GMC’s NHSLA level process

We are committed to ensuring that the process of calculating and issuing the NHSLA Standard 2.4 level is a fair process.

Following feedback from postgraduate deaneries, some changes were made to the way the levels for NHSLA's Risk Management Standard 2.4 were calculated. To ensure that all trusts are treated fairly, for this year’s NHSLA Standard 2.4 Level issue, we no longer take into account reports from GMC led visits. This is because not all deaneries and/or trusts will have been visited in a given year.

In addition to Clinical and Education Supervision, evidence based on the following indicators (taken from our National Training Survey) is also used to inform the NHSLA Standard 2.4 Level:

• Handover
• Workload
• Induction
• Undermining by the consultant
• Undermining by other staff

The levels that can be issued to individual trusts are as follows:

• Level 0 – There are concerns about supervision of doctors in training directly impacting on patient safety identified through the GMC evidence base, which are being investigated by the GMC. The GMC is investigating the concerns in relation to the trust’s approval of training.
• Level 1 – The trust has met the GMC’s minimum requirements for supervision set out in Domains 1 and 6 of The Trainee Doctor as determined by the evidence available through the Quality Improvement Framework, but there are concerns about the supervision of doctors in training identified through the GMC evidence base that outweigh any areas of good practice.  
• Level 2 - The trust has met the minimum requirements of level 1 and demonstrated clear quality control measures for supervision. There are no concerns raised regarding supervision of doctors in training and no areas of notable practice have been identified or there are some concerns but they are outweighed by identified areas of good practice in supervision of doctors in training through the GMC evidence base.  
• Level 3 - The trust has met the minimum requirements of level 1 and successfully demonstrated that the quality control measures in place exceed the GMC's requirements. There are no concerns raised regarding supervision and the trust has demonstrated one or more areas of good practice in supervision of doctors in training.   The criteria have been updated to reflect the changes and evidence used to assign each level are detailed in the accompanying table (pdf).