1 / ARCP advice for Panel Chairs
Drs. Ramesh Mehay, Paul Johnson & Mike Tomson

Help?

If you have any concerns about what outcome to give, want more ARCP advice or have difficulty in making an ARCP outcome decision, please get in touch with your locality lead. Get in touch with them AFTER the panel but BEFORE signing off the ARCP form.
LOCALITY LEADS:
  • WYLO: Dr. Simon Hall
  • SYLO: Dr. Sandra Brinkley
  • NEYNL: Dr. Paul Johnson
In addition Dr Rhiannon Davies(Lead for QA of ARCP) and Dr Mike Tomson(ARCP lead APD) are available.

Believe it or not, this 10 page document is a lot shorter than the official DAL/EA guidance for ARCP panel chairs and (we hope) easier to read. 90% of what you need to know about local panels is within this condensed document. [DAL/EA = Deanery Assessment Leads & RCGP External Advisors group.]

The ARCP write-up

  • Before any ARCP write-up, start off by
  1. Reviewing the last ARCP form 2. Reviewing the last two ES reports
  1. Browsing through the Educator’s Notes.

Reviewing these 3 areas can give you an idea of whether the trainee is generally performing okay, underperforming or whether they’re doing okay but need to get their act together; in other words, helps you decide whether to give an Outcome 5 (unsatisfactory) or whether to delay ARCP sign off whilst the trainee getsthings together.

  • 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.
  • Therefore, the ARCP outcome should be written up at the time of the panel and finalisedafterwards when pressure is off. It should be circulated to and confirmed by panel members before sign off.
  • Panels should add as much information as necessary to ARCP forms, especially in cases of an ‘Unsatisfactory’ Outcome. This must be duplicated in the Educator’s Notes.
  • In fact, we advise that all panel outcomes (whether good outcome given or not) & any additional feedback should be duplicated in the Educator’s Notes. Inform the trainee, their CS and ES once it has been pasted there.

ARCP Outcomes

It is really important for panel chairs to get to grips with the different types of outcomes. We know there are lots of them, but the main ones that local panels/panel chairs needs to get familiar with are Outcomes 1, 5, 6 or 8. Out of these, only outcome 5 is an adverse outcome.

  • Outcome 1 – basically satisfactory, allow trainee to move to next stage of training.
  • Outcome 6 – satisfactory, allow trainee to finish training for CCT.
  • Outcome 8 – trainee is out of programme
  • Outcome 5 – adverse outcome, additional training time MAY be required.

If you think one of the other outcomes (2, 3, or 4)should apply, then simply refer to a central deanery panel for them to make that decision. One important thing to remember when considering an outcome which recommends additional training is whether any concerns are so serious as to need say 6 months extra in training at a minimum cost of £40,000.

Outcomes 1 & 6 (GOOD)

□Outcome 1 – satisfactory let the trainee move to the next ST stage (for ST1s and ST2s).

□Outcome 6 – completed training, award CCT. (for ST3s)

There’s not much to say about these outcomes. If the trainee is doing just fine, is of no concern and their ePortfolio looks good – give Outcome 1 or 6 and move on. Don’t dwell too much.

Outcome 5 (NOT GOOD)

□Outcome 5 – incomplete evidence presented – additional training time may be required.

  • It is given when there are missing WPBA elements (CBDs, COTs, DOPS, CSR, MSF, PSQ), or when log entries or PDPs are deficient which in turn hinders the panel from making a decision about progress.
  • In other words, it is used when missing evidence isa sign of trainee underperformance. One place to go to is the Educator’s Notes section of the ePortfolio – where the trainer or Educational Supervisor may have written something about whether the trainee is underperforming or not.
  • If a trainee is missing evidence (and underperforming)….
  • Give Outcome 5, but be v clear about what evidence is missing.
  • The trainee will then be given time to rectify things
  • Another panel, 2-4 w later can then review and give another outcome.
  • If the evidence is now complete  give outcome 1 or 6
  • If not  refer to deanery panel  who will give adverse outcome (2, 3 or 4)
  • 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).

