26 June 2013 Performance and Resources Board

12 For decision

Associate Engagement and Appraisal Issue 1. At its meeting on 25 April 2013 the Performance and Resources Board agreed that all Associates should receive structured feedback from us on their work. The Board commissioned further work on the options for supporting whole practice medical appraisal for Associates with no prescribed connection (NPC) and agreed to a review of engagement arrangements for all Associate groups. Options 2. This report sets out two approaches to supporting Associates with no prescribed connection: a. Option A: Support for Associates with NPC, subject to an agreed qualification threshold based on days worked. b. Option B: Assess the viability and cost effectiveness on an individual basis of supporting whole practice medical appraisal and revalidation for NPC Associates. Recommendations 3.

The Performance and Resources Board is asked to: a.

Choose between the options A and B.

b.

Note the initial assessment of resource implications.

c.

Note the proposed engagement review terms and timescales.

Issue 4. We currently engage with 1200 medical and lay Associates. The majority of our medical Associates have a prescribed connection and a route to revalidation. A significant minority do not. We currently have 145 medical Associates with no prescribed connection. They have revalidation dates from March 2014 to March 2016. In some cases their revalidation date falls after their existing GMC contract ceases. The total number of Associates without a prescribed connection has fallen as contracts end or they confirm that they have a prescribed connection. An overview is set out in Annex A. 5. We expect that the total number of Associates that we engage with will decrease as we proceed with our review of our current engagement model. If this does happen we can expect to see higher levels of activity for individual Associates. These potential future changes and varying levels of engagement currently will present some challenges for planning our support. 6. Support for NPC Associates would require whole practice medical appraisal, peer review feedback and access to a suitable person, but this would not in itself ensure an NPC Associate could revalidate. Given the resource implications it would be sensible to restrict this support to those Associates who would be able to revalidate and where investment from the GMC is viable and cost effective. Two possible approaches have been considered. Option A: Support for Associates with NPC, subject to an agreed qualification threshold based on days worked. 7. An approach based on provisional threshold of 20 days work per year was considered by the Board in April. The advantages of using this approach is that it helps to ensure consistency across the GMC, restricts support to Associates who make a significant contribution, and would be at a level where our investment could be judged as cost effective. Making support dependant on a certain level of activity would also make peer review feedback viable, an essential element that would not be practical for Associates who undertake a few days work in any year. 8. A threshold at 20 days reflects the MPTS panellist minimum annual requirement. This threshold would exclude the vast majority of Associates with NPC based on current usage levels, although this might increase as we review our engagement arrangements in each area. 9. A further disadvantage of an approach based on days worked is that it would not automatically ensure we support the Associates whose services we most need. 10. However, a threshold does help us assess the overall level of support we might need to provide. 11.

The impact of setting a threshold at a range of levels is set out in Annex A.

2

Option B: Assess, on an individual basis, the viability and cost effectiveness of supporting whole practice medical appraisal and revalidation for NPC Associates. 12. An alternative option would be to assess all NPC Associates on an individual basis against a set of criteria. This would include an assessment as to whether peer review on their GMC work was viable and whether they would have enough evidence to revalidate. Further areas of assessment could include an assessment of their importance to delivering a particular service or securing the availability of specialist skills. 13. The advantage of this approach would be that all contracted medical NPC Associates would be considered for support. There would also be additional flexibility to reflect various patterns of work and handle individual circumstances more effectively (such as an Associate not undertaking GMC work due to maternity leave). It would allow us to tailor our approach to the requirements of individual operational areas. While some additional resource implications might arise, the process may also assist in longer term plans to move to a smaller Associate pool. 14. It is also likely that our review of Associate engagement will reduce the numbers of Associates who do a very small number of days per year, making an approach based on an individual review more viable. 15. An assessment as to whether we offer support for whole practice medical appraisal could be integrated into the appraisal and feedback framework we expect to cover all Associates. 16. This main disadvantage of this approach is its inclusion, at an initial stage, of a number of Associates with little practical prospect of revalidation. We will also need to communicate very clearly that this approach does not guarantee that an individual will, ultimately, be able to revalidate.

