ARCP Advice

GP School Summer 2013

Introduction

Until relatively recently the school managed its localities with slightly different approaches being taken in each locality. This guidance is intended to facilitate a consistent approach to the concerns panels deal with across the school. Where in any doubt ask advice or consult Gold Guide /COGPED.

Index

Panel Organisation

  • Notice of ARCP
  • Panel composition
  • Local/Scheme panels vs. Central panels
  • Referral to Central Panels
  • Lay assessors required
  • Lap reps and their role
  • APD attendance at Scheme Panels
  • Conflicts of interest
  • Keeping colleagues informed
  • Feedback to ES
  • System for ensuring midyear Adverse ESRs are picked up

Outcomes

  • Educational and Disciplinary Routes
  • ESR below on 3 or more competencies
  • Outcome 3 or Outcome 2
  • Outcome 3 comments
  • Outcome 3 duration of extension
  • Outcome 4
  • Additional Training vs. additional training time.
  • Outcomes 3 & 4
  • Outcome 5
  • RCP write up

Revalidation

  • GMC or other revalidation concerns
  • Form R

Particular Circumstances

  • Continual exam Failure vs. Single Exam failure
  • Naturally occurring Evidence
  • Requests to delay a panel
  • ESR: Panel opinion requested or unsatisfactory progress at a non annual panel time
  • OOH
  • Lack of self assessment by trainee
  • Resignations
  • Less than 18m of GP experience
  • Short posts
  • Out of programme ARCP panels (includes Pregnancy)
  • New Evidence after giving an outcome 6

Panel Organisation

Notice of ARCP

The Deanery, as a result of the enhanced ARCP process, requires a minimum of 6 weeks’ notice of any ARCPs. The reason for this is to allow sufficient time to obtain information from host Local Education Providers and to allow time for the trainee to complete the new Form R. The 6 weeks’ notice rule does not apply to arranging follow up ARCP meetings after an Outcome 5 has been awarded.

All trainees are also expected to have good notice of ARCP dates according to Gold Guide.

Panel Composition

All panels whether held at scheme level or centrally are deemed to be ‘deanery’ panels and therefore all members should have been approve by the Specialty Training Committee. This implies that the members should have received Equal Opportunities training and all should either have had training in ARCP panel work (e.g. through spring and autumn school or at courses run by the deanery) or have “inherited rights” as experienced members of ARCP panels. Each locality will hold a list of those suitably trained for GP ARCP panel work.

All panels must have a minimum of 3 listed members approved for this purpose by the Speciality Training Committee. One of these members must be an APD or TPD, or approved Deputy of the postgraduate Dean (i.e. has GP school approval as a central panel chair.) There are additional details about the membership if an academic trainee is being assessed. The Gold Guide is not clear in its definition of who else should be on the panel, best practice would be to have 3 clinicians, but variations including lay representatives are not ruled out by the Gold Guide.

Local/Scheme panels vs. Central panels

Local or scheme panels are asked only to give outcomes which can be given when the trainee is not present (1,5 6 and 8) (1=satisfactory progress; 5= incomplete evidence presented additional training time may be required; 6 =Gained all competences will be recommended for CCT; 8 = out of programme (e.g. career break / maternity leave).

If the panel is concerned that an adverse outcome may be appropriate then a referral to the ‘central’ panel will allow a process which ensures the trainee is interviewed etc as required by Gold Guide.

Referral to Central panels

Referral to the Central panel should be made by the scheme panel when the scheme panel feels that outcome 1, 5, 6 or 8 may not be appropriate. The reasons for the referral should always be added by the scheme panel to the Educator’s Notes so that there is a permanent record of their review and so that the deanery panel is aware of the details of their discussions.

Details of anybody who is referred to a central panel should be e mailed to the locality Programme Support coordinator.

(It has been agreed that it is not appropriate to use an outcome 5 and list the locality panel as this implies all the panel discussed things together, also the assumptions around local and deanery panel are not ones shared outside this deanery.)

Lay assessors required

Lay assessors should be invited to all panels where there is a substantial risk of an outcome 4. Where there are complex decisions about outcomes 2 and 3 it is preferable to have a lay member too. It is therefore anticipated that all ‘central’ panels will have lay assessor representation.

Lay reps and their role

Lay representatives should have ARCP training and STC approval in line with all other panel members. They should be aware of the agenda and have access to the ePortfolio in order to review the cases under discussion in advance of the ARCP. Lay members are encouraged to take part in the discussion whilst also monitoring that process is being followed appropriately. Final decisions regarding ARCP outcome should be made by GP educators taking into account the views of the lay assessor.

APD attendance at Scheme panels

The experience at scheme panels has grown enormously over the years since ARCPs were introduced. The quality of our panels as assessed by the RCGP’s visits and reviews has suggested that there is not a continuing concern about most of the decisions we make.

