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THE THREE OPTIONS FOR IMPROVEMENT
Extensive discussions have been held with key stakeholders in advance of the review and the options recognise the valuable role of the Royal Colleges. Any change to the arrangements as a result of this consultation will be discussed with BMA Scotland, the Royal Colleges through the Academy and Health Boards.
Based on the findings of the research undertaken by Work Psychology Partnership three options to improve the recruitment of consultants have been identified:
Option One - Retain the status quo
The first option would be to retain the current arrangements regulating Advisory Appointment Committees, but to introduce improvements to the current process through the provision of training for National Panellists and a review of the number of panelists involved. This option would entail consultant appointments continuing to be made by Advisory Appointment Committees and regulated through existing legislation, as outlined in HDL (2007) 1.
The research identified that scope exists to improve the operation of the current arrangements by clarifying the role and boundaries of the National Panellists remit. Training for all involved in the candidate assessment process was also viewed as necessary for the future. Therefore in retaining the status quo this option would be inclusive of ensuring those making recruitment decisions have appropriate training, plus guidance and clarification on the role of the National Panellist.
Option Two - Setting up a two stage process involving the Royal Colleges through the Academy and NHS Boards
The second policy option entails removing the current regulations and providing direction to NHS Boards revising the current appointment system to divide the recruitment process between the Royal Colleges through the Academy and the NHS Board, with each playing a clear and distinct role in the recruitment of consultants. This division of roles would enable the Royal Colleges to undertake an assessment of candidates' clinical abilities while the NHS Boards as the employers would focus on assessing the organisational fit of the applicant.
The first stage in the recruitment process would be conducted by the Royal Colleges through the Academy as an external assessor who would assess the clinical competence of the candidates. The NHS Board would then seek to recruit to the post from this group of clinically competent candidates. Already assured of the candidates clinical ability by the Royal College, the NHS Board's recruitment process would incorporate the best practice principles identified in the review, and would seek to assess the organisational fit of the candidate on the non-clinical competency requirements at this level. These were identified within the research as including team working, leadership, motivation, communication and intention for development of special interests.
Through this option the Royal Colleges through the Academy would have a clear and distinct role within the process, assessing the clinical competence and abilities of potential candidates. The NHS Boards would then select the best candidate through an open recruitment process. Policy would be put in place to clarify the role and responsibilities of both the Royal Colleges through the Academy and NHS Boards in making consultant appointments under this system. The introduction of Scottish Government policy would provide a clear line of accountability and it would be incumbent on the Boards to comply, ensuring consistency within the recruitment process across Scotland.
Further discussions are to take place to establish the detail of how this option would work and be managed in practice.
Option Three - Allowing NHS Health Boards to exercise autonomy in consultant recruitment
Option three would entail removing the current legislation which currently regulates the operation of Advisory Appointment Committees. In place of the regulations guidance would be issued by the Scottish Government to NHS Boards based on the findings of the research into best recruitment practice. The guidance would seek to include a role for the Royal Colleges within the Boards own recruitment process for consultant positions. However, within the guidance scope would exist for the policy and procedure for appointing consultants to be decided by each individual NHS Board, with the potential for variations to arise in the recruitment process across NHSScotland.
The findings of the review highlighted that significant interest in the use of other selection methods, such as presentations, work-based exercises, personality measures, but currently many stakeholders are unsure of the evidence and acceptability for their use in the current context. Deregulation would enable the Boards to introduce improvements based on the inclusion of these other selection methods to the current interview panel.
External Review Within the Three Options for Improvement
The development of either of the three options outlined above will include consideration of the role of external assessment within the process of consultant recruitment.
Within the current process the role of the National Panellists is to provide clinical assessment of the candidates. However, through the course of the review it has been identified that in addition to assessing clinical competence, National Panellists may also act as an external assessor, providing a check on the recruitment process itself.
As it is proposed that the recruitment process for consultants be audited by the Boards to ensure it is a transparent, robust and quality assured process, this raises a number of issues regarding the process and need for external assessment within the recruitment process. The key to compliance with employment legislation is to devise and adhere to a job specification that focuses on the qualifications, skills and experience required to undertake the role. This requires a contemporary process that is objective and capable of scrutiny. This approach has checks built in that alleviate the need for external checks. Specifically this issue relates to whether the need exists for an external assessment if the recruitment process is being audited by the Boards, and, if so, whether peer assessment is the most effective option to provide a check on the recruitment process.
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