality, by reducing une(plained %ariation and uni%ersalising best practice? -ith best practice defined as care, that is both clinical and cost@effecti%e, these tariffs will also help the 2HS deli%er the producti%ity gains re$uired to meet the tough financial challenges ahead? !he aim is to ha%e tariffs that are structured and priced appropriately both to incenti%ise and ade$uately reimburse for the costs of high $uality care? !here is no one definition of what best practice looks like? # specific model will be de%eloped for each of the ser%ice areas, each tailored to the characteristics of clinical best practice in that area and the a%ailability, $uality and flow of data? /est practice tariffs for 2F11G12 Set out below are some of the new approaches and ser%ice areas for which we are considering setting best practice tariffs in 2F11@12? .nce we ha%e finished the in%estigation into the suitability and feasibility of these ser%ice areas we aim to confirm the package on this webpage? If you would like to be in%ol%ed in the de%elopment of these tariffs then please get in touch %ia interventional #adiology Inter%entional 6adiology is an alternati%e procedure to open surgery for a range of procedures e?g? ;terine Fibroid 4mbolisation as one the alternati%es to hysterectomy? )ess in%asi%e procedures such as Inter%entional 6adiology facilitate decreased lengths of stay, leading to lower unit costs for pro%iders and commissioners and impro%ed patient e(perience? 4ay ca&e G $*ort $tay !here are a number of procedures where it is best practice to perform them as a day case where clinically appropriate? !he /ritish #ssociation of +ay Surgery 9/#+S: ha%e suggested the day case rates which would be appropriate in most cases? !he model used in 2F1F@11 for cholecystectromy will be de%eloped for a selection of other high %olume procedures from the /#+S directory of procedures where there is a significant gap between the current national day case rate and that which /#+s say is achie%able? #gain, the intention of this approach is to encourage better %alue and better $uality treatment for patients? Some of the procedures we are considering for 2F11@12 areB @ "rocedures for breast surgery @ "rocedures for hernia repair @ .perations to manage female incontinence 1'1

@ Some orthopaedic surgery such as bunion operations @ "rocedures for prostate resection >e&t 6alue -ari33& #n alternati%e approach to linking payment to clinical characteristics is to set tariff prices normati%ely i?e? what the cost should be if best practice is followed rather than the national a%erage of reference costs? 2ormati%e pricing represents an alternati%e incenti%e model to change practice? !o a%oid the need for commissioners to monitor pro%ider performance against the best practice criteria in order to make payment, this approach is only likely to be appropriate to ser%ice areas where the cost of meeting best practice is below the national a%erage cost? .f course, commissioners will want know about the $uality of ser%ice pro%ided for other reasons? Clearly, this approach is different to any of those adopted in 2F1F@11 and we will work closely with the rele%ant clinical e(perts as well as pro%iders and commissioners to ensure that there are no per%erse clinical incenti%es and that any financial impact is manageable? =urt*er develo)ment& to eDi&ting &ervice area& -e will continue with the process to de%elop a best practice tariff for adult renal dialysis? Following on from the best practice tariff for acute stroke care we plan to de%elop a tariff for follow@up ser%ices for patients who ha%e had a mini@stroke 9known as a transient@ischaemic attack or !I#:? 2n3ormation on t*e 2010G11 be&t )ractice tari33& If you ha%e a $uery about the 2F1F@11 best practice tariffs then there are a %ariety of sources of information we recommend that you consult in the first instance? If your $uery cannot be answered by this information then please submit your $uery following the process detailed below? !he first port of call should be Section < of the 2F1F@11 "b6 *uidance? *i%en that best practice tariffs are a new concept introduced for the first time in 2F1F@11, we ha%e intentionally pro%ided more detailed guidance than other sections? It is hoped that rele%ant information not contained in the guidance is either referenced below or pro%ided in an answer to one of the F#7s, a%ailable in the M"b6 in 2F1F@115 section of the "b6 website? )isted below are additional sources of information that were not a%ailable at the time of the guidance being published? #s further information becomes a%ailable we continue to update this page? !ataract& +at*way

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Further information about the cataracts e(tract is a%ailable in the S;S 6A e@learning tool a%ailable from the weblink below Connecting for health @ S;S 9opens new window: =ragility :i) =racture !are #dditional information relating to the element of the tariff price conditional on meeting the clinical characteristics of best practice can be found on the 2ational Hip Fracture +atabase website? #s further information becomes a%ailable it will be published on the 2HF+ website? 2HF+B hip fracture 9opens new window: %cute $troke !are !he 2HS Stroke Impro%ement website continues to be updated for case studies, information and useful resourcesB 2ational Stroke Impro%ement Initiati%e 9opens new window: 4%aluation of the 2F1F@11 tariffs !he "b6 team plan to e%aluate the first wa%e of the best practice tariffs? -e e(pect the e%aluation to look at both the implementation of the tariffs as well as the impact that they ha%e had on changing clinical practice? .ne of the main reasons for e%aluating the tariffs is to inform de%elopment of the policy and future tariffs? -e hope therefore to feed initial findings from the e%aluation into the de%elopment of the 2F11@12 set of tariffs 7uery process 2HS trusts or "C!s should contact SH# "b6 leads in the first instance with $ueries, outstanding and new? If the $uery can still not be answered, then SH# "b6 leads will contact +H for clarificationG answers? !his is appropriate for both e@mails and telephone calls?

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214,+,14,1- $,!-0# -#,%-M,1!,1-#,$ F2$-!;

httpBGGen?wikipedia?orgGwikiGIndependentVsectorVtreatmentVcentre Inde)endent &ector treatment centre& 9IS!Cs: are pri%ate@sector owned treatment centres contracted within the 4nglish 2ational Health Ser%ice to treat 2HS patients free at the point of use, like any other 2HS hospital? !hey are sometimes referred to as PsurgicentresP or Mspecialist hospitals5? IS!Cs are normally co@located with 2HS hospitals? !hey perform common electi%e 9i?e? non@emergency: surgery and diagnostic procedures and tests in the same way as 2HS hospitals? !ypically they undertake PbulkP surgery such as hip replacements, cataract operations or &6Iscans rather than more comple( operations such as neurosurgery? Since specialised treatment centers concentrate on a set type of procedures they are able to streamline the patient care pathway, Z1[ resulting in an impro%ed patient e(perienceZ2[ and helping the 2HS to $uickly meet waiting time targets?Z'[ -a%e I IS!Cs currently work on pre@arranged central go%ernment bulk contracts nominally at or below the national tariff Z2[ on which 2HS hospitals can charge commissioning 2HS "rimary Care !rusts? !hese contracts include a profit margin and the treatments are paid for in ad%ance by central go%ernment whether or not the numbers paid for are taken up and regardless of success rates? !he rationale is that the waiting times for patients are cut by separating routine electi%e surgery and tests from emergency work? 6eferral rates %ary across the country, with some IS!Cs performing as much 118K of their contracted %olumes but with the a%erage referral rate around D8K? #ccording to the 2HS "artners 2etwork, which represents pri%ate pro%iders working within the health ser%ice, *" referral rates are rising as patients report positi%e e(periences back to their *"s?Z0[ # criti$ue of this de%elopment is that difficult and e(pensi%e work is left for the 2HS hospitals to do, increasing their marginal costs and making them appear less PefficientP? 6ecent opinion printed in the /ritish &edical Iournal 9/&I %ol ''2 11 &arch 2FF<: has also suggested that treatments may be proportionally less successful in IS!Cs due to the employment of ine(perienced or less fully trained staff with less backup than the 2HS facilities? !his could result in the 2HS ha%ing to fund difficult re%ision operations 9insofar as they can be so re%ised: and would defeat the object of the e(ercise? Howe%er, a subse$uent study conducted by the researchers from )ondon School of Hygiene Q !ropical &edicine and the 6oyal College of Surgeons of 1'0