BUT YOU DON’T ALWAYS HAVE TO USE AN OUTCOME 5

i)ARCP panel chairs can use their discretion:

□If they feel that the missing evidence is a simple oversight easily remediable then advice to the trainee (with an educator’s note) may be all that is needed.

  • In this case the panel would give the outcome that would be given if the evidence was there, but not to 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.

ii)Consider referral to a central deanery panel:

□Where the amount of missing evidence is too much to be made up in a short period.

□Where the missing evidence is thought to be evidence of significant non-engagement with the requirements of WPBA.

  • In these cases, refer to a central panel who will then decide whether one of the adverseoutcomes 2, 3 or 4should be considered. More on these outcomes below. These are appropriate where insufficient evidence is evidence of lack of progression rather than lack of evidence of progression.

Outcome 8 (Out Of Programme/Maternity)

□Outcome 8i = OOP-Experience

□Outcome 8ii = OOP-Research

□Outcome 8iii = OOP-Career Break

  • Outcome 8 iii – Current practice is to use it for maternity or sick leave as well, but that will change when GG 2013 is adopted and we will use non-assessment forms instead.
  • More specific points for maternity detailed under ‘Particular Circumstances’ below.

Outcomes 2, 3 and 4

□Outcome 2 = specific competencies required – additional training time not required.

□Outcome 3 = inadequate progress – additional training time required.

□Outcome 4 = released from training– with or without specified competencies.(i.e. being chucked out, but not for resignations)

  • These outcomes are given to trainees who are not progressing and NOT to trainees who are doing okay but have missing evidence because of a lack of attention to due process.
  • Can only be given by central deanery panels – not local panels.
  • Otherwise, you don’t need to know much about them.

But…. in terms of outcome 4, there are a few things you should know…

  • If they are being thrown off the scheme – an Outcome 4 can only be given if it has been preceded by an Outcome 2, 3 or 5 at a previous ARCP panel. In other words, they have to have had a ‘warning’ AND an opportunity to fix things.
  • Resignations–do not give an Outcome 4 for resignations. Outcome 4 is reserved for trainees performing badly, not for resignations. For resignations, see section appropriate section below under ‘Particular Circumstances’.

Particular Points

  • ESR competency ratings: if an Educational Supervisor has rated the trainee BELOW EXPECTATIONS on 3 or more competencies, the ESR should say ‘unsatisfactory progress’ or ‘panel opinion requested’ and the local panel needs to decide whether the trainee is making progress or not. If not, refer to a central deanery panel.
  • Curriculum Coverage:

You basically need to determine whether the trainee is making reasonable progress in covering the curriculum for the ST stage they are at. However, by the end of ST3:

  • There cannot be zero entries for any one curriculum area.
  • But there is no set number of log entries for each curriculum heading.
  • However, for curriculum areasfrequently encountered in GP - we would expect double figures. Smaller numbers for those areas less frequently encountered.
  • What's also important is the quality of those entries - the level of reflection and learning within them? It's not all about the numbers! Please use your judgement – if you find slightly low numbers, look at the quality of those entries – is there enough there to make you feel that there is enough learning in this particular area?
  • PDP: The ES report should generate action points of which 3 items can be converted into a PDP item. The trainee should generate an extra ONE item based on their next post. Non-engagement with the PDP or not auctioning?Explore why this is not happening rather than given an adverse outcome. Is there a plan to help with this?
  • CSR:In community or innovative posts, there needs to be a CSR from each supervisor.

Particular Circumstances

If this is the final ARCP panel for an ST3

  • As well as doing the normal type of review for the final ST3 year, you must check the whole 3 year training period for correct WPBA numbers. If there is a discrepancy (e.g. missing CBD in ST1), this must be made up in a subsequent ST year. If it has not and you get the impression it is a sign of the trainee underperforming, then givean Outcome 5 – incomplete evidence, additional training time required. However, if this is just an oversight and the trainee is generally okay - use your discretion (award Outcome 1 or 6 [satisfactory] but delay signing of the ARCP form until the trainee has filled in the gaps).
  • Also check for child protection training. It is not an RCGP requirement but it is considered a professional obligation by the GMC. See this article: Trainees will revalidate after CCT. If level 2 or 3 safeguarding has been achieved, great. If not, then it should be in the PDP (as a future learning point) as it will be needed when the trainee starts independent practice.

