Reports & Guidance

Report of an Intercollegiate Working Party chaired by the Royal College of Anaesthetists

The Working Party, having reviewed existing guidelines, concluded that these documents provide advice which should prevent such complications. However, the recent literature provides disturbing evidence that the recommendations have not been implemented fully and that, as a result, patients are exposed to unnecessary risk. 

In this report the established principles of managing patients undergoing healthcare procedures, and current guidance on the safe use of sedative drugs are drawn together and supported strongly. However, it is recognised that more specific advice is required if the barriers to changes in practice are to be overcome.

Outlines the services that Colleges and Faculties involved in the appointment process of Consultant and SAS posts are able to offer.

The Academy of Royal Medical Colleges established a working group to consider the impact of Shifting the Balance of Power on the commissioning of specialist services. This was in response to discussions at Academy meetings that raised issues about the impact of new structural changes on the delivery of specialist services and the definition of just what these were. Particular concerns were raised about the learning curves and capacities of Primary Care Trusts (PCTs) as well as their relationships with Strategic Health Authorities (StHAs) and clinical networks.

Comments on the Proposal for a Directive of the European Parliament and the Council on the Recognition of Professional Qualifications

The Intercollegiate Service Specialties’ Committee (ISSC), of the Academy of Medical Royal Colleges, comprised the Royal College of Anaesthetists, the Royal College of Pathologists, and the Royal College of Radiologists. The purpose of this guidance was to advise commissioners and to ensure that NHS provider organisations have considered fully the service implications (anaesthesia, pathology and radiology) before contracts are agreed. Failure to do so could adversely affect waiting times and clinical outcomes.

The Academy had no part in negotiations or had any formal position in relation to the contract it has an important role in giving leadership and support to consultants. This guidance provides general advice on the implications of contracts for consultant job descriptions. It is based on a number of agreed principles. The constituent Colleges and Faculties provide fuller guidance on matters that are particular to each specialist field.

Published: May 2004

Guidance from the Academy of Medical Royal Colleges

Guidance for Medical Royal Colleges on their invovlement in consultant appointments.

Electronic learning or more commonly, e-learning is an all-encompassing term to describe learning supported by the use of information and communications technology (ICT). This report outlines the major advances the Royal Colleges have made in this area. It will be important to maximise the gains from all that they have learned, and to minimise duplication. The Academy of Medical Royal Colleges is taking a leadership role in co-ordinating the work of the colleges and helping to shape the national strategic direction for e-learning.

This document explores options for the organisation of acute health care. In many areas, there will be little or no change, but in others change will be needed.

This short guidance document outlines 10 principles that Colleges and Faculties should consider when creating CPD schemes.

Decisions on the nature and shape of the medical workforce require clear understanding of the distinguishing roles of doctors and what is expected from them. The report identifies those roles and the added value, measured as improvements in quality and efficiency of care that doctors bring to the healthcare team.

Key points from two reviews commissioned in support of the Enhancing Engagement in Medical Leadership project, providing a systematic and research based overview of the evolution of medical leadership and the reasons why a concerted focus on the training and support for doctors taking on leadership roles is needed.

This document provides the background to the characteristics of a good acute mental health service. It sets out clearly and firmly the principles and standards that we expect to be applied to any acute medical and surgical service. These should be essential features of the psychiatric speciality service that supports the Emergency Department and the medical, paediatric and surgical wards. The input of mental health services to Emergency Departments and to acute hospitals is a vital element of the delivery of a modern, responsible and integrated service to patients.

This document describes the characteristics of a good acute mental health service. It sets out clearly and firmly the principles and standards that we expect to be applied to any acute medical and surgical service. These should be essential features of the psychiatric speciality service that supports the Emergency Department and the medical, paediatric and surgical wards. The input of mental health services to Emergency Departments and to acute hospitals is a vital element of the delivery of a modern, responsible and integrated service to patients.

A report by the Enhancing Engagement in Mecial Leadership project.