4ngland confirmed the high $uality of care, concluding that Rpatients undergoing cataract surgery or hip replacements in IS!Cs achie%ed a slightly greater impro%ement \ than those treated in 2HS facilitiesS and R"atients treated in IS!Cs were less likely to report post@operati%e problems than those treated in 2HS facilities\S9/&C Health Ser%ices 6esearch 2FFD? DBAD:?Z8[ In the 2FFD Healthcare Commission 2FFD 2HS Inpatient Sur%ey,Z<[ IS!Cs scored highly on a number of measures, including o%erall $uality of care?ZA[ !he 2HS "lan originally concei%ed of opening eight treatment centres by 2FF8, but by #ugust 2FF8 at least 28 had been opened, with more being planned? # second -a%e of IS!Cs was completed in 2FFE and those marked the end of the centrally planned centres?ZD[ &o%ing forward, local "C!s will make decisions on how best to work with their local IS!Cs after the initial fi%e year contracts ha%e e(pired?ZE[ In 2FFE a British Medical Journal paper concluded that up to LE2Am of the L1?8bn first wa%e of IS!C contracts Omay ha%e been paid to IS!Cs for patients who did not recei%e treatmentO?Z1F[ !his was based on a Scottish e(ample and does not in fact reflect the e(perience of the 4nglish IS!C program, where referrals ha%e been more inline with the e(pectations of the original contracts and continue to grow? 2&&ue& 1? 2? '? 0? 8? <? #S# grade 1s treated at IS!C G 2HS hospitals Cherry picking !raining +ealing with complications Continuity of care #udit G 6esearch

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1%-201%( -%#7,-$
-%#7,-$ !he +epartment of health has set out targets for impro%ement in all aspects of health and treatment of disease? >ou need to know the targets related to your subspecialty? 4(ampleB !he following is an e(ample in the Scottish 2HS set out in the year 2FF' -eenage +regnancy 2FK reduction in teenage pregnancies amongst those aged 1'@18B target date 2F1F? 4ental :ealt* Children aged 12 should ha%e, on a%erage, no more than 1?8 teeth decayed, missing or filledB target date 2FF8? #t least DFK of dentate adults aged '8@00 should ha%e at least 21 or more standing teethB target date 2FFD? )ess than 8K of 08@80 age group to ha%e no natural teeth by 2F1F? <FK of 8 year old children should ha%e no ca%ities, fillings, e(tractionsB target date 2F1F? $moking 6educe smoking among young people 912@18 age group: to 11KB target date 2F1F? 6educe the rate of smoking among adults 91<@<0 age group: in all social classes to '1KB target date 2F1F? 6educe the proportion of women who smoke during pregnancy by EK to 2FKB target date 2F1F? %lco*ol Mi&u&e &ales aged 1<@<0 @ reduce incidence e(ceeding weekly limit of 21 units to 2EKB target date 2F1F? Females aged 1<@<0 @ reduce incidence e(ceeding weekly limit of 10 units to 11KB target date 2F1F?

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6educe the fre$uency and le%el of drinking of 12@18 age group by 0K to 1<KB target date 2F1F? 4rug Mi&u&e 6e%erse upward trend in drug related deaths and reduce the total number by 28KB target date 2FF8? Increase the number of drug users in contact with drug treatmentGcare ser%ices in community by at least 1FK e%ery yearB target date 2FF8? 6educe the proportion of drug users who inject and the proportion of injecting users sharing needles and syringes by 2FK by 2FF8? 6educe the proportion of injecting drug users sharing needles and syringes by 2FKB target date 2FF8? 6educe percentage of injecting drug users testing antibody positi%e for the "C by 2FKB target date 2FF8? +*y&ical %ctivity 8FK of all adults 9aged 1<T: accumulating a minimum of 'F minutes per day of moderate physical acti%ity on 8 or more days per week? DFK of all children 9aged 2@18: accumulating one hour per day of physical acti%ity on 8 or more days per week? >rea&t =eeding &ore than 8FK of women should breast feed their babies at < weeksB target date 2FF8? 4iet Increase the proportion of the population consuming increased le%els of fruits and %egetables, carbohydrates and fish as defined by the Scottish +ietary !argetsB target date 2FF8? Increase the proportion of the population consuming decreased le%els of fat, sugar and salt as defined by the Scottish +ietary !argetsB target date 2FF8? 2mmuni&ationG6accination AFK of o%er <8s %accinated against fluB annual target? E8K uptake target for all childhood %accinations 9ongoing:?

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(ow >irt* 'eig*t >abie& !o reduce incidence of low birth weight babies by 1FKB target date 2FF8? ,ye and 4ental !*eck& -e will in%est in health promotion and, as a priority, we will systematically introduce free eye and dental checks for all before 2FFA? :earing -e&t& -e will introduce hearing tests for all new born babies? 4,(%A,4 42$!:%#7, 2ational +elayed +ischarge "lan targets to be set for each indi%idual 2HS /oard following e%aluation of )ocal Ioint #ction "lans to sustain progress in reducing delayed discharge numbers? Focus of planning will be to continue to relie%e pressure on the acute sectorH to look at whole systems re@design and capacity planning and to consider the de%elopment of appropriate con%alescent care which should be outcomes focused rehabilitati%e care rather than the creation of new con%alescent homes? -e will in%est 'Fm per annum for ' years to pro%ide 1,FFF community and con%alescent places for people lea%ing hospital? 48/:0<# %!!,$$ -e will ensure that anyone contacting their *" surgery has guaranteed access to a *", nurse or other health care professional within 0D hours by #pril 2FF0? !%1!,# 2FK reduction in the age standardised mortality rate from cancer in people aged under A8B target date 2F1F? For targets on -aiting !imes refer to -aiting !imes "riority? /reast screening target AFKB ongoing? Cer%ical screening target DFKB ongoing? !:4G$-#0?,