There is missing evidence (like log entries, WPBA elements, or a poor PDP)

  • It depends whether this missing evidence is a sign of underperformance. If so, give Outcome 5 – incomplete evidence, additional training time required.
  • If the trainee is generally okay, it then depends on how bad the deficit is.
  • If only a few things are missing

Delay signing off the ARCP form and tell the trainee to ‘get their act together’ by specifying what they need to do. Give an outcome that would have been given if the evidence was there. But do not complete and submit the ARCP form until the panel chair has subsequently checked the gaps have been filled in(if not, give outcome 5).

  • If the missing evidence is large

In other words, 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, give Outcome 5 – incomplete evidence, additionalmay be training time required and refer to central panel. The central panel may decide to give an outcome 2, 3 or 4 where insufficient evidence is evidence of lack of progression rather than lack of evidence of progression.

  • In both cases, detail exactly what evidence is missing in the ARCP form and paste a copy to the Educator’s Notes.

Missing Naturally Occurring Evidence

  • Trainees are strongly encouraged to do (i) one SEA every 6m, (ii) a case presentation every 6m, (iii) a reflection towards the end of each post and (iv) one audit throughout the entire 3 years. However, no one can force a trainee to do NOE. It is not a national requirement and individual Deaneries cannot enforce it.
  • Therefore, a missing SEA, audit, or lack of a presentation does not mean that you can automaticallymark the trainee as unsatisfactory.
  • However, the trainee should be involved in some sort of Quality Improvement Activity (QIA) activity– of which audit, SEA and a case presentation are great examples. Good Medical Practice states that such activity is expected of all doctors and an absence of QIA activity should be noted and should raise concerns about satisfactory progress.
  • If missing, don’t jump to awarding an adverse outcome! Look for evidence of it elsewhere see if its absence is a marker of a wider concern. An adverse outcome can only be given if there’s a competency deficiency and NOT because of missing NOE
  • Where to look other QIA activity? Usually in the log entries bit; for instance, the presence of an analysis of one’s prescribing or referral behaviour would be acceptable alternatives. Panels cannot mandate what type of QIPactivity is recorded.
  • There must be personal involvement in all QIA/NOE activities (i.e. not spectators!).

No Form R uploaded

  • Automatically give an outcome 5 (incomplete evidence) – no exceptions.
  • Completion of a Form R is a Gold Guide requirement to commence training and aForm R is an annual requirement to remain in training(because it details things like probity, health and involvement in significant untoward incidents – which are important things to know about when making an ARCP recommendation). There is no excuse of it being missing. Trainees should just do it!

Not passed AKT or CSA by the end of training but everything else is okay

  • In terms of competency rating scales – trainees can still be rated as Competent for Licensing even if they have failed AKT/CSA. The ES outcome will still need to be ‘unsatisfactory progress’ and be referred to a central deanery panel (because passing AKT/CSA are mandatory).
  • An extension will be granted by the Deanery up to the date of the result and 2w after (unless they have failed WPBA too).
  • If they then fail again - what happens next depends on their score compared to the previous one (all decided by central deanery panels).
  • If there is a significant improvement in score AND their score is within 5 marks of passing, the trainee is given Outcome 3 - extra training time required (no more than a maximum of 6m).
  • If there is little improvement in score AND score greater than 5 marks away from the pass mark, the trainee is given Outcome 4 - released from training.