Shares findings from research into a link between medical engagement and Organizational performance, including a literature review, interviews with Chief Executives and medical directors, and development of a Medical Engagement Scale.

 

 

This revised Code builds upon the earlier Code published in 1998 and updates a number of important aspects. It provides clear, scientifically rigorous criterias for confirming death, both in clinical settings where confirmation of death by brain-stem testing is appropriate, and where confirmation of death following cardiac arrest is required.

The record standards, approved for all specialties by the Academy of Medical Royal Colleges.

This good practice guide has been produced to inform hospital doctors about current developments in medical record keeping standards for the Electronic Patient Record. It describes why standards are needed for the structure and content of medical records and how their introduction will affect doctors' work. 

 

These standards were developed by the Health Informatics Unit, Royal College of Physicians, in a project supported by funding from NHS Connecting for Health. The standards for the structure and content of medical records were developed in collaboration with the other medical Royal Colleges and specialist societies.

They were approved by the Academy of Medical Royal Colleges on 17th April 2008. 

The standards should be used for all hospital patient records.

A report by the Academy Health Inequalities Forum. Equality in healthcare is an important factor in good patient care, and this project aimed to construct a set of competencies concerning health inequalities. Some of these are identified as core, applicable to all specialties, whereas others will be relevant to some specialties but not to others. The intention is that this set of competencies will serve as a resource on which Colleges can draw and integrate into their specialty curricula. A number of these competencies will also be applicable to the undergraduate curriculum, and to the curricula in other healthcare professions.

The Academy's Intercollegiate Cancer Committee report recommends education and training initiatives which would improve the quality of multi-professional cancer care within the NHS in the United Kingdom. It also contains recommendations about the function of cancer MDTs, evidence about the effectiveness of MDTs and recommendations about the prerequisites for effective team working.

The aim of this document is to provide guidance on designing and implementing workplace based assessments (WPBAs) for all doctors. WPBA is an essential part of an assessment system, alongside traditional examinations. A comprehensive assessment system will collectively form an overall profile of an individual by testing their skills, knowledge and behaviours against those identified in a PMETB-approved curriculum.

This guidance is designed to highlight the advantages of WPBA and provide an overview for overcoming the potential difficulties that might be faced when introducing new methodologies alongside more traditional practice.

Developed jointly with the NHS Institute for Innovation and Improvement as part of the Enhancing Engagement in Medical Leadership project. This Framework describes the leadership competences doctors need in order to become more actively involved in the planning, delivery and transformation of health services.

Developed jointly with the NHS Institute for Innovation and Improvement as part of the Enhancing Engagement in Medical Leadership project. This Curriculum describes the leadership competences doctors need in order to become more actively involved in the planning, delivery and transformation of health services.

This guide, jointly prepared by the Academy of Medical Royal Colleges and the Audit Commission, is aimed at medical students and doctors in the early stage of their training. It draws attention to the benefits that result for patients when clinicians get properly engaged in managing NHS money. All doctors should understand at least the basics of NHS finance. This is not about turning doctors into accountants; it is about enabling doctors properly to engage with finance colleagues so as to make the best use of NHS resources for patients.

There is a clear link between mental and physical health and an urgent need to strengthen both the provision of mental health care to people with physical illness and the quality of physical health care provided to people with mental health problems in general hospitals and primary care. This report provides a framework with a focus on improvement within the general hospital, which can be brought about at relatively little additional cost by focusing on five priority areas.

The Academy of Medical Royal Colleges was asked by the four Chief Medical Officers (CMOs) to explore “a UK wide approach to assessment with common standards and common processes and instruments.” This report comprises the outcome of that project.

A report detailing the development and activity of the Academy between 2006 and 2009.

The Common Competences Framework for Doctors was developed by the Academy Specialty Training Committee to help inform the development of core and specialty curricula of the Royal Colleges and Faculties. The Framework will supplement the specialty specific competences within the specialty training curricula.