Resource implications 17. An overview of the resource implications are set out in Annex A and will be evaluated in detail as part of the engagement review and reported to the Board.

Associate engagement 18. At its meeting in April the Board agreed to a review of our engagement model for Associates, including the current requirement for a licence to practise. The project scope also includes the development of appraisal and feedback processes for all Associate groups. The initial draft has been shared with all the relevant operational leads. 19. This review will potentially affect the levels of support we provide Associates on revalidation, assessment of performance and future engagement. During the first phase of the project an equality assessment will be undertaken and reviewed prior to any final recommendations being made.

3

Project Management 20. The scope of our work on Associate appraisal, supporting revalidation and the review of our engagement model is set out in the first version of the project initiation document, attached at Annex B.

4

Supporting Information How this issue relates to the corporate strategy and business plan 21. Associates support a significant proportion of our operational work that amounted to over 10,000 days in 2012. The engagement review will assess the suitability and cost effectiveness of our existing approach and therefore relates to strategic aim 7, continuing to use our resources efficiently and effectively. What engagement approach has been used to inform the work (and what further communication and engagement is needed) 22. The Associate pool are important and influential representatives of the GMC. Maintaining good working relationships is important both operationally and in terms of our reputation. Communication plans to engage with Associates on the engagement review and appraisal and revalidation will be developed. If you have any questions about this paper please contact: Andrew Bratt, Assistant Director – Human Resources, [email protected], 0161 923 6215

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12 – Associate Engagement and Appraisal

Annex A

Appraisal Requirements and Resource Implications This annex sets out estimates of the number of medical Associates with revalidation dates between 2014 and 2016 who currently have no prescribed connection, the impact of applying qualifying thresholds for any GMC support, and overall Associate numbers with reference to performance reviews and feedback.

A1

Medical Associates with NPC 1. We currently have 143 medical Associates who have no prescribed connection. These numbers have reduced since the previous update to the Performance and Resources Board as either contracts ended or associates were able to connect to a designated body or suitable person. 2. Of the 143 there are 39 whose contract ends prior to their revalidation date. Of the 104 who remain 46 have revalidation dates in 2014, 49 in 2015 and nine in 2016. These figures will change; it is likely that some existing Associates might lose their existing prescribed connection (for example due to retirement). Some will also have their contracts ended because they are not being used (based on 2012 usage this might be as many as 25% of our NPC group). In other cases contracts may be renewed and extended beyond a revalidation date. 3. Activity levels in 2012 for these Associates are set out below along with the year their revalidation date falls: 2012 Usage in days 0 1-5 6-10 11-20 20+ Total

Revalidation in 2014 13 17 8 4 4 46

Revalidation in 2015 13 13 16 2 5 49

Revalidation in 2016 1 5 1 2 0 9

4. These figures are based on 2012 Associate usage and we expect these patterns to change. We would expect to see overall Associate numbers reduce, subject to the findings of the engagement review, but an increase in the average number of days per year they work. 5. The main conclusions from this existing pattern are that a lower threshold for support (say 10 days) does not significantly increase the Associates we would potentially be supporting. If option B was preferred we would be engaging with around 75 over a three year period. This is based on the current number of NPC Associates (104) and automatically excluding those who undertake no work for the GMC, despite having a contract. 6. So, an individual assessment as to whether we support whole practice medical appraisal and revalidation would be feasible. This process could form part of the appraisal and feedback processes we are committed to for all Associates.

A2

Resource implications 7. The resource implications relate directly to the number of NPC Associates we would support. These numbers will change over the next three years. We would expect some Associates to undertake more work for us, while we will continue to end contractual relationships with those who we use rarely. Based on current usage patterns, if we provided support to half our NPC Associates we would be supporting around 40 medical associates in the period 2014-2016. We would expect the cost of external whole practice medical appraisal to be approximately £1000 per head. In addition we will need to fund two Suitable Person appointments on a permanent, but probably part-time, basis. 8. Peer review would, in the initial phase, be provided by our existing Success Factor system. In addition to meeting the significant set-up, training and communications requirements we would require half a day administrative support per participant and expect the relevant lead manager to meet with the Associate to discuss their report. 9. In the medium term the administrative burden would decrease as the Learning and Development Portal is expanded to support peer review and appraisal for all Associates.