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8FK reduction in the age standardised mortality rate from CH+ in people aged under A8B target date 2F1F? 8FK reduction in the age standardised mortality rate from stroke in people aged under A8B target date 2F1F? For targets on -aiting !imes refer to -aiting !imes "riority? M,1-%( :,%(-: 6educe 2ational Suicide 6ate by 2FK by 2F1' 9Suicide "re%ention Strategy +ec 2FF2:? Closure of all long@stay institutions for people with learning disabilitiesB target date 2FF8? :,%(-:!%#, %!5<2#,4 21=,!-201 Implement Full !echnical 6e$uirements of the *lennie 6ecommendations for +econtamination of &edical 4$uipment and +e%ices by '1 &arch 2FF0? '%2-217 -2M,$ :o&)ital 2n/+atient and 4ay !a&e -reatment 2o patient with a guarantee should wait longer than 12 months for in@patient or day case treatment? !his will be reduced to E months from '1 +ecember 2FF' and to < months from '1 +ecember 2FF8? !hese targets are firm guarantees? If a patientPs host 2HS /oard is unable to pro%ide treatment within the target time, the patient will be offered treatment elsewhere in the 2HS, in the pri%ate sector in Scotland, or 4ngland, or o%erseas? !oronary :eart 4i&ea&e /y '1 .ctober 2FF1 women who ha%e breast cancer and need urgent treatment will get it within one month where appropriate? /y '1 .ctober 2FF1 the ma(imum wait from urgent referral to treatment for childrenPs cancer and acute leukaemia will be one month? /y '1 +ecember 2FF8 no patient urgently referred for cancer treatment should wait more than 2 months?

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!oronary :eart 4i&ea&e From '1 +ecember 2FF2 the ma(imum wait for angiography will be 12 weeks from seeing a specialist? !his will be reduced to D weeks from '1 +ecember 2FF0? 0ut/+atient& /y '1 +ecember 2FF8 no patient should wait more than < months for a first out@ patient appointment with a consultant, following referral by *&"G*+"? +rimary !are -e will ensure that anyone contacting their *" surgery has guaranteed access to a *", nurse or other health care professional within 0D hours by #pril 2FF0? +%-2,1- =0!<$G+<>(2! 2160(6,M,14ach 2HS /oardGhealth system identifies strategic leadership at +irector le%el to achie%e implementation of an integrated approach to patient focus and public in%ol%ement across their area? 4ach 2HS /oardGhealth system agrees a strategy and framework for implementing an integrated approach to patient focus and public in%ol%ement with S4H+ by .ctober 2FF'? !he agreed frameworks should set outB How action to support staff build the capacity of patients, carers and the public to be in%ol%ed as e$ual partners in decision about ser%ice de%elopment will become an integral part of /oardsP strategic planning arrangements proposals for a sustained programme of training in patient focus and public in%ol%ement for all staffH action to de%elop CH"Ps capacity to in%ol%e front line staff, patients, carers and the public in de%elopment is detailed o%er the ne(t ' years? =21%1!2%( >#,%?/,6,1 2HS /oards toB operate within their re%enue resource limitH operate within their capital resource limitH meet their cash re$uirement 9"#FB 2o% 2FF2:?

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2HS !rusts toB break e%en taking one year with anotherH stay within their capital resource limit 9"#FB 2o% 2FF2:? $,#62!, #,/4,$271 2HS /oards to form a Ser%ice 6e@+esign Committee with in%ol%ement of clinicians? 2HS /oards to submit a Change and Inno%ation "lan? -e will support Change and Inno%ation through a series of national collaborati%es including major priorities such as cancer, out@patient waiting, primary care access and emergency medical admissions?

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!%#, 5<%(2-A !0MM2$$201 F!5!;

*tt)"GGwww.cBc.org.ukG !he Care 7uality Commission is the independent regulator of health and social care in 4ngland? .ur aim is to make sure better care is pro%ided for e%eryone, whether that5s in hospital, in care homes, in people5s own homes, or elsewhere? !hey regulate health and adult social care ser%ices, whether pro%ided by the 2HS, local authorities, pri%ate companies or %oluntary organisations? #nd, they protect the rights of people detained under the &ental Health #ct?

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(0#4 4%#J2H$ 1:$ 1,9- $-%7, #,62,'

httpBGGwww?dh?go%?ukGenG"ublicationsandstatisticsG"ublicationsG"ublications"olicy#n d*uidanceG+HVFD8D28 In e(change for these new powers and new management positions, clinicians will be e(pected to use their professional skills to assess the e%idence base for ser%ice reconfigurations and the distribution of resources? Hospital doctors will hold their own budgets and *"s will ha%e greater freedom under practice based commissioning? O"atients, the public and staff alike e(pect to see clinical leaders e(plicitly making the case for these changes to ser%ices which e%idence shows will impro%e patient care,O the re%iew states? !he re%iew follows resistance from a number of clinicians across the 2HS to the regionalisation of specialist ser%ices? /ut )ord +ar3i said a new accountability structure would ensure high@$uality clinical leadership that would be measured in terms of o%erall outcomes for patients? &edical training programmes will now include management and leadership skills as standard? !he workforce report also commits to implementing Sir Iohn !ookePs recommendation to establish a new body, &edical 4ducation 4ngland, to scrutinise the $uality of training and design training pathways? !raining for other professional groups will be commissioned by strategic health authorities, guided by another new body, the Centre for 4(cellence, which will gather and analyse data to effecti%ely model future demand for different specialties? &irroring reforms elsewhere in the 2HS, deaneries will need to establish a formal split between the commissioning and pro%ision of training and education? !his will help ensure objecti%e assessments of the $uality of training programmes, the report says? -ith the shift towards more primary care, the workforce strategy places particular emphasis on *"s? 4ight hundred e(tra *" training places will be made a%ailable to meet the ambition that Oat leastO half of all doctors entering specialist training do so as *"s? !his will be done using Oe(isting resourcesO, but a new transparent tariff whereby up to L0?'bn training funds follow the students will guard against the OraidsO on training funds seen o%er the last few years? !he report also commits the +H to a re%iew of healthcare professions not currently regulated? It specifically mentions clinical psychologists? O!hose workers whose role in%ol%es significant risk should ha%e proportionate assurance arrangements to ensure safe and high@$uality care for patients,O )ord +ar3iPs report says?

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2HS 24U! S!#*4 64VI4-B I&"#C! #2+ 47;#)I!> I&"#C! #SS4SS&42!S Introduction 1? !he final report of the 2HS 2e(t Stage 6e%iew @ High 7uality Care for #ll @ sets out an o%erarching %ision for the future of the 2HS? !his document does not attempt to assess the impact or e$uality impact of indi%idual proposals but sets out the background, o%erarching %ision and ne(t steps? Impact #ssessments and 4$uality Impact #ssessments for specific proposals will be published as they are further de%eloped in consultation with stakeholders o%er the coming months? /ackground 2? )ord +ar3i was asked by the "rime &inister, Chancellor and Secretary of State for Health to lead a re%iew of the 2HS in 4ngland in Iuly 2FFA? !he 6e%iew has been dri%en through a strong engagement process in e%ery 2HS region? Clinical -orking *roups were established in each 2HS region 9Strategic Health #uthorities: to identify potential impro%ements to local ser%ices? In total A0 such groups, led by 2FFF frontline clinicians 9doctors, nurses and other health and social care professionals:, ha%e e(amined ser%ices across eight or more Mpathways of care5 from maternity to end@of@life, engaging with patients, 2HS staff, stakeholders and the public? '? !he Clinical -orking *roups ha%e de%eloped impro%ed Mmodels of care5 based firmly on the best a%ailable clinical e%idence and the needs and preferences of local users? 4ach Strategic Health #uthority has now published its long@term %ision for impro%ing health and healthcare in its region based on the work of these groups? 0? !hese %isions will now be turned into practical action locally and deli%ered on the ground, with local communities engaged and proposals de%eloped and taken forward transparently based on the best a%ailable clinical e%idence? !he key priorities emerging from the %isions includeB N Stronger and more proacti%e focus on public health and helping people stay healthy, with more support to tackle childhood obesity, alcohol misuse and smoking? N Clearer and simpler routes to finding the right care 20GA? N #s much care as possible deli%ered closer to home, with treatment of major trauma, heart attack and stroke care within specialised centres? N Impro%ing the li%es of those with long@term conditions by ensuring that patients can take a full part in their own treatment and care, including the 1use of health plans and more assisti%e technology to help people manage their own conditions? N Impro%ing patient e(perience by ensuring pri%acy, dignity and cleanliness, and by pro%iding more information and choice? 8? !he local %isions challenge the +epartment of Health to enable and empower the local 2HS to deli%er the priorities and impro%ements that ha%e been agreed locally? In particular they challenge the +epartment to

