PATIENT SAFETY
Walking out? NCAS has helped reduce the number of unnecessary medical suspensions.
The National Clinical Assessment Service (NCAS) has just had some of its busiest ever months, as it considers its future in a reformed NHS. We spoke to its founder and director,Professor Alistair Scotland.
N
CAS has had a huge effect on medical practice and patient safety in its ten
years in existence, having overseen a huge fall in the number of unnecessary medical suspensions while ushering in a new era of understanding regarding doctors, dentists and pharmacists in diffi culty.
Professor Alistair Scotland, who founded the organisation from a ‘standing start’ in 2001, told NHE: “The bottom line is that we are there to resolve concerns about pro- fessional practice. That is our job. We bring expertise to that resolution.
“An NHS or independent health organisa- tion may come to us and say they are con- cerned about an individual doctor, dentist or pharmacist.
“That concern could be anything, but broadly, they fall into three groups, which overlap: their ability to do the job, as in their knowledge, their skills, their technical capability; the way they behave towards col- leagues or the whole organisation; or their health and whether it is getting in the way.
“We give them advice, we work with them and with the practitioner, to try to resolve it. We are not a regulator; our job is not to investigate or put people on trial.
“Now, the $64,000 question – how do we help patient safety? Our job is to see a
50 | national health executive Mar/Apr 11
case before it has deteriorated to the point where it’s too late for the patient and too late for the practitioner. In other words, as early as possible, people need to come to us so patients are not damaged.
“When something has got to the regulator, honestly, it’s too late.
“We’ve rarely found ourselves in situations where we’ve had to make direct contact with the service regulator to say we are concerned about the way governance is be- ing handled in a particular organisation. It’s not quite as rare for us to recommend a referral to the GDC, the GMC or the GPhC.
“But our job is not to be the agent of the employer or contractor, but to be inde- pendent and to settle the question.”
NCAS has seen a year-on-year increase in referrals, Professor Scotland explained, but with a particular jump in the past year.
He said: “We think revalidation is part of the cause of the upsurge in referrals.
“In our fi rst year, 2001, we dealt with about 130 referrals; I handled every single refer- ral myself because we started from scratch. But that’s increased over the years to the point where we’re settling out at some- where between 1,000 and 1,200 referrals a year. That means that one in 200 doctors
gets referred to us every year, and 1 in 250 dentists.
“That’s a very low referral rate. But we have seen, over the course of this NHS year, quite a marked increase, with three or four of our busiest months ever.
“Our instinct is that the most likely reason for that is we know revalidation is coming, and we know people are preparing to have much more robust governance processes in place. They will almost certainly be taking a fresh look and deciding that, yes, they do need outside help to resolve something.
“We will be quite an important element of the continuity of governance as the reforms come into place.”
NCAS itself will be subject to reform, especially as its parent body, the National Patient Safety Agency, is being abolished. NCAS must move to operating on a self- funding basis over the coming years, meaning the reputation and relationships it has established will be vital to its future viability.
Professor Scotland said: “It is not yet clear where NCAS will sit in a reformed NHS. There is the three-year transition period, from April this year, during which we have to look at everything we do and how we do it, because we’re set up to be an arm’s
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