Associate appraisal 10. Alongside our support for Associates with NPC we are committed to ensuring that all Associates receive structured appraisal feedback that is proportionate and relevant to their roles. The project plan includes a process to assess and develop suitable options for each operational area where these are not already in place. 11. In some operational areas there are significant numbers of Associates making the review and sign off of appraisal challenging. Investment in appraisal systems and training is necessary along with a review of our current engagement. 12. As part of the engagement review we will assess the most suitable options for each individual area and agree an implementation plan. This process will also identify additional resource requirements and inform the development of our on-line systems we expect to deploy from 2014. These will be heavily dependent on the total number of Associates who we engage with and we expect this number to fall.

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12 – Associate Engagement and Appraisal

Annex B Associate Engagement and Appraisal – Project Initiation Document

B1

Project Initiation Document

Project Name:

Associate Engagement & Appraisal

Date:

31 May 2013

Version

Final 1.2

Author:

Matthew Chadwick

Owner:

Andrew Bratt

Document Number:

HR002

B2

Distribution This document has been distributed to: Name

Operational Area

Date of issue

Kate Gregory

Education Visitor

Tara Wilmott

Curriculum Assessment Panellist – Education

Robin Benstead

RCAT

Susan Redward

QSG

Stephen Cunliffe

Certification Panellist

John Foley

Registration and Certification Appeal Panellist

Frances Conway

Registration Panellist

Jane Durkin

PLAB board members, examiners, question writer

Alison Eden

FTP Panellist

Liam Conlon

Performance assessor, health assessor

Stephanie Pollitt

IC Panellist

Version

Document Control Version

Reason for Change

Author

Draft V0.1 Initial draft

Date

M Chadwick

23/04/13

M Chadwick

8/05/13

Draft V0.3 PDD updated following AB comments

M Chadwick

10/05/13

V1.0

Document for release

M Chadwick

21/05/13

V1.1

MC updated Risks

M Chadwick

27/05/13

V1.2

AB updates

M Chadwick

31/5/13

V2.0

NR updates include, and document release

M Chadwick

3/6/13

Draft V0.2

Updated following interviews

initial

stakeholder

Related documents Version

Title / Description

Author

V1.0

Associates project RAIDS log

Matt Chadwick

V1.0

Governance approach

Matt Chadwick

Date approved/completed

B3

B4

Contents 1. 1.1. 1.2. 1.3. 1.4. 2. 2.1. 2.2. 2.3. 2.4. 3. 4. 4.1. 4.2. 4.3. 4.4. 5. 5.1.

Introduction...........................................................................................................6 Outline of the proposed solution ..........................................................................6 Objectives of Project .............................................................................................7 a. Work stream based objectives ...................................................................7 b. Project level objectives: .............................................................................7 Assumptions ..........................................................................................................8 Constraints.............................................................................................................8 Project Definition...................................................................................................9 Within Scope ..........................................................................................................9 Outside Scope ........................................................................................................9 Approach .............................................................................................................. 10 Success Criteria ................................................................................................... 10 Project Plan .........................................................................................................11 Resource ..............................................................................................................11 Project Structure ................................................................................................. 11 Governance .......................................................................................................... 12 Project Controls ................................................................................................... 13 a. Key Project Risks ..................................................................................... 13 b. Key Project Issues ................................................................................... 13 Communications .................................................................................................. 14 Appendix ..............................................................................................................14 Resource roles and responsibility ...................................................................... 14

B5

1. Introduction The GMC currently contracts with 1215 Associates, (993 medical, 222) lay who undertook approximately 12 000 days of work in 2012. As part of the GMC’s management of Associates, there is a commitment to ensure that appropriate and proportionate performance management and appraisal systems extend to all associates who work for the GMC. For those medical Associates with a prescribed connection, the feedback they receive should be suitable for inclusion in their annual medical appraisal, and therefore utilised for Revalidation. Where Associates have no prescribed connection the GMC will consider providing support for whole practice medical appraisal and revalidation. Underpinning this work the way in which Associates are utilised will be reviewed to ensure the most appropriate engagement model is identified for each operational area. This will include an assessment as to whether the existing requirement to have a LtP should be retained.