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support and enableB N Integrating care around the needs of patients and empowering people to better manage their own care? N 4mpowering patients with better information to enable a different $uality of con%ersation between professionals and patients? N "rioritising patient safety and recognising, sharing and adopting best practice? N /ringing the benefits of inno%ation directly to patients more rapidly, with stronger and deeper local partnerships? <? !he key themes set out in the local %isions are summarised in Chapter 1 of High 7uality Care for #ll? Impact #ssessment A? !he 2HS 2e(t Stage 6e%iew5s terms of reference were to Rhelp local patients, staff and the public in making the changes they need and want in their local 2HSS? !he purpose of the final report, and rationale for go%ernment inter%ention, is to respond to the challenges that they ha%e identified and deli%er the impro%ements to the system that will enable local priorities to be met most effecti%ely? Chapter 2 of High 7uality Care for #ll sets out in more detail this case for change? /y taking the approach of building an enabling system that supports local decision@making the *o%ernment has sought to minimise the additional burdens placed upon the 2HS? D? !he de%elopment of High 7uality Care for #ll has been taken forward through a series of national workstreams? Se%en of these ha%e been supported by national working groups that ha%e brought together key stakeholders and clinical leaders to consider the issues raised locally? !hese groups wereB N 7uality impro%ement @ the %ision and strategy for $uality impro%ement and the measurement, systems and incenti%es to dri%e it? 2N Inno%ation @ to speed, spread and imbed inno%ation in health and social care, in terms of pharmaceuticals, clinical practice and deli%ery models and management? N "rimary and community care strategy @ to deal with the barriers and enablers to change identified locally, including identifying how the contractual and commissioning arrangements for primary medical care can continue to e%ol%e to reflect trends and challenges? N -orkforce @ the commissioning and pro%ision of planning, education and training? N )eadership @ clinical and non@clinical, medical and non@medical? N Informatics @ information needs, system and management structuresH ma(imising the benefits for patient care of the national programme for I!? N Systems and incenti%es @ any other systems and incenti%es that the local groups ha%e said are needed to support the changes they ha%e suggested? E? !he national workstreams ha%e de%eloped policy proposals 9summarised in the summary letter within High 7uality Care for #ll and identified the

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need for Impact #ssessments? Impact #ssessments ha%e been published alongside High 7uality Care for #ll to accompany the separate publication of the 2HS 2e(t Stage 6e%iew documentsB N # consultation on an 2HS Constitution 9'F Iune: N 2HS 2e(t Stage 6e%iewB # 7uality -orkforce 9'F Iune: 1F? Impact #ssessments will also be published to accompany the separate publication ofB N 2HS 2e(t Stage 6e%iewB .ur %ision for primary and community care 9' Iuly: N # Health Informatics 6e%iew 6eport 91F Iuly: 11? Impact #ssessments for other policy proposals announced in High 7uality Care for #ll will be published as these are further de%eloped and implementation plans drawn up o%er the coming months? Subject to the detailed analysis that will be de%eloped in the Impact #ssessments to be published later, it is the +epartment5s assessment that the benefits of the proposals far outweigh the costs? 12? !aken as a package the proposals will help transform the $uality of care patients e(perience and their relationship with health and healthcare? '!hey will support and empower the frontline of the 2HS in deli%ering the %isions that ha%e been de%eloped and agreed locally? /enefits, Costs and 6isks 1'? !his document does not attempt to discuss the options assessment process or assess the costs, benefits or risks for particular proposals? !he number and di%ersity of proposals prohibits an o%erall summary of their costs and benefits in this document and, in many cases, the details of implementation are dependent on further consideration of options and discussions with stakeholders? !hese will inform the de%elopment of specific Impact #ssessments, outlining the benefits, costs and risks, in line with the indi%idual timescales for each proposal? !his document commits the +epartment of Health to publishing Impact #ssessments for the proposals set out in High 7uality Care for #ll as appropriate as they are further de%eloped o%er the coming months? "olicy e%aluation 10? #s the +epartment of Health de%elops the policy proposals further, it will do so in partnership with 2HS organisations and stakeholders to ensure that the benefits identified are fully realised? !he +epartment will also commission independent scientific e%aluation to ensure transparency and public accountability? 4$uality Impact 18? !he +epartment of Health is committed to promoting e$uality and di%ersity? High 7uality Care for #ll welcomes the e(cellent opportunity that the 6e%iew has pro%ided for the +epartment to pursue it duties to promote e$uality and reduce discrimination under the 4$uality and Human 6ights #ct?

10<

1<? !he 6e%iew has focussed on a range of measures that are aimed at impro%ing access to care and the personalisation of treatment? It has also looked at the role of staff in decision@making, alongside their career progression, education and training? 1A? *i%en the potential of the proposals to affect patients, 2HS staff and the public, most will need 4$uality Impact #ssessments? !o illustrate the potential e$ualities issues raised it is worth noting thatB N #ll patients will, for the first time be guaranteed 2IC4 appro%ed drugs and treatments where clinicians recommend them, ending the postcode lottery on a%ailability? "ayments to hospitals will be influenced by patients own %iews on the successfulness of treatments and the $uality of their e(periences, further incenti%ising fair and personalised treatment for all? #ccess to care will be simplified with more of it a%ailable closer to peoples5 homes or on a walk@in basis? !he proposed 2HS Constitution includes a right to choice and 0information on $uality so that patients are empowered to make informed choices? N Changes to workforce planning, education and training will affect many in the 2HS5s 1?' million strong workforce? Staff will be empowered through clearer career progressions, a stronger focus on de%eloping leadership skills and more control for clinicians o%er budgets and H6 decisions? !he draft 2HS Constitution makes pledges on work and wellbeing, learning and de%elopment, and in%ol%ement and partnership that apply e$ually to all 2HS staff and will help guarantee e$uality of treatment? 1D? How measures such as these are implemented on the ground will be key from an e$ualities perspecti%e? #s part of the 2HS Constitution proposed by the 6e%iew, which all 2HS organisations would ha%e a duty to take account of in their decisions and actions, the rights and responsibilities of patients and staff are safeguarded as followsB N "atients and the public ha%e the right not to be discriminated against in the pro%ision of 2HS ser%ices, on grounds of disability, race, gender religion or se(ual orientation? N Staff ha%e the right to work in a di%erse working en%ironment, free from discrimination on the basis of race, se(ual orientation, se(, disability, age or religious belief? N Staff ha%e the right be treated fairly in recruitment and career progression e?g? promotions to posts in the 2HS? N Staff ha%e the right to work in an en%ironment where e$uality of opportunity is promoted for all those who work in it? 1E? It is in accordance with these principles that the 2e(t Stage 6e%iew proposals ha%e been de%eloped and will be taken forward? 2F? &any of the 2HS 2e(t Stage 6e%iew proposals with the potential to ha%e an impact on e$ualities issues will be set out in more detail in the strategy documents 2HS 2e(t Stage 6e%iewB # 7uality -orkforce and 2HS 2e(t Stage 6e%iewB .ur %ision for primary and community care, both of which are accompanied by their own 4$uality Impact #ssessments?

