NHS Employers has responded to the Department of Health consultation on "Responsible Officers (ROs) and their Duties Relating to the Medical Profession".
We are grateful for comments made at a meeting of the Medical Workforce Forum which we shared more widely with the NHS, and for the additional comments we received as a result of our online consultation. Those views helped to shape our response. The response reflected the concerns of employers about the practicalities of introducing the RO role to trusts in terms of accountability and affordability, in particular:
- the default position of PCTs for doctors working outside of recognised employment structures;
- the need for clear guidance on providing RO services externally; the need for clarity of the relationship between the RO and others with statutory responsibilities; and
- the potential for conflict of interest; resources implications and the role of the RO in signing off revalidation submissions.
NHS Employers will remain in contact with the Department of Health team responsible for the RO project so that the structures and processes that emerge in future reflect the concerns and interests of NHS employers.
The Consultation
The Health and Social Care Act 2008 allows ministers, through regulations, to require healthcare organisations to appoint a senior doctor known as a responsible officer. The responsible officer will have specific duties for monitoring the performance and conduct of doctors under the oversight of the organisation and for liaison with the General Medical Council (GMC) over revalidation and fitness to practise procedures.
The full consultation document is available on the Department of Health website. It covered a number of detailed issues, including:
- linking ROs, doctors and organisations; every doctor will have to relate to a single RO
- the requirements to be met in appointing ROs,
- the functions of the RO, particularly in relation to revalidation and the evaluation of fitness to practise
- the functions of the RO in relation to clinical governance, including their relationship with contracts of employment, admission to the Performers Lists, monitoring conduct and performance and ensuring appropriate action is taken
- resourcing ROs, including those resources necessary for them to undertake their statutory duties and the arrangements which would need to be made where a doctor from one organisation acts as the RO for a doctor from another.
Medical Workforce Forum
We discussed some of the key points emerging from this consultation with the Medical Workforce Forum (MWF). The MWF considered in particular the relationship between the statutory responsibility of the individual RO and the extent of their independence from the appointing organisation, the conflicts which might arise from difficult and borderline cases and the safeguards which might need to be put in place.
Amongst the points raised in discussion were:
- whether it would be reasonable or practical for PCTs to act as the default appointing organisation for doctors working outside recognised employment structures
- whether this would be consistent with a PCT role increasingly focussed on commissioning with different arrangements for provision
- what indemnity arrangements would be put in place and how would individuals be supported by employers in making decisions
- how would cross charging apply in providing an RO service to a different organisation
- how to resolve the potential conflict between a more strategic role for medical directors and an increase in the volume of process-driven case work
- how to manage possible issues of tension between ROs and those with other statutory responsibilities, eg board members and clinical governance and those with responsibilities designated in Maintaining High Professional Standards in the NHS and other procedures
- the importance of clear and consistent standards to determine if a threshold had been breached, particularly where there was a question of clinical capability
- the need to take full account of the impact on resources and not add to the bureaucratic burden of employers
- the need to ensure that difficult cases are not passed around the system thus endangering patient safety
- clarifying the accountability of GMC affiliates and their relationship to the SHA, foundations trusts and other employers
- the importance of ensuring that systems are right for medical staff before replicating procedures for other professional groups.
For further information please contact Sean.King@nhsemployers.org telephone 0113 3063057