The framework identifies the common competences that should be acquired by doctors in core and specialty training in the United Kingdom. It has been derived primarily from competences that were previously defined within the specialty training curricula and, where appropriate, the revised Foundation Programme Curriculum. It has been supplemented by information from additional curricula and frameworks that had been developed by other bodies.

A report from the Academy’s Clinical Audit working group drafting a series of principles, criteria and key indicators for the use of clinical audit in revalidation. The content of this document was based as far as possible on existing research and evidence about clinical audit. However, in those areas where evidence was limited, the working group used a consensus approach.

A report from the Academy’s non-clinical working group identifying the different types of non-clinical work undertaken by doctors and developed generic cross-specialty standards for these mapped against Good Medical Practice.

A report from the Academy’s MSF working group reviewing existing research and findings around the use of MSF and PF in medicine, defining a series of principles, criteria and key indicators that should underpin any MSF or PF tools used for revalidation and make recommendations about the frequency of MSF and PF for revalidation.

A report from the Academy remediation working group that considers and describes how remediation and revalidation processes can interrelate, identifies a list of organisations that provide remedial support and identifies and define guidance and support processes that doctors can utilise when concerns are raised about their performance.

This report forms the core model for CPD and is the link between revalidation and the CPD schemes
which are in existence or in development across Colleges and Faculties. Despite a diverse range of CPD schemes, from medicine to surgery, from pathology to occupational health, we believe this document will provide a central model which will set a future standard for the purposes of revalidation, of which CPD is a major component.

The Academy makes recommendations regarding SPA's in consultant job planning.

Models for specialty including General Practice training.

Guidance regarding roles and components of external advice.

This report presents the results of a study of doctors who have become  chief executives of primary care trusts, NHS trusts (including Foundation Trusts) and strategic health authorities in England.
The study was commissioned by the NHS Institute for Innovation and Improvement and the Academy, from the Universities of Birmingham and Warwick with the aim of learning about the career paths taken by medical chief executives. The NHS Institute and the Academy wanted to understand the facilitators and barriers facing doctors in becoming chief executives in the NHS in order to inform ways in which this transition might be supported. The work summarised in this report helps to explain why there are few medical chief executives at present and outlines what can be done to encourage more doctors to take on leadership roles in future.

A report prepared on behalf of the College of Emergency Medicine, Manchester Metropolitan University and the Federation of Royal Colleges of Physicians.Commissioned by the General Medical Council and Academy of Medical Royal Colleges.

This report is based on research carried out for a GMC study into the effectiveness of CPD. It has involved non-training doctors from staff grades to senior consultants, including those primarily involved in management, CPD provision and assessment; and institutional officials, such as in Deaneries and universities, across a range of specialties.

Seven medical specialties address how they can help tackle the NHS financial change.

A joint report from the NHS Confederation, AOMRC, JMCC and the BMA

Presentations and round table discussion groups took place for six topics. Each session was based around pre-determined discussion points. The outcomes of these discussions is detailed in this outcome report, and an overall summary is found at section 7. 

Forty two ophthalmologists working outside the hospital eye service in a variety of settings underwent appraisal between September and December 2010 using a modified version of the “Strengthened Medical Appraisal” format currently being evaluated in revalidation pathfinder pilot projects in England.

The format incorporated existing draft specialty standards for the revalidation of ophthalmologists. A single appraiser conducted all appraisals and the appraisal summaries were reviewed by a former NHS Medical Director who acted as a Responsible Officer for the purpose of the project. The appraiser and appraisees completed evaluation forms (as used in the national Pathfinder Pilots) following appraisal.

As part of a series of quality initiatives on GP prescribing, medicines management and quality improvements, a mechanism is being developed whereby data extracted from a clinical system (in this example in primary care), is analysed by applying a set of rules to it derived from a complex knowledge base (or ontology). This also provides the ability to take set of indicators from elsewhere and convert them into ‘computable statements’ that can then be applied to the extracted data.

The RCGP indicator project derived such a set of indicators. This phase of the project aimed to take these indicators and explore the feasibility of ‘computerising’ the indicators and testing them against some ‘real’ patient data.