It is therefore planned that there will be no further routine APD or GP tutor input to scheme panels. Scheme chairs are encouraged to contact one of the ARCP leads for advice in advance of any likely difficult decisions or after the panel and before signing and confirming where there is uncertainty.

Conflicts of interest

Where the panel includes a member who has been ES or CS for the trainee or worked closely with the trainee, and especially where there are possibilities of that trainee receiving an adverse outcome, the GP educator should not take part in the discussion and where there is a possibility of an adverse assessment should not be listed as a panel member. To ensure that the trainee does not perceive that there is hidden input which would cause problems at an appeal it is best practice for educators in this position to leave the room until after the trainee has had their meeting with the panel.
Keeping colleagues informed

It is important that the results of the panels are shared promptly with those who need to know. The Programme co-ordinator or their named colleague in the Deanery team should be informed of all outcomes at local panels within 3 working days. For any central panels it is important that the outcomes are all shared with the Locality Directors of GP for any trainees seen at the panel. The offices have a common approach to informing the trainees of the outcomes.

Feedback to ES

Where there are concerns about the quality of the ESR then the panel chair should ensure that there is feedback to the ES.

It is not expected that panels will feedback on all ESRs.

System for ensuring midyear adverse ESRS are picked up

All schemes should have a system to ensure that all adverse ESR outcomes at 6m 18m and 30m (as well as those for the middle of the years for LTFTT trainees!) are known by the scheme and are reviewed.

Outcomes

Educational and Disciplinary routes

It is important for ARCP panels to be clear that their responsibility is to make an educational judgement on the evidence of progress ( or lack of it)

Sometimes it may be appropriate for the Panel Chair to ask the employer whether the employer has considered adopting a disciplinary approach.

ESR below expectations on 3 or more competencies

In particular it would be expected that no ESR which has assessed the trainee as “below expectations” on 3 or more competencies should be assessed as making satisfactory progress. This should always result in either an unsatisfactory progress or Panel Opinion Requested outcome.

Outcome 3 or Outcome 2

The level of concern about competencies should be much greater when an outcome 3 is given as opposed to an outcome 2, because of the implications for trainees of an extension and the financial investment being made by the deanery extending training. There is no rule to follow here which is simple beyond looking at the definitions: page 68.

An Outcome 2 may be appropriate where there is evidence of concerns but the amount of evidence is not sufficiently strong to justify an outcome 3. Others will receive an outcome 2 because there is evidence of concern but the panel assesses that within the time specified the individual will be able to resolve the concerns highlighted with extra input whilst in normal training.

Outcome 3 comments

It is essential that there is a clear explanation of why an outcome 3 has been given. This should detail the evidence to be accumulated by the trainee to demonstrate progress and any other expectations to be achieved within the extension period.

Some phrases which may be useful here include:

·As well as all other WPBA and contractual requirements of the post the following will be expected….

·Sufficient CbD should be undertaken to provide evidence of competency on at least 2 occasions for each competency.

·Although this 6m post is in ST1 the panel expects to review 6 CbD and 6 COT at the review

·The trainee is expected to sit the CSA/AKT at the next opportunity.

Outcome 3 duration of extension

The school’s policy on length of extensions changes from time to time in accordance with the financial resources allocated to the school. Details of the current policy can be found at :

Outcome 4

It is important to detail all competencies completed or if the only problem was passing an exam to state that all competencies have been passed apart from CSA/ AKT e.g. “Outcome 4 was solely due to CSA failure. The panel was satisfied that all the other competences for licensing as a GP were demonstrated” (Future employers may need this information.)

If an outcome 4 is given for failure to achieve WPBA comments are needed to define which ones have not been completed satisfactorily so it is appropriate to have variations on “Despite a period of remediation the trainee is still below expectations in (e.g.) 2 competences [1. maintaining performance, learning and teaching 2. Working with colleagues]. He has been given outcome 4 for this reason. The panel noted that the trainee meets expectations for his stage of training in the other competences required for General Practice and has passed the AKT exam”

An Outcome 4 Can be given after outcome 2, 3 or 5.

Additional Training vs. Additional Training Time

GG specifies that trainees may need ‘additional training‘but not training time. HOWEVER –the trainee would need to have had additional training input/supervision etc over and above routine training. If an ARCP panel gives outcome 2 (especially if they anticipate the trainee may ultimately receive an outcome 4) they need to specify what additional training recommended (e.g. meet with performance management team). If at subsequent ARCP there is evidence that additional training has happened and trainee has not made satisfactory progress - panel could then give an outcome 4.

Once the trainee, ES and possibly local performance team have planned the additional work that needs to be attended to then it can be seen that additional training has commenced even if additional training time has yet to commence.