10A

21? #s with Impact #ssessments, this document does not attempt to assess the e$ualities impact of the proposals but commits the +epartment of Health to publishing appropriate 4$uality Impact #ssessments o%er the coming months as they are further de%eloped in consultation with key stakeholders?

10D

!:%+-,# 9 $<MM%#A Mr %lok -ekriwal !on&ultant 0)*t*almic $urgeon +ilgrim :o&)ital >o&ton (incoln&*ire

10E

Health system in the UK

Health structure & bodies Clinical Governance Good medical practice Health policies Medical training IT Others

Health structure
Department of health Strategic health authority (SHA) Primary care trust (PCT) NHS Trusts

Care Quality Commission

18F

Department of health

Government department providing guidance, information and support to NHS trusts and PCTs

Health is the second largest department. Annual budget 60 billion 7% of GDP (17% in USA)

Secretary of health and 5 ministers 12 Directorates 5 Executive Agencies NHS Estates NHS Pensions agency Medicines control agency Medicines devices agency NHS purchasing and supply agency

Non-departmental public bodies [NDPB] o Executive HCC replaced CHI in 2004 English national board for nursing, midwifery, and mental health

Advisory: 20 Committee of the safety of medicine, Advisory Committee on Distinction Awards etc.

Strategic Health Authorities: Replaced 95 health authorities in England PCTs 152 Group of GP practices and healthcare professionals (dentists, opticians, pharmacists etc.)

181

Has funding for purchasing secondary care and specialist services in hospitals [Shifting the balance of power]

NHS direct: 24 hour telephone advice

Strategic health authority (SHA)

28 Strategic Health Authorities were created by the Government in 2002 to manage the local NHS on behalf of the Secretary of State. performing well provide more services Developing plans for improving health services in their local area Making sure national priorities - for example, programmes for Increasing the capacity of local health services - so they can Responsible for performance and strategy setting of the local NHS and public health The health authorities have a strategic role. This means they are responsible for: Making sure local health services are of a high quality and are

improving cancer services - are integrated into local health service plans Planned reduction in numbers to 10

Strategic Health Authorities manage the NHS locally and are a key link between the Department of Health and the NHS. SHA will cease in 2013.

Primary care trust (PCT)

152 PCTs

182

Remit is to improve local health by commissioning (not

providing) hospital and community health services Aims to improve contestability and deliver 15% pa savings PCT controlled by statutory board, accountable to SHA PBC to move commissioning from PCT to individual practices Receives a single fund

Incentive for better financial management

PbR (payment by result) Practice based commissioning Foundation trusts Increased focus on financial management in ratings system

PCT is going to cease in 2013

NHS Trusts

Care Quality Commission

Establised in July 2008 Tough powers to inspect, investigate and intervene the health and social care providers (residential care)

Brings together the expertise of HCC, Commission for social care inspection, and Mental Health Act Commission

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Clinical Governance
Clinical governance is a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish. [DoH website]

7 pillars (SPARE IT):

Staff management Patient and Public involvement Clinical audit Clinical risk management Clinical effectiveness Information use Training

Staff management
ASSESSMENT Regular process Evidence collected about progress towards a goal Judgement made whether goal achieved

4 stages of a skill

180

Factual - knows

e.g. MCQs

Clinical - knows how to e.g. clinical exam Competence Action does shows how to e.g. OSCE e.g. trainer report, video consultations

APPRAISAL A process of facilitated self-reflection Confidential review of progress focusing on Past achievement Future activity

Feedback on performance and assistance in career progression

(cf. assessment The process of measuring progress against defined criteria)

Both appraiser and appraisee need to be trained There is a list of appraiser in every hospital Appraisal forms available from DoH site

5 aspects of appraisal (CREAM) Clinical Education Research and audit Approach Management

7 steps of appraisal 188

Gathering information (appraisee) Reviewing information (appraiser) Meeting understanding the individual in relation to work (appraisee & appraiser)

Reflection (appraisee & appraiser) Feedback agreeing strength and development points (appraisee & appraiser)

Action plan (appraisee & appraiser) Fulfill action plan (appraisee) Incorporate (anonymised) action into organisational planning (organisation)

REVALIDATION
Sir Liam Donaldsons (Chief Medical Officer) report on Revalidation (published Aug 2008). The important points:

o ALL doctors wishing to practise clinically will need to be relicensed by the GMC
and those who are currently on the specialist register will also need to be recertified. Eventually all doctors will need to recertify in the specialty of their practice, and relicensing and recertification for revalidation will be a single process. o All practising doctors will be given a licence by the GMC in 2009. o Relicensing will rely on the information derived from the annual appraisal which will include evidence from clinical governance, performance, multi-source feedback from peers, colleagues and patients. It will probably commence in 2010 or 2011 o Revalidation will normally take place every 5 years but appraisal will be annual.

o o specialists) o Doctors to demonstrate, on a regular basis, that they are up-to-date and Revalidation = Relicensing (all doctors) + Recertification (for

fit to practice in their chosen field.

18<

Issue has come about as public confidence in doctors low from Bristol

case, Shipman, Alder Hey Organs Enquiry etc. o o o o o o o o o Based on annual appraisal Revalidation issues (based on good medical practice) Good clinical care Treatment in emergencies Good medical practice Teaching and training Maintaining trust Working with colleagues and in Team Health and conduct

Patient and Public involvement

Clinical audit
thing the right way?) (Research what we ought to be doing) Clinical audit is a quality improvement process that seeks to Are we doing what we ought to be doing (are we doing the right

improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change Systematic critical analysis of the quality of health care

STEPS: Observe clinical practice to determine audit theme

18A

 research or evidence

Set standard of care, guidelines and protocols using existing

Monitor clinical practice and compare against these standards Implement change Close the audit loop re-audit

MULTIDISCIPLINARY AUDIT: care Analyses the patient journey rather than a single component of

Cyclical process Audit is all about setting standards An audit must be governed by the principles of good practice Supports health professionals in making sure their patients

receive the best possible care Inform managers about the need for organisational change Gives public confidence

Never involves experiments Never involves a completely new treatment May divide patients in different treatment groups, but after full

discussion with the patients and giving them a free choice

There is no ethical problem if:

The data are taken from clinical records The data is gathered from routine practice There is no approach to patients The data is only seen by the clinical team

In layman's terms, Clinical Audit is all about the quality of care given to patients. It usually involves asking one or more of the following questions:

18D

Did the patient get better? Did we give the best available treatment? Did we deliver that treatment in the best possible way? Was treatment and care provided in the best possible environment?