 

 RCGP indicator analysis - Appendix

Produced by the Academy and the NHS Institute for Innovation and Improvement.

Medical engagement in the leadership and management of healthcare organisations is a key determinant of organisational success. This short paper shares the key findings from a study of seven trusts which achieved high Medical Engagement Scale scores from an initial survey involving 30 trusts in England.

This paper seeks to describe the actions and initiatives taken by these Trusts to achieve high levels of engagement and thereby to make this ‘best practice’ available to others. The research clearly indicates that medical engagement plays a crucial role in supporting organisational achievement and that leadership is essential in creating the appropriate culture for medical engagement to flourish.

Annual report of the UKDEC for the year 2010. 

A report prepared for Sir Bruce Keogh, NHS Medical Director, from the Academy of Medical Royal Colleges in collaboration with the Royal Pharmaceutical Society and Royal College of Nursing Terms of reference.

The Academy of Medical Royal Colleges was asked by Sir Bruce Keogh, the NHS Medical Director, to work closely with the Royal Pharmaceutical Society and the Royal College of Nursing to develop standards for the design of in-patient prescription charts, using expert opinion and evidence where available. 

More information and Appendices 3 and 4 for the report can be found on the standards for the design of hospital in-patient prescription charts project page.

Financial report of the Academy for the year ending 30 September 2010.

Executive Summary of the full discussion document. 

Safe and efficient patient care relies on high quality data but a serious lack of clinical engagement over the accuracy of hospital data has been a major concern among Royal Medical Colleges and Directors of Trusts.

This report (produced by The NHS Information Centre and endorsed by the Academy) highlights how improvements to the collection and use of hospital data by clinicians can be made to secure good quality outcomes and inform patient choice.

The report stresses the need for more discussion within Trusts and colleges over the importance of:

• Clinician access to raw data
• Recording clinical terms
• Outpatient coding
• Clinicians working in teams
• Diagnoses present on admission
• Enhanced data linkage including primary care

Clinicians are encouraged to join the discussion and responded to the content of this report via this online survey

This framework has been developed by the Scottish Government and the Academy, to define the knowledge, skills and behaviours that are required by practising clinicians who have a role in eHealth at a local, regional or national level. The framework covers abroad range of domains from generic competences required by all, such as the safe and secure management of health information, to areas of in depth informatics knowledge which may only be required by a limited number of individuals. It is hoped medical and dental practitioners can use the framework to demonstrate achievement of competences relevant for their roles within their own organisations at different stages of their professional careers.

Research has shown time and again that there is a significant risk that patients’ medicines will be unintentionally altered when they move care providers. The NHS outcomes framework has already recognisedthe significance of this to patient safety. All NHS providers, and commissioners of those services, are now charged with reducing harm to patients caused through medication errors. 

Having safe systems in place for managing information and supply of medicines across care providers is also seen as central to safe, high quality care by the Care Quality Commission.

The development of this guidance was led by the Royal Pharmaceutical Society, in collaboration with other royal colleges, patients, health and social care professionals, and is closely mapped to a range of related national initiatives and guidance. It gives organisations tools to develop their systems, and to help effect the culture change necessary in their organisations to raise this important patient safety issue higher up everyone’s agenda.

Useful leaflet for patients when moving between care providers.

 

Research has shown time and again that there is a significant risk that patients’ medicines will be unintentionally altered when they move care providers. The NHS outcomes framework has already recognisedthe significance of this to patient safety. All NHS providers, and commissioners of those services, are now charged with reducing harm to patients caused through medication errors.

Having safe systems in place for managing information and supply of medicines across care providers is also seen as central to safe, high quality care by the Care Quality Commission.

The development of this guidance was led by the Royal Pharmaceutical Society, in collaboration with other royal colleges, patients, health and social care professionals, and is closely mapped to a range of related national initiatives and guidance. It gives organisations tools to develop their systems, and to help effect the culture change necessary in their organisations to raise this important patient safety issue higher up everyone’s agenda.

