We have a small group of internal clinical advisers, who provide advice regularly on the clinical specialisms that we see the most complaints about. We have a larger external group of advisers who provide advice on a less frequent basis, usually on more specialised clinical areas.
We have processes and checks in place to make sure that clinical advisers have the appropriate knowledge and expertise to advise on our cases, and that the quality of their work is assured.
Recruitment and employment of clinical advisers with us and within the NHS
- When we appoint a new clinical adviser, we require evidence that they are fully registered with their respective professional regulator (for example, the General Medical Council) and that they are in current clinical practice in the NHS. We check this against the regulator’s register each time we request advice from an external clinical adviser. Internal clinical advisers provide evidence of their annual appraisal and revalidation.
- The internal clinical adviser contract and external clinical adviser agreement both stipulate that the individual must inform us if:
- they retire from active NHS clinical practice, and/or
- do not revalidate with the regulator for any reason.
- We stop using internal clinical advisers once they retire from clinical practice. We might still use an external clinical adviser if they are very recently retired (within 12 months of retirement from NHS clinical practice) and/or if they are from a specialism which is difficult to get advice on.
- As part of their contract or agreement, clinical advisers must tell us if they are subject to a ‘fitness to practice’ investigation with their regulator. For an external clinical adviser, we would not ask them to provide clinical advice on a case until the outcome of the ‘fitness to practice’ investigation is known. For internal clinical advisers, we would assess the situation on an individual basis.
How we select a clinical adviser for a case
- We choose a clinical adviser based on the clinical specialism involved in the issues complained about. Sometimes, a case requires clinical advisers from more than one specialism. Caseworkers seek advice from lead clinicians if they are unsure about the specialisms involved in a case.
- Once the relevant specialism and appropriate clinical adviser have been identified, they review the case and provide their advice. They will also provide details of:
- their qualifications
- their current specialist area
- why they are suitable to provide advice on that case.
- Each time, the adviser also signs an agreement to confirm they have no conflicts of interest that would prevent them providing independent and unbiased advice on that case.
Assuring the quality of clinical advice
We have a robust clinical advice quality assurance programme:
- The first three pieces of advice from a newly appointed internal clinical adviser are quality checked by a lead clinician. When they finish their induction and probation period they move into the annual review process. A peer will then check four pieces of their advice each year.
- New external clinical advisers have their first piece of advice checked by a lead clinician. If this meets the quality standard they move into an annual review process. External clinical advisers may only provide one or two pieces of advice per year, with one piece of advice checked by a peer. If their first piece of advice does not meet the quality standard then their next would also be checked (up to a maximum of three checks). After three checks we would decide whether to ask them to provide further advice on our casework.
- A quality check can be arranged where there are concerns about advice. This can be requested by a caseworker, lead clinician, complainant, or organisation, depending on the concerns raised.
- All clinical advisers receive our adviser agreement when appointed. This includes reference to:
- all review periods and quality checks
- details of the Clinical Standard
- how to approach and write advice.
- All clinical advisers who have advised on our most serious cases review our provisional views on that case. This is to make sure the caseworker has correctly interpreted and applied their advice as part of the evidence used to make a decision on the case.