RESEARCH
knowledge Usually involves an attempt to test a hypothesis May involve the application of strict selection criteria to patients Systematic investigation which aims to increase the sum of

with the same problems before they are entered into the research study

Clinical risk management

Proper record keeping Informed consent Incidence reporting system in place Complaint procedure in place Induction programme for new staff Identify, analyse and control risks

NATIONAL PATIENT SAFETY AGENCY (NPSA)

Collecting and analysing information on adverse incidents Additional roles Safety aspects of hospital design

18E

Cleanliness and food Safe research [responsible for COREC (central office of research & ethics committees)]

Doctors and dentists performance, through NCAS (National clinical assessment service)

Confidential enquiries

Has rolled out National Reporting and Learning System (NRLS),

a system for confidential and anonymous electronic national reporting system. One can report through the local incidence route or directly to NRLS. than who made the error Incidences, adverse events and near misses The agency is interested in learning why things go wrong, rather

NATIONAL CLINICAL ASSESSMENT AUTHORITY (NCAA)

Undertakes assessment of doctors where local procedures have

not been effective or appropriate Protects patients and supports doctors Patient himself or one of the office bearer (MD, CE, clinical

director etc.) can contact

COMPLAINT PROCEDURES 3 stages

Stage 1: Trusts Complaint Manager response within 3 weeks clinician concerned involved in making a reply Established by Convener (Non-

Stage 2: Independent review panel executive member of the trust)

1<F

Stage 3: Ombudsman

Adults can make claim up to 3 years (?6 months) from the date of

being aware of potential problems advocacy service)

Patients can get help from ICAS (independent complaints

Can also complain to professional body (GMC) Medical records kept for 10 years, obstetric 25 years, childrens

up to 25th birthday

Commonest cause of complaint is poor communication. Others

are poor clinical care, physical or sexual assault, behavior, confidentiality breach, improper consent that you care Cannot use NHS complaints process if taking legal action The patients do not care how much you know unless they know

CONSENT: 3 conditions should be satisfied: 1. Patient must be competent to give consent 2. Patient should have sufficient information to make a choice 3. Consent must be given freely

Demand for efficiency and productivity puts strain on the ability to offer time and empathy

1<1

PATIENT CONFIDENTIALITY THE CALDICOTT REPORT (1998): 6 PRINCIPLES: Justify the purpose do not use person identifiable information unless it is absolutely essential Use the minimum person-identifiable information access to the person identifiable information should be on a strict need-to-know basis everyone with access to person-identifiable information should be aware of their responsibilities understand and comply with the law

CHILD PROTECTION
Child protection register can be accessed from the A&E Child protection register is updated monthly Out of hours Emergency Social Services Team can be contacted

Clinical effectiveness
Practice of evidence based medicine NICE and NSF provide guidance

NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE [NICE]

1<2

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

Produces guidance in 3 areas of health Public health promotion of good health; prevention of ill health

Health technologies Clinical practice NICE and NSF set clear national standards for NHS NHS obliged to make resources available, normally within 3 months (from Jan 2002) Established 1999 Special health authority Provides authoritative, robust and reliable guidance on current best practice National center for clinical audit has been incorporated in NICE Scotland Scottish Intercollegiate Guidelines Network (SIGN)

NICE focuses on clinical conditions that have significant impact on public health, and aim to improve standard of care and reduce variation in provision.

Information use

Training

1<'

Good medical practice

Good clinical care Maintaining good medical practice (CPD) Teaching, training, appraising, assessing Relationship with patients Working with colleagues Probity Health

Good clinical care Providing a good standard of practice and care Decisions about access to medical care Treatment in emergencies

Maintaining good medical practice Keeping up to date Maintaining your performance

Teaching and training, appraising and assessing Making assessments and providing references Teaching and training

Relationships with patients Obtaining consent Respecting confidentiality 1<0

Maintaining trust Good communication Ending professional relationships with patients Dealing with problems in professional practice Conduct or performance of colleagues Complaints and formal inquiries Indemnity insurance

Working with colleagues Treating colleagues fairly Working in teams Leading teams Arranging cover Taking up appointments Sharing information with colleagues Delegation and referral

Probity Providing information about your services Writing reports, giving evidence and signing documents Research Financial and commercial dealings Conflicts of interest Financial interests in hospitals, nursing homes and other medical

organisations

Health

1<8

If your health may put patients at risk

Health policies
NHS constitution Highest quality care for all (Darzi) Our NHS our future (Darzi) NHS improvement plan 2004 NHS Plan 2000 New deal

NHS constitution
NHS

Right to all NICE approved drugs and treatments Legal right of choice to any provider Right to be treated with dignity and respect Clean and safe environment Right to complaint and redress To be renewed every 10 years

Patients

Patients to contribute to their own good health Keep appointments or cancel within a reasonable time

Staff

Training and support provided

1<<

Highest quality care for all (Darzi)

(June 2008) (Quality at the heart of NHS) NHS (Disease treatment) Giving patients more information and choice Measuring and publishing quality of care across the NHS (Quality defined as clinically effective, personal and safe) All healthcare provider working for NHS will require by law to publish Quality Accounts Right to all NICE approved drugs and treatments National Quality Board will advise the Ministers on the priorities for NICE New NHS best-evidence service Legal right of choice to any provider Personal care plans for all 15 million patients with long-term condition New personal budgets for 5000 patients with complex long-term conditions Promote innovation; new partnership between NHS, universities and industry Greater emphasis on community health services

Preventing disease Promoting health Help people to stay healthy Reduce your risk campaign for vascular checks

NHS Staff

1<A

Frontline staff to initiate and lead changes

No additional top-down targets beyond the minimum standards Clinical voice at every level based on best medical evidence Clinical excellence award to be strengthened

OUR NHS, OUR FUTURE (DARZI REPORT)

(Oct 2007)
5 elements SAFE Support NPSA in establishing a single point of access for EFFECTIVE Deliver outcome that is best in the world Establish a Health Innovation Council discovery to adoption FAIR Equally available to all, reducing health inequalities PERSONALISED Tailored to the needs and want of each individual Patient choice New GP practices starting with 25% of poorest PCTs Health centres in easily accessible locations Greater flexibility of GP hours - in evening and weekends

frontline workers to report incidents: Patient Safety Direct powers

New health and adult social care REGULATOR with tough

Give matrons further powers to report to the regulator MRSA screening for all elective admission in 2008