Out of Hours Requirements

  • The simple thing to remember is that there must be 18 sessions of OOH by the time of CCT (i.e. one session per month when in GP). Forget working out the number of hours.
  • By CCT, it’s okay to defer 2 of the 18 OOH session after their last ARCP panel – but check to make sure the trainee has logged dates when these will be done and nominate someone at the scheme to check completion (?scheme administrator). Failure to complete these sessions should result in a phone call to the RCGP certification unit asking them to halt the issuing of the CCT (Tel 020 3188 7656).
  • Prior to the final ST3 panels GPRs should be encouraged to include a log entry detailing the evidence contained within the eP which demonstrates competency in OOH care.
  • Extended hours attendance is not OOH work.

Maternity

  • An ESR must be done before someone goes off on maternity leave for four reasons
  1. To validate the evidence submitted so far so that it counts towards training
  2. To record progress
  3. To help formulate a development plan (i.e. what they need to do) upon their return.
  4. Because once it is created and accepted, it automatically generates and ARCP form – in other words, we’re all set up for a future ARCP.
  • Alternatively an ESR giving an OOP outcome can be created by a Deanery administrator when the trainee is out of programme so that the ARCP Panel can record the exact dates the trainee is out of programme and give an Out of Programme ARCP outcome (Outcome 8). A further ESR should be undertaken when the trainee returns to the programme to ensure the personal development plan is appropriate.
  • In terms of local panels give an Outcome 8 (career break)– but in the Additional Comments section, add ‘Trainee on Maternity Leave’.
  • If a trainee is out of programme for more than 12 months, they need to have their Professional Competences reassessed in training once back from leave. Thus it is recommended that they have an extension, usually lasting 3 months, but to be determined by the Deanery on a case by case basis.
  • When the trainee is back on the scheme and due their next ARCP that ARCP will need to review all the evidence since the previous ARCP not counting any Outcome 8 ARCPs.
  • If very little training time – i.e. less than 6 weeks - remains after the trainee returns from planned leave then the penultimate ESR and ARCP should state that the trainee is fully competent and the ES/Panel is happy to recommend them for CCT once the remainder of their training time is completed (record in the Additional Comments section of the ARCP form). Otherwise, there will not be enough time to get everything together for a timely CCT. The final ESR and ARCP (done within the 6w) would then officially sign everything off having made reference to the penultimate ARCP (again, in the Additional Comments section). (Same applies if a trainee is coming back from extended sick leave).

Short Posts (<3m) – (can happened when a trainee goes on maternity)

In short, for posts <3 months W.T.E., the certification unit requires a CSR, at least one PDP entry relevant to the post, learning log entries demonstrating learning (number not specified i.e. do some) and the number of WPBAs (CbDs, mini-CEX etc.) pro-rata for the time in post.

The Trainee is involved in a Significant Untoward Incident (SUI)

  • Review the SUI and see whether progress is being made on it.
  • If the SUI is minor and the trainee has learnt from it with a good reflective log entry, make a note of it and approve if all else in the eP is okay.
  • If SUI is serious and is being investigated, again identify the nature of the problem. In this case, the ARCP panel still judges the trainee based on the remaining evidence in their ePortfolio and gives a grade as if the SUI wasn’t there. The reason is that it is not the panel’s job to make a decision on the SUI. The panel decides whether the trainee is educationally progressing well. The SUI will be dealt with by the dean (as Responsible Officer for trainees) and certification unit – who will decide whether to involve the GMC.
  • In other words, the panel makes an assessment of the educational progress and awarding an outcome 6 (award CCT) is appropriate if all the evidence in the eP is fine – despite outstanding GMC investigations.The Dean decides whether information on the Form R affects his/her revalidation recommendation to the GMC –this should be separate from the ARCP outcome based on demonstrating educational progress.
  • As panel chair, double check to ensure deanery are aware of the major SUI though.
  • This is why we encourage the panel assessor to read the Form R – the place where an SUI will be declared. And if it is, the panel is interested in the educational implications - has the trainee reflected and learnt from the incident? Is there a Log Entry - there is always a learning opportunity whether or not the trainee did anything wrong.

Conflicts of Interest – ‘I know the trainee’