1.1. Outline of the proposed solution The Associate appraisal project therefore has three distinct streams, although the performance management process and revalidation are interwoven. Associate Performance Management & Appraisal Systems

Revalidation Support for NPC Associates

Associate Engagement

The projects will support best practice across the operational areas and local operational needs. Key stakeholders will be fully engaged in defining the plan to deliver the key objectives of the project. There will be a strong and clear governance framework in place, with defined measures of success for the project. The project will assess our current engagement model, and recommend suitable future options for all operational areas. The team will work closely with the Heads of Sections, supporting them through the project, and collaboratively developing a solution that meets as closely as possible, the needs of each section. B6

1.2. Objectives of Project All dates stated will be ratified during high level planning a.

Work stream based objectives

Appraisal A clear corporate framework and standards for appraisal and feedback for all Associates Agreed arrangements for the application of the corporate framework for each associates area Revalidation Agreed arrangements for supporting revalidations for NPC Associates, subject to any qualification criteria or assessment – including the availability of Peer Review, WPMA, and a SP Engagement An assessment of the current effectiveness of existing engagement arrangements in each associate area. Development of suitable alternative engagement options for each operational area An assessment of the current LTP requirement for each area and, if applicable, develop alternative proposals

b.

Project level objectives:

Complete a detailed review of the As-Is Associates delivery model across all Sections by the end of July Ensure we achieve consistently good practice through the implementation of the Appraisal process throughout 2013 measured through positive feedback Complete the cycle of appraisal activity for all Associates by the end of 2014 Ensure the availability of Success Factors; the online tool which supports multi source feedback peer review by the end of October 2013 Secure director sign off for engagement proposals and appraisal arrangements for each operational areas

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1.3. Assumptions Number Description

Status

Date to reviewed

1

All associates will be given Open feedback, on their work for the GMC

End of June

2

Appraisal and Feedback suitable for Open medical associates to use in Revalidation portfolio

September 2013

3

The GMC will agree arrangements Open for supporting the revalidation process for GMC medical Associates WITHOUT a prescribed connection, including any agreed qualification threshold or assessment process

End of June 2013

4

The implementation of a portal for Open On-line appraisals in 2014

December 2013

5

Engagement and ongoing Open management will reduce Associate numbers

September 2013

be

1.4. Constraints The following constraints are in place for this project: Resources:

Potentially limited resources to support the project across IS, HR and the associate support teams

Capacity within Sections: There will be a requirement upon each section to implement and execute key deliverables throughout this project. Each section must review against BAU workloads, manager/associate ratios/practical considerations/access and location to Associates/range of activities Existing systems

The project will look to utilising existing systems where they meet the needs of the project, such as Success Factors

Location

A number of sections are constrained by the limited access to their associates, whom are spread over a wide area and numerous locations

B8

Utilisation

There will be unpredictable usage patterns across certain operational areas which makes planning difficult

2. Project Definition 2.1. Within Scope The Associates Project will cover the following areas:

Appraisal •

Implementing new appraisal and performance management standards

•

Initial scoping of requirements and a specification for an on-line appraisal solution

•

Revalidation •

Supporting revalidation for NPC Associates through whole practise medical appraisal and a suitable person, subject to any qualifying criteria

•

Providing feedback and appraisal documentation for all medical associates

Engagement •

Review the utilisation of Associates

•

Providing recommendations on alternative engagement models

•

Reviewing the existing engagement model for Associates and their respective sections

Supporting Activities •

Training and Guidance materials

•

Communications plans

•

Equality impact assessment

2.2. Outside Scope The following areas are deemed out of scope for the Associates Project: •

Delivery of the appraisal process. This is to be completed by each Section, but supported centrally.