& all emergency admission within 3 years LOCALLY ACCOUNTABLE NHS: Any major change in the local NHS

service should be clinically led and locally accountable

1<D

Change initiated only if there is a strong clinical basis Consultation should proceed only where there is effective and

early engagement with public ones closing Independent clinical and managerial assessment Resources made available to open new facilities alongside old

NHS IMPROVEMENT PLAN (2004)

Choose and book (2005)

Unlimited patient choice of NHS provider + private provider who meets NHS tariff/HCC standards (2008) Information about provider waiting time and quality of care 18 weeks patients journey (2008) Minimum 15% of operations/tests in private sector (2008) NHS Cancer plan (1 month to treatment 2008) PCT to control 80% of NHS budget Fewer national targets

CHOOSE AND BOOK

Started in summer 2004 Patients able to choose from Jan 2006 Choice of 4 providers Can book the first appointment

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18 WEEK PATHWAY
By Dec 2008 maximum wait from referral to treatment for non-urgent

cases will be 18 weeks

OUR HEALTH, OUR CARE, OUR SAY

(A new direction for community services) Feb 2006 Patient-centered community services

NHS PLAN 2000

Shifting the balance of power [2000]
need

10 year plan, developed after public consultation Consistently high standard of care Patient centered services when they require and tailored to their

Investment and increases in funding Modernising agency (now defunct) had been developed to lead all

these changes

Health service fit for 21st century

The vision of NHS plan is to offer people fast and convenient care delivered to a consistently high standard. Services will be available when people require them, tailored to their individual needs.
More and better paid staff Reduced waiting times and high quality care centered on patients

1AF

Improvements in local hospitals and surgeries

National standards NICE (clinical and cost effectiveness of

available treatment), NSF (for consistency of care across the country) Demarcation between staff and barrier between services reduced Incentive for improved performance Decentralisation of services, patients empowered

Plurality Patient choice Led by frontline devolved primary care

Planning for 3/5 years DoH has created 10 task forces Locally PCTs will purchase services (outlined by NICE, NSF)

under the direction of SHA from hospital trusts, and clinical governance within the hospitals will ensure that they are enacted locally. The HCC will inspect the trusts regularly (5 years cycle) to ensure that these principles of practice are put into practice. 19,000 more doctors; 67,000 more nurses

NHS plan is consultant based not consultant led May 2005]

[Gary Francis BAPIO

AGENDA FOR CHANGE: It is a new NHS pay and terms and conditions that apply to all directly employed NHS staff except doctors, dentists and senior managers.

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New deal
An agreement made in 1991 between the government, NHS executive, conference of medical royal colleges and the BMA

It sets standards for hours worked, intensity of work,

accommodation and catering

Medical training
Royal Colleges Deanery Modernising medical career Teaching skills

Royal Colleges
Conducts the final professional examination Inspect and accredit training units Appoints advisors at local and regional level to assist the college

(SACs specialist advisory committee) SACs are responsible to the joint committee of higher surgical

training (JCHST) of the college

The royal college sets the training standards and organizes examinations at the end of the training period; whereas the postgraduate deans ensure that the standards are met.

1A2

RITA (Record of in-training assessment) Assessment is a formal process by which progress is measured

APPRAISAL: informal process by which a trainee and his trainer agree objective for a training period.

Deanery

Modernising medical career

FOUNDATION PROGRAMME
training

Focused on developing key competencies Move from experience/time based to competency/outcome based

2 years foundation programme has replaced the pre-registration

and 1st year SHO positions

F1 = PRHO F2 = SHO 1st cohort started in August 2005 Medical students now have to apply for these posts on a national

basis.

The application has 12 sections with 4 points each; only first two

relates to academic achievements

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Consultants with whom the young doctors will be working has no

say in the selection process

Old system will run in parallel till 2009 6 four months placements There will be educational and clinical supervisors (could be the

same person) for specialty training specialty areas: o

o

The programme will give generic skills to junior doctors After completion of foundation programme a trainee can apply

Basic specialist training programme in the following broad based

Medicine in general Surgery in general Child health GP Mental health Anesthesia Pathology in general

1 of 8 programmes, includes GP training From F2 competitive entry to either Run-through training (7 years in ophthalmic) or fixed-term specialist training

TOOKES REPORT
Oct 2007

WEAKNESSES IDENTIFIED
ST training Introduction to FY training had gone reasonably well, but not to

1A0

 training

The need to select sub-specialty 6 months in FY2 is premature Selection to ST training was rushed and undervalued clinical

Underestimated the number of IMG Ineffective communication with the medical profession Single changeover caused logistic problem Service element of ST reduced significantly

KEY RECOMMENDATIONS
DH should consult with medical profession and NHS FY1 to be aligned to medical school. FY2 merged in 3 years core

training (six six months training) Entry to core training by computer adaptive test at the end of FY1 Entry to ST3 by national assessment centre for each specialty

with CV and interview at deanery level; 3 times a year PMETB to be merged with GMC The position of overseas students graduating from UK

universities to be clarified with regard to their eligibility to PG training regime the medical directors Funding issue to be addressed Responsibility of the local delivery of training should be given to Include education and training in HCC performance reporting

Teaching skills

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ADULT LEARNING
Concrete experience Reflective observation Activist Reflector

Conceptualisation New ideas Theorist Active experimentation Pragmatist

Seek feedback

TEACHING
The students need to see the whole picture the relevance of the

new ideas with respect to the whole Attention spam of adults is about 15 minutes Adults learn in different ways to children Plan learning objective Aims: Objectives: general statements Specific, clear statements

Establish mood and climate Assessment Question classification i. Knowledge ii. Comprehension iii. Application iv. Analysis v. Synthesis vi. Evaluation

Giving Feedback vii. Start with the positive viii. Be specific

1A<

ix. Refer to behaviour which can be changed x. Offer alternatives xi. Be descriptive rather than evaluative xii. Own the feedback xiii. Leave the recipient with a choice xiv. Think what it says about you Receiving feedback xv. Listen to the feedback xvi. Be clear about what is being said xvii. Check it out with others xviii. Ask for feedback that you do not get xix. Decide what to do with the feedback

LEARNING APPROACHES: SURFACE LEARNING: Accept ideas and information passively

DEEP LEARNING: Intention to understand material for oneself

Information technology (IT)

CONNECTING FOR HEALTH
National IT network NHS Care records (CRS) across the country Choose and book PACS (Picture archiving and communication systems)

1AA

Do once and share Support (financial, audit, target, governance data) Over 6 billion over next 10 years; increased to 20 billion Challenges security, compatibility

Do Once and Share

Software development programme which will integrate single record keeping between primary and different departments in the secondary care. 45 pathways are being developed by individual action teams, 4 of which are in ophthalmology Diabetic eye disease Cataract Glaucoma Follow-up Philosophy is to provide the right information at the right place at the right time, without paper record and without duplication of data entry.

Others
New consultant contract Business plan Teamwork & Leadership skills Resolving conflict, difficult colleague European working time directive DVLA

1AD

New consultant contract

Consultants role better defined Recognition of on-call duties Significant increase in average career earnings Opportunity to undertake extra NHS work Prevents any conflict with private practice Maximum part-time contract abolished. Contract based solely on

agreed time and service commitments More equitable system of awarding clinical excellence awards Faster , fairer and more effective disciplinary procedure

PROGRAMMED ACTIVITIES: For full time consultants there will be 10 PA of 4 hours each.

