1. RCS Invited review Mechanism

2. What? Invited to support local healthcare management. Individual, service, or case note review. Peer and patient partnership. Identify if causes for concern exist. Confidential subject to duty to report to GMC/CQC. 2

3. Why? Maintain highest standards of surgical practice. Ensure service improvement is clinically led. Importance of peer and patient led review. 3

4. How? 4 Review 2 clinical 1 Lay reviewer 2-3 days Interview and documentation Review 2 clinical 1 Lay reviewer 2-3 days Interview and documentation Report Team produces report Recommendations Quality control via IRM committee input Handed to trust – trust property Report Team produces report Recommendations Quality control via IRM committee input Handed to trust – trust property Monitoring 1, 3 and 6 month follow up/evaluation Take action if recommendations are not implemented Monitoring 1, 3 and 6 month follow up/evaluation Take action if recommendations are not implemented Request CEO or MD Approval by College/ specialty Terms of reference and indemnity Request CEO or MD Approval by College/ specialty Terms of reference and indemnity College support for reviewers Recruitment and training Documentation Quality assurance Dedicated staff support College support for reviewers Recruitment and training Documentation Quality assurance Dedicated staff support

5. Activity 2000 - 2012 5

6. What are we learning? No mono-causal explanation of problems. Rarely simple solution. Each situation needs a tailored response. BUT common themes do exist. 6

7. Regularly issues involve the quality of: 1.Surgical working environment. 2.Surgical service delivery. 3.Individual surgical behaviour and team working. 4.Quality of performance improvement processes (Audit, M and M, appraisal). 5.Activity and outcome information available. 7

8. Most regularly occurring problems Issues with quality of surgical care. Team working between surgeons. Organisational responses to concerns. Individual surgeon behaviour. MDT functioning. Quality of activity and outcome data. Support to juniors. Poor quality appraisal. Management of service change. 8

9. 9 Improving surgical practice - learning from invited reviews. http://www.rcseng.ac.uk/publications/docs/improving- surgical-practice Acting on concerns – your professional responsibility. http://www.rcseng.ac.uk/publications/docs/acting-on- concerns

10. 10

11. Further information Ralph Tomlinson, Head of Invited Reviews rtomlinson@rcseng.ac.uk 020 7869 6223 www.rcseng.ac.uk/standards/irm 11