The Topol Review

The Topol Review
An independent report on behalf of the Secretary of State for Health and Social Care, 11 February 2019

This report aims to examine

• how technological and other developments (including in genomics, artificial intelligence, digital medicine and robotics) are likely to change the roles and functions of clinical staff in all professions over the next two decades to ensure safer, more productive, more effective and more personal care for patients;

• what the implications of these changes are for the skills required by the professionals filling these roles, identifying professions or sub-specialisms where these may be particularly significant;

• the consequences for the selection, curricula, education, training, development and lifelong learning of current and future National Health Service staff.

Digital healthcare technologies, defined here as genomics, digital medicine, artificial intelligence (AI) and robotics.

The Review proposes three principles to support the deployment of digital healthcare technologies throughout the NHS:

1. Patients need to be included as partners and informed about health technologies, with a particular focus on vulnerable/marginalised groups to ensure equitable access.

2. The healthcare workforce needs expertise and guidance to evaluate new technologies, using processes grounded in real-world evidence.

3. The gift of time: wherever possible the adoption of new technologies should enable staff to gain more time to care, promoting deeper interaction with patients.

Digital technologies will have an impact on patients, carers and the wider community, health workforce, and health service leadership.

Recommendations

General Practitioners with Extended Roles (GPwERs)

General Practitioners with Extended Roles
RCGP

• GPs with Extended Roles (GPwERs) undertake roles that are beyond the scope of GP training and the MRCGP and require additional training. The term GPwER includes those previously referred to as GPs with Special Interests (GPwSIs).
• The RCGP has developed a framework in partnership with NHS England, which describes a new approach to the accreditation of GPwERs and is aligned to the appraisal and revalidation process. The framework will form the basis of specialty-specific frameworks developed in the future.
• See the guidance and competences for GPwERs for Dermatology and Skin Surgery

Commissioning for wellbeing: Career pathways

Commissioning for wellbeing: Career pathways and journeys into commissioning
Skills for Health 2017

• Information about working in a commissioning role or team within health or social care, the types of activities and the potential career pathways.

Checklist for induction and training of CCG lay members

Checklist for induction and training of CCG lay members
NHS Clinical Commissioners 4 September 2017

• A checklist to support CCGs with induction and training of lay members.
• The checklist looks at induction, mentoring and buddying, networking and ongoing and further training.

Quality principles for NHS apprenticeships

Quality principles for NHS apprenticeships
National Skills Academy for Health 11 April 2017

• A new set of principles to ensure excellent practice in apprenticeship provision across UK health care organisations.
• The 21 principles are structured around three main themes:
• Embedding apprenticeships in your organisation’s workforce strategy.
• Securing management commitment.
• Effective learning programmes and processes.

Acute care in remote settings: challenges and potential solutions

Acute care in remote settings: challenges and potential solutions
Nuffield Trust and the Academy of Medical Royal Colleges July 2016

• Report of a seminar held in April 2016 
• The workshop brought together representatives from the Royal Colleges, rural systems around the UK, NHS England and NHS Improvement. 
• Case studies from the Cumbria Success Regime and Belford Hospital Fort William were used to inform the discussion. 
• The problems identified in the workshop include
• staffing models, including sub-specialisation and recruitment 
• training and education 
• standards, inspection and regulation 
• patients and the public.
• Possible solutions iidentified include:
• new staffing models
• networks
• revised approaches to training
• reviewing standards and regulatory requirements
• costs and payment mechanisms
• dialogue with the public

Revised Conflict of Interest Standards for CCGs

Managing Conflicts of Interest
NHS England Board meeting paper 31 March 2016

• Revised guidance for CCGs on managing conflicts of interest based on the statutory guidance developed to support the delegation of primary care commissioning to CCGs.
• An audit of conflicts of interest management in ten co-commissioning arrangements was undertaken in 2015/16 (see Annex for a summary of the audit findings)
• From April 2016 NHS England will be consulting on revised statutory guidance to CCGs 
• Core proposals (subject to consultation) are:
• All CCGs have a minimum of three lay members on the Governing Body,
• A conflicts of interest guardian in all CCGs to be undertaken by CCG audit chairs 
• All CCGs will include an annual audit of conflicts of interest management within their internal audit plans and to publish the audit findings within their annual endof-year governance statement
• Strengthen the provisions around the management of gifts and hospitality. 
• Strengthen the provisions around decision-making when a member of the group is conflicted.
• CCGs will be required to have a robust process for managing breaches within their conflict of interest policy and to publish any breaches on the CCG’s website
• All CCG staff and the staff of their member practices are to complete mandatory online conflicts of interest training, which will be provided by NHS England. 
• Final guidance will be taken to NHS England Board meeting in May 2016 with a view to publishing it in early June 2016. CCGs will be required to review their processes in line with the guidance and strengthen them, where required, by the end of November 2016 
• Rationalising medicines optimisation arrangements (para 28)
• To support the work around Managing Conflicts of interest around medicines across NHS England four regional medicines optimisation committees will be created and medicines evaluation will be shared across the NHS.
• “local medicines formulary committees will be far less involved in processes that the pharmaceutical industry may seek to influence. It also reduces the wasteful multiple requests for the same information being made by the NHS by the pharma sector”. 
• It is expected these principles will be in place by April and the committees operational later in the year.

