A GMC-NICE partnership: supporting doctors’ appraisal and promoting quality improvement.
Background
Patient safety is an issue that’s relevant to all clinicians on a daily basis. It can and must be addressed within the time constraints and challenges of clinical commitments.
In July 2020, Baroness Julia Cumberlege published an Independent Medicines and Medical Devices Safety (IMMDS) Review. The review examined how the health system protects patients from harmful side effects from medicines and medical devices, and proposed a number of actions to improve patient safety. It focused on one medicine, one diagnostic test and one medical device from which harm has occurred: sodium valproate, the hormone pregnancy test Primodos, and surgical mesh insertion for female urinary incontinence. The review was clear that collaboration and intelligence sharing at a system level needs rapid improvement to promote better patient safety and to reduce the risk of harm.
A partnership to promote patient safety through quality improvement
The National Institute for Health and Care Excellence (NICE) has established a patient safety oversight group to bring leadership and coordination to NICE’s patient-safety-related activities, including engagement and partnership with the wider patient-safety system in the UK. This has included strengthening areas of collaboration, where partnership with others can increase quality and reduce risk in healthcare delivery.
One such partnership is with the General Medical Council (GMC). This partnership has been driven by a shared desire to support evidence-based quality improvement in the NHS in line with the wider strategic ambition of the system and to reduce risks and promote patient safety.
NICE and the GMC saw an opportunity to work together to support improved implementation of NICE guidance and the GMC’s aim of supporting doctors to deliver high-quality, person-centred care. The two organisations collaborated to develop illustrative examples of how doctors can demonstrate best practice to support their revalidation.
The examples show how doctors can use NICE guidance to inform quality improvement (a revalidation requirement), and how they can demonstrate this at appraisal. While these examples focus on particularly important topics, the principles and practices that they highlight can also be applied to other scenarios.
One of the examples is ‘Prescribing valproate in primary care: how to demonstrate quality improvement’. This was selected because the Cumberlege review highlighted that valproate poses risks during pregnancy. The Medicines and Healthcare Products Regulatory Agency also require appropriate counselling and monitoring of people of child-bearing potential who are prescribed this drug.
Using quality-improvement methodology, health professionals can ensure that patients are counselled about the risks, and that the risks are reduced by avoiding prescribing the drug to people of child-bearing age unless they are part of a pregnancy prevention programme.
Conclusion and learning
The key successes of this partnership include the following.
- Improved scanning to identify important areas of focus for the scenarios based on current priorities in the NHS. It will be important to continue monitoring and prioritising topics of high relevance to the system.
- Development of resources for doctors that are now available on the GMC website. These scenarios support doctors to think broadly about how to demonstrate they are meeting revalidation requirements.
- Clinical oversight and supervision in development of content from NICE’s senior reporting officer for patient safety.
- Ongoing dialogue throughout content development, with regular touchpoints between organisations to address challenges and obstacles where they arise.
Achieving the partnership’s objectives has not been without its challenges. For example, there has been a need to adjust content to ensure its applicability across the UK-wide jurisdiction of the GMC, as NICE guidelines only officially apply in England. Guidance across different nations, where available, essentially all propose the same principles of patient management and can inform quality improvement in a similar way. However, it has been important to highlight to readers that they must be aware of their national and local system contexts and guidelines as there might be some variation between settings.
Following this collaboration to produce the scenarios and publish them on the GMC website, the GMC has gathered data on webpage views to monitor their impact and usefulness. Since publishing, the webpages have had a substantial number of views with a particularly high number for the scenario that focuses on the prescribing of valproate in primary care. The number of views the pages have achieved so far is encouraging and it highlights how resources like these are helpful for doctors.
This joint initiative with NICE aims to provide doctors with more guidance and resources when carrying out their responsibilities in relation to revalidation. We hope that this blog will alert more doctors that these resources are available.
Overall, we have found this to be a successful and productive partnership and would suggest the keys to replicating our experience are:
- setting out a shared purpose that is in line with the vision and priorities of both organisations;
- requiring each organisation to bring resources and expertise relevant to the purpose;
- demonstrating respect for the different ways of working and priorities of both organisations, including allowing sufficient time for collaborators to refer back to colleagues and ensure alignment with other organisational activities and communications.
Authors
Chris Bird1, Sarah Walpole1, Blake Dobson2.
1. NICE
2. GMC
Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.