This guidance is for the use of information on the quality of medical record-keeping at appraisal and revalidation.

This document aims to determine the extent to which evidence on generic matters relating to medical recordkeeping can be used in support of appraisal and revalidation, and how that evidence may be used by:

• Identifying what doctors view as their responsibilities regarding good clinical practice in relation to medical notes
• Determining doctors’ views on the use of medical notes information at appraisal 

This consensus-based guidance looks at how information on quality of medical note keeping can be used in supporting information at appraisal for revalidation.

There are two features of medical notes that are relevant for appraisal and revalidation. The quality of the written entries (are they legible, accurate, dated, signed etc) and the clinical content of those entries (do they show appropriate levels of care or clinical outcome). 

This guidance addresses the quality of written entries; it does not address matters of clinical content.

Further to the MEE Evaluation of the Foundation Programme Curriculum, the Academy of Medical Royal College’s Foundation Programme Committee are revising the Foundation Programme Curriculum which will be in use for the 2012 cohort. 

 

The Royal College of General Practitioners (RCGP), on behalf of the GMC, was charged with proposing the criteria and standards of revalidation for general practitioners. The College has commissioned a series of pilots, running concurrently with the NHS Revalidation Support Team Pathfinder Pilots, to investigate if their revalidation proposals are fair, accessible and achievable for all GPs in whatever capacity they are employed in the UK. 

The RCGP identified GPs working in custodial settings as requiring further investigation to explore the feasibility of their revalidation proposals for this group of practitioners. 

The pilot aimed to learn about the issues facing GPs who work predominantly (i.e. at least 50% of their total work role) or in an extended practice role within secure environments, and the feasibility of  their re-licensing using the RCGP revalidation proposals.

In response to the Bill, a Clinical Commissioning Summit was convened on 6th October at BMA House in London to bring together key stakeholders from Royal Colleges, professional bodies, patients and service representatives. Organised in partnership between The Royal College of General Practitioners Centre for Commissioning, The Health Foundation and the Academy of Medical Royal Colleges, the Summit aimed to make recommendations around the key issues that will underpin clinical and professions commissioning and joint working.

This document provides delegates with a summary of the main points from the various elements of the Clinical Commissioning Summit day. 

This guidance discusses the key ethical issues that arise in considering controlled donation after circulatory death. This document has been developed from a draft published for consultation in January 2011.

It is presented in three parts:

• The principal ethical issues that are relevant to donation after circulatory death, including determination of the potential donor’s best interests and issues relating to the diagnosis and confirmation of death.
• The principal ethical issues in the context of the patient pathway, and sets out recommendations for current practice in more detail. 
• Areas where UKDEC believes that further consideration and development would be helpful, either by UKDEC or  other relevant organisations

The guidance is a working document, aimed primarily at doctors and other healthcare workers who are responsible for the various aspects of organ donation and transplantation, rather than the lay public.

Executive Summary of the final report from the UK Donation Ethics Committee

A single overarching framework for the leadership development of all staff in health and care, irrespective of discipline, role or function.

It is underpinned by a consistent set of guiding principles, contained in the NHS Constitution, which reflect the values of health and care staff. It therefore represents the foundation of leadership behaviour for staff throughout the NHS, to support all staff to improve quality for patients. 

A systematic review of the mental health outcomes of induced abortion, including their prevalence and associated factors

Continuing Professional Development is a continuing learning process, outside formal undergraduate and postgraduate training, which enables doctors to maintain and improve their performance across all areas of their practice through the development of knowledge, skills, attitudes and behaviours. It covers all learning activities, both formal and informal, by which doctors keep up to date. 

Standards and Criteria are needed to assist the accreditation process. Issues which need consideration include: accreditation of individual activities from many providers; how doctors can tell whether the accredited activity is suitable for them; how appraisers can tell whether a doctor's attendance at an accredited activity supports the requirements of that doctor’s personal development plan. Evidence of learning is also required to complete the information for appraisal.