NHS Leadership Review

Better leadership for tomorrow: NHS leadership review

Lord Rose,  June 2015

• This review, initiated by the Secretary of State, examines what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS. It also asked how strong leadership in hospital trusts might help transform the way things get done and how best to equip CCGs to deliver the NHS five year forward view. 
• Lord Rose concludes that "the NHS, as a whole, lacks a clear, consistent, view of what ‘good’ or ‘best’ leadership look like" (p20). He found "that there was no consistant clear picture for CCGs of what ‘good’ commissioning performance looks like." (p22)

Highlights for CCGs:

• When considering the importance of leadership to support large scale change within CCGs Lord Rose says: 
•  "The current level of support given to CCG Chairs and other senior individuals such as Accountable Officers and Chief Clinical Officers is woefully inadequate. There is no ‘step up’ for these individuals: either they have the necessary leadership skills or they don’t. A systematic way to identify and develop this group is needed."
• The review also considers the place of cross-functional training of CCG Chairs to support their relationships with other CCGs and local providers.
• When considering the training which is available, Rose concludes that more can be done to encourage those working in CCGs to take part in courses offered by the NHSLA and the NHS Staff College, and that this provision needs to be supplemented by a new training programme for the specific needs of those working in commissioning.
• The review acknowledges the concerns of CCG Chairs around balancing their role as Chair and their responsibilities as practicing GPs. 
• Greater collaboration and integration of working between CCGs and providers to reduce the fragmented nature of commissioning would reduce tensions between the different organisations.
• The lack of performance management and talent management is discussed, in particular the inadequate support for CCG lay members and NEDs.
• " the NHS is drowning in bureaucracy" (p40)

The review makes 19 recommendations:

Framework 15 - HEE strategic framework

Framework 15:  Health Education England Strategy  Framework for a 15 year Strategic Framework
2014 - 2029
HEE, June 2014

• Framework 15 sets out HEE’s approach to the various local, national and international challenges in healthcare over the next few years, suggests solutions and ensures the focus remains on delivery of quality care to patients.
• Interactive pdf

Developing skills across community care

Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values: A mandate from the Government to Health Education England: April 2013 to March 2015
Health Education England, 28 May 2013

• This mandate provides details of the strategic objectives of the Government in the areas of workforce planning, health education, training and development for which HEE and the LETBs have responsibility. It aligns with the mandate for NHS England and the Francis Report as well as the requirements of the NHS, Public Health and Social Care Outcomes Frameworks.
• This mandate aligns with the Education Outcomes Framework (EOF), which sets out the outcomes we expect from the reformed education and training system. 

Guide to healthcare in England

Guide to the Healthcare System in England
DH, 3 May 2013 (36pp)

• This guide explains organisations in the healthcare system and how they work together and includes the Statement of NHS Accountability.
• The Guide will be updated annually and  covers:
• providing care
• commissioning care
• safeguarding patients
• empowering patients and local communities
• education and training
• supporting providers of care
• the role of the Secretary of State for Health

Education outcomes framework

Education outcomes framework for healthcare workforce 
DH, 28 March 2013

• Education outcomes are set in terms of the impact for patients, users of services and carers and will be used to measure improvements in education, training and workforce development and the impact on the quality and safety of services for patients.

Support for HWBs, PH and Healthwatch

Health and wellbeing system improvement support 
LGA, 27 March 2013

• Help and support for the members and organisations involved in local health and wellbeing boards, public health in local government, and local Healthwatch is being developed by the LGA.
• Building on the work of the National Learning Network for health and wellbeing boards, the offer is anticipated to continue supporting boards in 2013-14 including a single information hub, a self assessment framework, and tailored support for clinical commissioning groups.

Learning for HWBs

Resources for health and wellbeing boards
NHS Confederation, 8 November 2012

• A collection of resources produced by NHS Confederation, NHS Institute for Innovation and Improvement, Department of Health and Local Government Association summarising key points of learning for HWBs.
• Includes integration, engagement, patient public engagement, health impact assessment, leadership
• Products are also available on the LGA's Knowledge Hub 

How do we teach quality improvement?

Quality improvement training for healthcare professionals
Health Foundation, August 2012

• An evidence scan of the types of training about formal quality improvement techniqueswhich are available for health professionals, and discussion of the evidence about the most effective methods for training clinicians in quality improvement.

CCG learning portal

CCG learning and support tool
NHS Commissioning Board, June 2012

• A series of web pages signposting the key learning and development opportunities available to proposed CCGs organised by the domains of authorisation. 
• Includes resources for individual leaders, senior teams, governing bodies, extended teams and Whole CCGs 
• Resources from key national bodies includingthe NHS Commissioning Board Authority, NHS Institute for Innovation and Improvement, the Royal College of General Practitioners, the NHS Leadership Academy and the NHS Alliance / NAPC.

Health Education England – an introduction

Introducing Health Education England

DH, 22 June 2012

• The vision and purpose, values and culture and the proposed advisory structure of Health Education England (HEE) and the Local Education and Training Boards (LETBs).

Critical report from HSC report on education and training

Education, training and workforce planning in the NHS
Health Select Committee, 23 May 2012

• According to the HSC report “Government plans to reform education, training and workforce planning in the NHS are unclear and lack crucial detail.”

Health Education England

Health Education England (HEE)

• The new national leadership organisation – ensuring that education, training, and workforce development drive the highest quality public health and patient outcomes.

What makes a good commissioner?

'Animateurs' and animation: what makes a good commissioning manager?

J Health Serv Res Policy 2012 Jan;17(1):11-7.

• Qualitative case studies in four PCTs, focusing on staff engaged in the commissioning of hospital services through both formal and informal observation and in-depth interviews conducted with managers and GPs.
• This research suggests that managers of the new commissioning organizations will require a deep and contextualized understanding of the NHS and that it is important that organizational processes do not inhibit managerial behaviour. 

 For the full background to this research see:

• Management practice in primary care organisations: the roles and behaviours of middle managers and GPs
  J Checkland, Stephen Harrison, Anna Coleman
  National Primary Care Research and Development Centre, University of Manchester, June 2011