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2.3. Approach The Associates project will use a standard waterfall approach of: Analyse/Review

Comprehensive review of the as-Is status

Develop recommendations

Turn the analysis into a series of products to be agreed by steering group and implemented by each section

Implement products

Develop key deliverables/products project, and implement them

Review

What went well, what could have been done even better

Closure

Formal closure of the project and ratification of costs and benefits

for

the

2.4. Success Criteria The project will be deemed a success when the following have been achieved: •

An agreed implementation plan for the application of the corporate framework and standards model for each operational area

•

A completed review of current engagement models

•

Delivery of a proposed engagement framework

•

Implementation of multi source feedback peer review

•

Sign off all proposals on appraisal and engagement by each director

•

Suitable person appointed

•

SP applications to GMC successful

•

All associates receive feedback on work undertaken for the GMC

•

Medical associates with No Prescribed Connection are supported with whole practice appraisal and a link to a Suitable Person (subject to any qualification criteria)

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3. Project Plan

4. Resource 4.1. Project Structure The following structure is proposed for this project:

M Chadwick Lead

U Pollman Associate SME

HoS Delivery Partners

Rachel Mooney IS Lead (Success Factors)

B11

4.2. Governance Project governance will be through the following: Meeting

Frequency

Attendees

Inputs

Outputs

Working party

Weekly

Key members of the project team

Weekly work stream reports, previous actions, current plan

Actions

Steering Group

4 weekly

Key RAIDS, stakeholders & Previous decision minutes, makers current plan

Updated plan Updated RAIDS Minutes Updated RAIDS

The project will follow a Gateway approval process. Throughout the lifecycle of the project, a series of Gateway checkpoints will be included. This will allow the Steering Group to confirm they are confident in the projects ongoing ability to deliver. The named individuals for all governance meetings will be agreed with sponsor and updated within this document and associated Governance paper

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4.3. Project Controls a. Key Project Risks Risk

Proposed Management

There is a Risk that the GMC loses its Project manager to closely experienced skill set of associates that it relies monitoring with Associates team heavily upon for certain roles Reputational risk for GMC for not having a To be reviewed by steering group suitable appraisal process in place The capacity/availability of resources in AST/IS to support Peer Review

Continually monitor through steering group and ensure assistant director of IS is a member

The workflow management and scheduling of associates makes appraisal implementation difficult

Contingency planning to undertake modelling review and inform approach

The resource requirements on some operational areas cannot be met

Close engagement with Head of Sections to continually monitor. Any additional resource requirements will be raise to steering group

b. Key Project Issues Issue

Proposed resolution

Availability of key stakeholders

Planning to reflect availability

Appointment and engagement of SPs for GMC MPTS

Initiate recruitment, identify range of appointment options

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4.4. Communications To be updated following agreement with Comms SME

5. Appendix 5.1. Resource roles and responsibility Role Sponsor

Responsibility • • • • • • •

Project Manager

• • • • • • • • •

Associate Services Manager

• • • •

Heads of Sections

IS Lead

Providing visible leadership and championing the project Supporting the defined project vision Owning the business case and target operating model Accountable for benefits realisation Signing off key project documentation – i.e. PDD Monitoring progress against plans; reviewing escalated issues, risks and change requests Assigning resources required for project delivery Provide project leadership Preparing the project brief, PDD (or equivalent) and business case Determining and managing risks to the project Managing the project budget Develop the Risk, Issue and Change requests for input to the PMO Providing project management guidance to the team Deputise for the Sponsor Act as a point of contact for external relationships Development of project documentation and diagrams to identify and track the project interdependencies Provide guidance and expertise in relation to the overall requirements across sections Review proposals weekly in cooperation with the PM Comms, procedures, FAQs, point of contact for HoSs and associates Collaborates with GMC RO/Senior Medical Advisor

•

Provide guidance and expertise in relation to each Sections requirements

•

Act as the main point of contact for their Section

•

Provide project sign off for key deliverables for their section

•

Implement and embed the proposals recommendations agreed by the steering group

•

To manage the delivery of all IS deliverables associated with the project Act as the key focal point for all IS contact Manage the interaction with all IS teams Provide support and expertise on all IS issues

• • •

and

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