This report examines the evidence for medical care being delivered by fully trained doctors who have either a Certificate of Completion of Training (CCT) or Certificate of Eligibility for Specialist Registration (CESR) and are thus eligible to be on the GMC Specialist Register, i.e. consultant-delivered care. The report does not address the questions of whether care should be delivered by doctors or other clinical groups.

The context and driver for the project is a climate in which it is increasingly asserted that the NHS cannot afford to have the number of consultants that current training numbers will deliver.

The purpose of the Foundation Programme, the outcomes expected and the step-up required from foundation year 1 (F1) to foundation year 2 (F2) are clearly articulated in this curriculum.

It will provide foundation doctors, their teachers and supervisors, other healthcare professionals and employers with a clear direction on what is necessary for the programme to achieve its important learning objectives.

New emphasis has been placed on the whole patient, on long-term conditions and the increasing role of community care. Recognition of the workplace as providing the majority of clinical and professional learning opportunities is an important message for learners. Acknowledgement of the significance of adopting new technologies which support learning is welcomed.

This document provides guidance to deaneries and foundation schools about the structures and systems required to support the delivery of the Foundation Programme  Curriculum 2012. 

A document from the Ethiclal Standards in Health & Life Sciences Group.
 

Final report of the working group of the medical Royal Colleges. 
This report recommends core competences which should be incorporated into postgraduate curricula for all doctors.
The work has consensus across 13 medical Colleges and Faculties.  

Overview of the Academy's activities over the 18 month period October 2010 to Macrh 2012. 

An overview of the UK Donation Ethics Committee's activities over the 2011-2012 financial year.

This project was undertaken to explore how revalidation, as a process, would impact on the different responsibilities of hospital doctors.

The views of over 2600 doctors working in the NHS (80% consultants, 20% SAS doctors) in Scotland and the North East of England  are presented in this report and give an up to date insight into how doctors use their time, their concerns about the effort required to deliver revalidation effectively and how they will engineer space in their professional lives given current NHS pressures.

 

The aims of the Faculty’s pilot were to develop a clear understanding of the variety of job plans across sports and exercise medicine, to establish a method(s) of assessment of these differing working environments and to create a robust enhanced appraisal system for sports and exercise medicine.

A comparison of the three faculties' results as well as each individual Faculty report can be downloaded below. 

  Medical Revalidation Tri-Faculty Evaluation: Comparison of the Results

  Tri-Faculty Revalidation Pilot: Faculty of Occupational Medicine

  Tri-Faculty Revalidation Pilot: Faculty of Public Health

  Tri-Faculty Revalidation Pilot: Faculty of Pharmaceutical Medicine

 

This report is written against the background of an expectation that the medical Royal Colleges and Faculties should be “part of the solution” for the remediation of doctors whose performance has given rise to concern.

A short summary of the e-Learning for Healthcare projects, some of which the Academy is involved with. 

Presented on behalf of the Royal Colleges of General Practitioners, Paediatrics and Child Health, Physicians and Psychiatrists.

A two-year structured programme for doctors who have successfully completed the Foundation Programme, providing six-month placements in four specialties to allow broader experience before applying for specialty training.

The Broad Based Training Programme has been designed to give trainees a broad experience of specialties that have complementary aspects and if the programme is properly implemented there will be a synergism in the training that will promote the learning processes across the specialties.

This document, produced by the Academy Directors of CPD Committee, is intended to provide guidance to appraisers on what they should be considering when reviewing a doctor’s Continuing Professional Development (CPD) activity, and guidance to doctors on the things that they should expect to be discussed during an effective appraisal meeting. It will help doctors and their appraisers to structure the supporting information and the appraisal discussion in a way that allows a proper evaluation of a doctor’s learning since the previous appraisal, and supports the development of the subsequent personal development plan (PDP).

The Medical Profession's Prescription for the Nation's Obesity Crisis 

 

• Actions to be taken by the healthcare professions
• Changing the ‘obesogenic’ environment
• Making the healthy choice the easy choice.