Frequently asked questions
Guidance notes for the submission of a request for review
How are NHSLA levels decided and issued?
There are 50 NHSLA standards in total. The NHSLA seeks assurance from the GMC for the calculation and issue of levels to acute trusts, related to standard 2.4, which is supervision of medical staff in training. For all other standards please visit NHSLA’s website.
We use quantitative and qualitative data analysis methods to calculate the NHSLA levels for individual trusts.
Regarding quantitative data - above and below outliers (red and green flags within certain indicator groups) generated from the 2011 National Training Survey for a given trust are summarised.
For the purposes of determining NHSLA levels, we take into account any survey indicators that were tested and found to be significant to making medical errors.
The related indicators are:
- Clinical Supervision
- Education Supervision
- Workload
- Induction
- Handover
- Undermining by the Consultant
- Undermining by other staff
The total of above and below outliers of the listed indicators is used to work out proportions by dividing the number of above or below outliers by the maximum number of outliers that a trust or specialty can obtain. This is to ensure that there is a fair balance between the number of outliers and trust size.
Qualitative data are subject to a separate and independent analysis than the quantitative data from the National Training Survey.
From the qualitative reports such as the Deanery Reports (DR), Annual Specialty Reports (ASR) and Response to Concerns (R2C), we verify if there were any unresolved concerns or areas of good practice regarding supervision of doctors in training, taking care not to duplicate the use of any evidence source.
After all the data are summarised, they are then used in a triangulation process and measured against the set criteria to enable us to calculate a level. This process involves treating each piece of information individually, and then reviewing all data holistically to determine a level.
The following table shows the criteria used to inform the NHSLA Standard 2.4 level (pdf)
What happens if we disagree with the level the GMC has awarded us for supervision?
You can request a review of your NHSLA level by completing the GMC’s levels for NHSLA risk management standard 2.4: supervision of medical staff in training request for review form (word) and emailing the completed form with any supporting evidence to quality@gmc-uk.org.
Is there a deadline for the submission of a request for review of our NHSLA level for supervision?
You have a total of 60 calendar days from the day of receipt of your level sent to you by NHSLA. However, if your risk assessment by NHSLA is due before this date you will need to submit a request for review as soon as possible. The review must be completed before the risk assessment takes place to ensure NHSLA assesses your trust at the correct level.
Can we provide any new or additional evidence in support of our request?
Yes, you are encouraged to provide any additional documentation that will support your request for review. However, only information related to the time period that was used to calculate the levels will be considered. Any information that falls outside this period will be taken into consideration for the next year’s level. For the purposes of request for review, we accept the following:
- Evidence of good practice pertaining to the areas mentioned above. This could be in the form of substantiated good practice that your trust is undertaking in relation to these areas, for example spreadsheets designed to make communication easier
- Evidenced measures taken to enhance induction or innovative ways to improve supervision
This list is not exhaustive. Evidence could also be in the form of details from a deanery visit that we are not yet aware of. Care must be taken to ensure however that the evidence relates specifically to your trust as the GMC cannot take into account items that do not specifically mention or relate to your trust. Action plans are acceptable only if there is additional supporting evidence to illustrate that the actions taken have been effective and improvements are sustained.
What happens after we have submitted our request for review?
When the GMC receives a request for review, the first thing we do is review the existing evidence, to see why the level was issued initially. We may contact the relevant deanery to find out if there are any items that we are not aware of – these could be concerns or examples of good practice. We then review the newly provided evidence against the previously detailed criteria, taking a fresh look the data, as if to re-issue the level. Based on the evidence that is before the analyst undertaking the review, there could be the following outcomes. These are:
- Raise the NHSLA level based on the evidence
- Retain the NHSLA level based on the evidence
How long before the trust hears the outcome of the request for review from the GMC?
The GMC has a Service Level Agreement (SLA) of 10 working days. However if a trust’s request for review is particularly complex, this can take longer, but we will keep you informed of any progress and changes.
Can the GMC turn down a trust’s request for NHSLA level review?
If the deadline has been missed, we will not review the information until the following year when the new levels will be issued.
Our trust missed the deadline for appealing the NHSLA level it was awarded. What happens next?
Unfortunately, the trust will have to wait until the issue of the new NHSLA level in April of the following year.