They may be programmed in half-units of 2 hours each. Separated into: Direct clinical care Supporting professional activities Training CPD Teaching audit job planning appraisal clinical management local clinical governance activities

Additional responsibilities clinical audit lead

1AE

clinical governance lead clinical tutor undergraduate and postgraduate dean

Other duties Trade union work GMC work Royal College Work for various commissions and advisory committee

There will be 7 PA for direct clinical care, and 3 for supporting

professional activities; 8 and 2 in the first phase of their career (within 7 years of being appointed)

Scope for extra PA On-call paid separately up to 2 PA 8% of salary Flexibility to vary the weekly PA within an annual total

Business plan
How the service is delivered at the moment How the service could be delivered better in the future How can this change come about SWOT (Strength, weakness, opportunities, threats) PEST (political, economical, social, technological) aspects

Difficult colleague
DIFFICULT COLLEAGUE:
Difficult colleague may be colleague in difficulty Take the first opportunity; do not duck Listen, do not prejudge

1DF

Negotiate with clear expectation Dealt with communication and understanding +/- disciplinary

action

CRIMINAL COLLEAGUE:

Remove from clinical area patient safety paramount Follow trust procedure Report to relevant person

WHISTLEBLOWING:
Report to clinical director if any of the following has been, is being or is likely to happen, or deliberately concealed A criminal offence Failure to comply with legal obligation Miscarriage of justice Endangerment of health or safety of an individual

EUROPEAN WORKING TIME DIRECTIVE

hours rest rest in 14 days 20 minutes of break every 6 hours 4 weeks of annual leave an average of maximum 8 hours of night work in 24 hours 24 hours of continuous rest in 7 days, or 48 hours of continuous 58 hours maximum working week (48 by Aug 2009) Junior doctor not to work for more than 13 hours without 11

1D1

!:%+-,# 92 # $and $-%14%#4 5<,$-201$ <$,=<( (21?$ $-%14%#4 5<,$-201$

!ell me about yourself -hy did you choose this hospitalGuni%ersity and how did you arri%e at this decision -hy do you want this job Since you ha%e been in medicineGorthopaedicsGsurgery, what is it that you are proudest of How ha%e you changed personally since starting medicine -hat was your best job and why -hat was your worst job and why !ell me about your hobbiesGpastimesGad%entures .f the hobbies and interests listed on your resume what is your fa%ourite and tell me why If you could change a decision you made whist in medicineGorthopaedicsGsurgery what would you change and why !ell me about your curriculum %itae? +escribe a leadership role of yours and tell why you committed your time to it *i%e me an e(ample of an idea that has come to you and what you did with it *i%e me an e(ample of a problem you sol%ed and the process you used *i%e me an e(ample of the most creati%e project that you ha%e worked on -hat work e(periences ha%e been most %aluable to you and why 1D2

-hat ha%e the e(periences on your resume taught you about managing and working with people *i%e me a situation in which you failed, and how you handled it -hy ha%e you chosen this particular profession -hat challenges are you looking for in a position -hat goals ha%e you set for yourself How are you planning to achie%e them -hat is your most significant accomplishment so far -hat moti%ates you -hat turns you off If I asked people who know you well to describe you, what three words would they use If I asked the people who know you for one reason why I shouldnPt employ you, what would they say 6ecent political or medical news de%elopments -hat are your team@player $ualities *i%e e(amples -hat methods ha%e you used or would you use to assess student learning -hat characteristics do you think are important for this position 2ame two management skills that you think you ha%e -hat characteristics are most important in a good manager How ha%e you displayed one of them -e are looking at a lot of great candidatesH why are you the best person for this position Increasing you may be confronted with more OmodernO $uestions that are designed to make you thinkB +escribe a time in any job you5%e held when you were faced with problems or pressures which tested your ability to cope? -hat did you do *i%e an e(ample to a time when you were unable to finish a task because to did not ha%e enough information to go on? /e specific?

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*i%e an e(ample of a time when you ha%e to be relati%ely $uick in coming to a decision? !ell me about a time when you had to use your spoken communication skills in order to get a point across that was important to you Can you tell me about a job e(perience in which you had to speak up in order to be sure that other people knew what you though or felt *i%e me an e(ample of a time when you felt you were able to moti%ate your colleagues or subordinates? -hat do you do when one of your team member is performing badly, just not getting the job done *i%e an e(ample? -hen you had to do a job that was particularly uninteresting, how did you deal with it *i%e me an e(ample of a specific occasion when you conformed to a policy with which you did not agree? +escribe a situation in which you felt it necessary to be %ery attenti%e to your en%ironment? *i%e an e(ample of a time when you ha%e to use your fact@finding skills to gain information in order to sol%e a problem @ then tell me how you analysed the information to come to a decision?

*i%e me an e(ample of an important goal which you ha%e set in the past and tell me about your success in reaching it? +escribe the most significant written documentGreportGpresentation which you ha%e had to complete? *i%e me an e(ample of a time when you ha%e to go abo%e and beyond the call of duty in order to get a job done? *i%e me an e(ample of a time when you were able to communicate with another person, e%en though that indi%idual may not ha%e liked you personally?

+escribe a situation in which you were effecti%ely able to OreadO another person and tailor your actions according to your understanding of their indi%idual needs or %alues?

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-hat did you do in your last job in order to be effecti%e with your organisation and planning /e specific? +escribe a situation in your job when you could structure your own work schedule? -hat did you do +escribe the most creati%e work@related project which you ha%e carried out? +escribe a time when you felt it was necessary to modify or change your actions in order to respond to the needs of another person? -hat e(perience ha%e you had with a misunderstanding with a customer or fellow employee How did you sol%e the problem -hat did you do in your last job to contribute towards teamwork /e specific? *i%e me an e(ample of a problem which you faced on any job you ha%e had and tell me how you went about sol%ing it? +escribe a situation in which you were able to influence positi%ely the action of others in a desired direction?

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<$,=<( (21?$
N N N N N N N www?doh?go%?uk www?gmc@uk?org www?nhs?uk !he 2ational Health Ser%ice 9#ppointment of Consultants: 6egulations *ood "ractice *uidance Ianuary 2FF8 &aintaining High "rofessional Standards in the &odern 2HS February 2FF8 !erms and Conditions of Ser%ice for 2HS Consultants 1 2FF' Consultant Contract Implementation !eam &oderni3ation #gency &edical "rotection Society -ebsite !ooke report 9httpBGGwww?mmcin$uiry?org?ukGinde(?htm: 2IC4 www.nice.org.uk 2HS direct www.nhsdirect.nhs.uk 2HS &aga3ine 2HS risk management www.nhsla.com/RiskManagement +r Fosters website www.drfoster.co.uk Clinical *o%ernance www.icservices.nhs.uk/clinicalgovernance/pages/cg_request.asp 2ational newspapersB !he !imes, *uardian, !he Independent 96ead the current 2HS issues: 7ood luck 6 Sand Q + 6aj

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