Would you like to become an NCAS Assessor?

Dr Cliona Ni Bhrolchain

What is NCAS?NCAS is the National Clinical Assessment Service. It works with health organisations and individual practitioners where there is concern about performance of dentists, doctors or pharmacists. It helps to clarify the concerns, understand what is leading to them and support their resolution. The aim is to get involved early and, where possible, restore safe practice. More information is available at

BackgroundDo you remember when consultant suspensions were regularly referred to in the medical press? Suspension often lasted years and cost Trusts and doctors a lot in money, time and loss of expertise. The National Audit Office showed just how expensive suspensions were to the NHS1 and even the Parliamentary Public Accounts Committee became involved in 20042. On one hand, there was an underlying belief that at least some suspensions were due to victimisation but it was also difficult for Trusts to deal effectively with genuine performance difficulties or to return the doctor to work after the difficulties were addressed. NCAS was established in 2001 to manage doctors’ performance more effectively. It has been successful in reducing suspensions – now more correctly called exclusion – and has a good record in returning doctors to work

What happens now?The new disciplinary framework for employed doctors, Maintaining High Professional Standards in the Modern NHS, was introduced in 2003. It recommends exclusion only for specific purposes: to protect patients if voluntary restriction isn’t possible or to allow an investigation to be conducted without interference3. Any exclusion must be discussed with NCAS who will then help the Trust to manage it. One big change is that Trusts can now approach NCAS for advice on significant performance issues long before exclusion becomes necessary. External impartial advice can be helpful as many Trusts are not experienced in managing doctors’ performance. NCAS has a range of approaches to help Trusts including advice in managing the case, becoming actively involved or, in certain cases, assessing the doctor’s performance. This is where clinical assessors come in.

The NCAS assessment4An assessment consists of a broad-ranging review of a doctor’s performance to identify where performance is satisfactory and where there may be concern. It also seeks to identify what factors may be contributing to causes for concern and makes recommendations to inform an action plan to address difficulties. It includes an occupational health assessment, a behavioural assessment and a clinical assessment at the doctor’s workplace. Normally the clinical assessment will include a review of information provided by the practitioner and the employer; a clinical record review; multisource feedback from colleagues and patients; direct observation of practice; review of the working environment; assessment of clinical decision-making (Case Based Assessment) and an interview with the practitioner.

The assessment team includes at least two doctors (acting as clinical assessors), a lay assessor and a case manager. Each assessment is intensive and takes 5 days: 1 planning day, 3 days on site and 1 report writing day. Both doctors should be from the same specialty as the doctor being assessed and the assessment team will include at least one additional assessor or context adviser if the practitioner being assessed is not a Consultant. This is particularly relevant to our specialty, with our large proportion of SAS/Specialty Doctors. It is easy to achieve in large specialties. However in smaller specialties like community paediatrics it is harder. I have had to declare a conflict of interest on two occasions where I knew the practitioner who was going to be assessed and had to decline the assessment. This of course causes problems for specialties with a small panel of assessors. Where NCAS cannot identify appropriate assessors from its panel, it will seek help from the royal colleges and/or specialist societies.

Community paediatricsNCAS recruited its first assessors in 2002-03. When I saw the advert I was impressed that it recognised that community paediatricians existed and were specifically recruiting for us! I decided to apply and my application was successful. Four paediatricians were recruited – 2 general and 2 community. Since then more general paediatricians have been recruited and now, more community paediatricians are needed.

Why consider it?Assessment work is interesting and NCAS is a good organisation to work for. Assessments are hard work, but well supported, and feedback shows that NCAS has been effective in getting doctors back to work. NCAS assessments are objective and it takes great care to ensure that assessments are robust and based on the evidence collected. Thus previous concerns about fairness are minimised5. It is important that community paediatricians are assessed by their peers, especially in subspecialty areas like safeguarding and Looked After Children. It is also important that our SAS/Specialty doctors can be assessed by their peers.

NCAS work is paid at £350 per day plus expenses. This can be paid directly for those with part time contracts or to your Trust to support your absence for full time employees. Each year, NCAS offers at least 2 training days/workshops. The training is excellent and is usually transferable to the ‘day job’, so Trusts benefit. The assessment methodology is similar to those used for trainees, so your trainees will benefit too. I have used the expertise I have gained in assessment and performance management a number of times in our department to good effect. A number of BACCH members who know I work with NCAS have also sought advice. I also support colleagues in difficulty informally when I can.

NCAS will shortly be advertising for additional community paediatric assessors via the BACCH e-bulletin. However if you wish to strike now while the iron is hot you can send your contact details to register your interest at When the advert is placed, they will contact you so that you can apply if you wish. Anyone interested in assessment and performance should consider applying. It is enjoyable and hopefully does some good!

References

  1. National Audit Office. The Management of Suspensions of Clinical Staff in NHSHospital and Ambulance Trusts in England. London HMSO 2003
  1. House of Commons Committee of Public Accounts. The Management of Suspensions of Clinical Staff in NHSHospital and Ambulance Trusts in England. Forty–seventh Report of Session 2003–04. London. The Stationery Office 2004.
  1. NCAS Handbook accessible at
  1. Maintaining High Professional Standards in the Modern NHS. Dept of Health 2005. Accessible at
  1. Hey E, Fleming P, Sibert J. Learning from the sad, sorry saga at Stoke. Arch Dis Child 2002;86:1–3