What supporting information should I present at appraisal in relation to quality improvement across my whole practice?
This case study will help if you:
- use surgical or other interventional procedures
- practise both in the NHS and independent sector
- use new techniques or procedures.
The National Institute for Health and Care Excellence (NICE) worked with us to develop this case study. NICE’s interventional procedures guidance applies across the UK. However, other NICE guidance products may not always apply across the four countries of the UK, and we therefore recommend speaking to your employer if you have any questions.
Key points to consider
- The supporting information you bring to your appraisal should cover the whole of your practice, including any NHS and independent sector work you do.
- Your appraiser, employer or professional membership body can offer advice on what information to bring and how to present it. The NICE website also has guidance relevant to different areas and types of practice that might help you. This includes guidance on interventional procedures, which covers procedures that involve making a cut or a hole to gain access to the inside of a patient's body, gaining access to a body cavity without cutting or using electromagnetic radiation.
- Your employer should provide you with the opportunity to participate in national and local audits if one is being conducted in your area of practice. Your employer should also give you appropriate data to allow you to undertake and reflect on the outcomes of audits.
- Any novel techniques and procedures you use should be overseen by appropriate governance structures, which may include seeking authorisation from your hospital’s novel interventional procedures committee.
Scenario – Ms Adeola
Ms Adeola is an orthopaedic surgeon working across both the NHS and independent sector. Her practice includes using both established procedures and implants as well as new and innovative techniques. She’s considering how to demonstrate quality improvement across her whole practice.
How the doctor met our requirements
Ms Adeola was advised to look at the Royal College of Surgeons’ guidance on appraisal including its specialty-specific outcomes framework. This provided advice on how to present outcomes data for both her mainstream and less common procedures.
Through the support of her employer, she’s participated in national orthopaedic audits as well as a departmental audit of management relevant to her practice. She was given help to extract the appropriate data which allowed her to present her outcomes in line with the college’s recommendations. At her appraisal, she also presented national audit data as further context.
Before performing a new and innovative implant technique, in line with the relevant local policies and national guidance, Ms Adeola sought approval from her hospital’s novel interventional procedures committee. They reviewed her submission and noted NICE’s interventional procedures guidance. The guidance advised that, because of the limited existing evidence to support safety and efficacy, the procedure should be subject to special arrangements for clinical governance, consent and audit.
- agreed that she could proceed with the technique. But they emphasised that patients offered the procedure should be made aware of the special status of the procedure as part of the consent and shared decision-making process, and that this should be clearly recorded.
- required Ms Adeola to carry out an audit of outcomes and adverse events after she had completed a defined number of cases. They advised her to use the audit tool provided by NICE or predefined standards from her national professional body, and to report the results back to them.
- suggested that she should ask her royal college to put her in touch with other practitioners performing the same technique so that she could compare her experience and outcomes.
At her appraisal Ms Adeola presented outcomes data for all the procedures she’s performed in both her NHS and independent sector practice. She also discussed her outcomes from using this new procedure, taking into account both short-term periprocedural outcomes and longer-term data from clinic follow ups.
Ms Adeola's initial review of her outcomes relating to the new technique had shown they were not in line with those of other practitioners. She reported this to her hospital's novel interventional procedures committee and temporarily stopped performing the procedure. She contacted the Royal College of Surgeons who suggested a surgeon performing the same technique to peer review her performance.
Following detailed review and discussion of her experience and outcomes, and taking advice from the peer reviewer, the hospital's novel interventional procedures committee concluded that Ms Adeola could continue to perform this procedure with ongoing audit.
At her appraisal, she reflected on her outcomes and practice and on the risks associated with undertaking novel procedures and how these can be managed in practice.