National Clinical Assessment Service Supporting dentists in difficulty

National Clinical Assessment Service Supporting dentists in difficulty Janine Brooks BDS MCDH DDPHRCS MSc Associate Director

Purpose Set up to help the NHS deal in a more timely and consistent way with doctors and dentists whose performance gives cause for concern. Safer practitioners = safer patients In England, Wales and Northern Ireland

Providing support ØAdvice – on local management of performance concerns ØSupport – expert help to resolve complex performance disputes ØAssessment – full clinical performance assessment where detailed diagnostic work is needed ØAction planning and follow up

The Performance Triangle Work Context Clinical Capability Health Behaviour

The problems Ø Lack of knowledge or skill Ø Ø Ø Ill health, especially mental health Substance abuse Personality disorder Lack of probity or professional values Lack of support A combination of factors

Presenting Concerns: April 2003 – December 2004

Behavioural areas of concern in early assessment cases (NCAS) Ø Ø Ø communication team working time management/personal organisation poor leadership skills lack of insight into concerns of others failure to comply with treatment protocols (but all were reported to be highly motivated)

The dental casework story so far …. Ø To 31 March 2005, NCAS had received 95 referrals of dentists Ø Ø Ø Only 4 also involved the General Dental Council GDP referrals now outnumber H and C referrals Some clinicians are doubly-qualified – we count them as dental if they are working in a dental specialty

Referrals come from all age-groups

Other early observations …. Ø Women account for about one case in three - more than in medicine Ø Hospital referrals are normally of consultants – as in medicine Ø Amongst the dentists for whom we have ethnicity data, four in five are white

Assessment Components • • Occupational health Behavioural Clinical Organisational

Assessment Framework Stage 1 Request for help Advice Closure Assessment Framework Stage 2 Support and Assessment Support Assessment and Assessment Framework Stage 3 Delivery and Follow Up Action Planning Follow up Closure

Assessment Ø Its purpose – Clarify areas of concern – Seek to understand what is leading to these concerns – Make recommendations on how they may be addressed Ø Standard approach – 10 tools with triangulation of evidence – – Occupational health and behavioural assessments Information from referring body, and from doctor / dentist Multi-source feedback (colleagues and patients) Medical record review, direct observation of practice, assessment of clinical reasoning and interview

Thank you