Outcomes 3 & 4

When a trainee receives an outcome 3 or 4, they must be informed of their right to appeal. A hard copy of the ARCP outcome with a statement that the trainee has been advised of their right to appeal should be signed by the trainee and panel chair. This should be given to the trainee with a copy held for the trainees file.

Outcome 5

“Incomplete evidence; extra training may be required”.

This occurs when, at the time of the panel, there is missing evidence e.g. insufficient WPBA assessments for stage of training, no recent ESR. It can also include inadequate numbers of learning log or PDP entries where there is insufficient evidence for the panel to make a judgment about progression. The ARCP form should list what evidence is missing and then the trainee has another ARCP panel in a short period (of, say, 2 – 4 weeks later) when the second panel can give another outcome. A new ESR is not required for an ARCP panel reviewing previous outcome 5 unless a significant amount of time has elapsed since the outcome 5 was given (which should not normally be the case). If the evidence is now complete, outcome 1 or 6 may be appropriate, if not then a different unsatisfactory outcome (2, 3 or 4) will be appropriate.

Alternatives to giving outcome 5.

•Outcome 5 is an unsatisfactory ARCP outcome and remains a part of the GPST’s permanent record, so we recommend this outcome is used when there are concerns that missing evidence is a sign of trainee underperformance. This could also apply to trainees who do submit their evidence, but not in a timely manner despite advice from their CS/ES (educators’ notes are often helpful for panels trying to work out if this is the case).

•ARCP panel chairs can use their discretion; if they feel that the missing evidence is a simple oversight and easily remediable then advice to the trainee (with an educator’s note from the panel chair) may be all that is needed. In that case the panel would give the outcome that would be given if the evidence was there, but not complete and submit the ARCP form until the panel chair has subsequently verified that the missing evidence has been submitted (if it is not submitted by the required date then outcome 5 would be given).

•Where the amount of missing evidence is too much to be made up in a short period and/or the missing evidence is thought to be evidence of significant non-engagement with the requirements of WPBA, outcome 2, 3 or 4 should be considered (on a case by case basis). Outcome 2, 3 or 4 is appropriate where insufficient evidence is evidence of lack of progression rather than lack of evidence of progression.

ARCP write up

The Gold Guide says that the ARCP outcome should be written up at the time of the panel.

It is assumed that the admin support for the panel will normally complete the panel membership and dates for the assessments before the panel. It is appropriate for the panel chair to draft some likely sections in the form in advance of the meeting to facilitate the write up but everything written should have been confirmed and discussed by the panel. The wording of the ARCP outcome is very important –because it sets SMART objectives against which progress will be measured and will be examined for clarity and reasonableness at appeal or in legal challenge. For this reason the final edit should be done by the chair after the panel – when pressure is off. The wording should be circulated to and confirmed by panel members before sign off.

NB the revalidation unit only sees the ARCP certificates and so the more information provided on these the less likelihood of delay to the assessment of the request for a CCT.

Revalidation

GMC or other revalidation concerns

The panel should make an assessment of the educational progress including evidence provided to it of any GMC concerns as detailed in e-P.

If the evidence for progression is there and even if there are outstanding GMC investigations then the panel should decide on the outcome based on the evidence in e-P

If an outcome 6 is appropriate it is appropriate to inform both the Dean (as RO for trainees) and the RO for the Local Area Team who hold the revalidation responsibility for the areas GPs.

In complex cases with outstanding GMC concerns/SUI - It is likely certification unit will pass such issues on to the GMC

The Panel chair may wish to contact the certification unit to discuss and seek advice before completing the ARCP form in complex cases.

It is appropriate for local panels to review the portfolios and give outcomes as normal even when there have been concerns raised if the educational progress has been satisfactory.

Form R

It is a requirement that all trainees complete an enhanced form R for every ARCP.

Failure to complete an enhanced form 4 should result in the trainee being given an outcome 5.

Particular Circumstances

Continual exam Failure vs Single exam failure

The correct uses for these boxes are not intuitive.

Continual exam failure does not mean that the exam has been failed more than once but means that the maximum number of permitted attempts has been reached.

Naturally occurring evidence

RCGP and COGPED have confirmed that it is not appropriate for deaneries to have additional requirements beyond the requirements set nationally.

It is therefore important that ARCP panels should not make judgements based on the lack of an audit, lack of evidence of a presentation, lack of evidence of number of days of sickness or insufficient SEAs etc. However Audit, significant event analysis, Child protection training all fall under the heading Quality Improvement activity and although panels cannot mandate what type of QIP activity is recorded, GMP states that such activity is expected of all doctors and an absence of QIP activity should be noted and should raise concerns about whether there has been satisfactory progress.