london s12/ac approvals panel 1. dr masum khwaja and denista wincey - sa… · a section 12...

1London S12/AC Approvals Panel

Dr Masum Khwaja, Chair, London Region

Mrs Denista Wincey, Approval Lead, London Region

Mental Health Centre

Northwick Park Hospital Watford Road

Harrow, Middlesex, HA1 3UJ

Telephone Number : 0208 869 3515

Fax Number : 0208 869 3516

Email Address : [email protected]

INTRODUCTION


mailto:[email protected]

A section 12 approved doctor is a medically

qualified doctor who has been recognised

under section 12(2) of the MHA as having

specific expertise in the diagnosis and treatment

of mental disorder.

What is a S12 approved Doctor?


"Approved clinician" is defined as:

- a person approved by the Secretary of State (in relation to England) or by the Welsh Ministers (in relation to Wales) to act as an approved clinician for the purposes of the MHA

- is a healthcare professional who is competent to become responsible for the treatment of mentally disordered people compulsorily detained under the Act.

- Until the 2007 amendments, they would almost exclusively have been a consultant psychiatrist, but other professionals, such as social workers, clinical psychologists and nurse specialists, are being encouraged to take on the role.

What is an Approved Clinician?


https://en.wikipedia.org/wiki/Mental_Health_Act_2007

RC is the AC with overall responsibility for care and Rx of patents being assessed/treated under the MHA

The RC should be the AC with the most appropriate expertise to meet the patient's main treatment needs

RC provides medical recommendation for patient to be received into guardianship by LA

What is a Responsible Clinician


Giving medical recommendations for the compulsory

admission of mentally disordered persons to hospital or guardianship

Giving medical evidence to be taken into account by a court before ordering admission of a patient to hospital or guardianship.

Giving reports to be considered by the Home Secretary for directing the transfers to hospital or guardianship of prisoners and certain other persons.

These Section 12(2) powers can be used in England and Wales.

Powers under s12(2) of the MHA 1983

London S12/AC Approvals Panel 6

Clinical lead for a patient liable to be detained or on a CTO or guardianship;

Granting section 17 leave;

Reviewing need for detention, CTO or guardianship;

Discharging from detention, CTO or guardianship;

Deciding whether to bar NR discharge from detention or CTO;

Renewing detention, CTO or guardianship;

Recommending transfer to guardianship;

Making a Community Treatment Order (with AMHP);

Recalling from CTO;

Revoking CTO (with AMHP);

Reporting to Minister of Justice on restricted patients.

Powers of a Responsible Clinician

The Approved Clinician (or doctor) in charge of the treatment of an informal patient is the one with the power to prevent a patient from leaving under section 5(2);

May be authorised under s24 by NR to visit and examine a patient in private

May be authorised for Tribunal report to visit and examine a patient in private

May be authorised by CQC to visit and examine a patient in private

May provide reports to Court in some Part 3 cases.

Powers of an Approved Clinician when not a

Responsible Clinician

S12 /AC Approval is a statutory function held by the Secretary of State for Health

DoH on behalf of the SoS for Health in 2014 awarded contracts to 4 regional Panelsto undertake the approvals function (reduction from 7 regional panels)

London – remained unchanged – (CNWL NHS Trust)

North of England – North East, North West, Yorkshire & Humber (TEWV NHSTrust)

Midlands & East - East & West Midlands, East of England (RDASH NHS Trust)

South of England –(Winterhead Ltd - Independent Provider)

You must apply to the appropriate Panel for approval

S12/AC Approval


Exercises the Approvals function on behalf of the DoH

DoH have contracted CNWL Foundation Trust to oversee the London

Panel function (1.4.14 – 31.3.17).

London Approval office is based at Northwick Park Hospital

Chair – Dr Masum Khwaja

Vice Chair – Dr Hagen Rampes

Approvals Lead – Denista Wincey

Administrators – Philip Thompson and Shareen Khan

The Panel consists 28 members from various Trusts and specialism in

Psychiatry

London Approvals Panel


S12/AC Approvals

Up load all approvals information for Sec 12(2), AC, and DoLSstatus on to the National Database

Approve s12/AC training courses

Ensure sufficient courses are available

Promote good practice s12/AC practice regionally

Liaise with GMC regarding complaints about s12/AC approveddoctors – note Panels do not directly investigate complaints

What do Panels do?


Total number of Practitioners

2165

No of AC 1433


S12/AC Approvals activities from April 2015 to

March 2016

Activities Total

S12 Initial approvals 133

S12 renewals 110

AC Initial approvals (includes ST6s) 109

AC renewals 285

AC Portfolio - medic 02

Refusals 01

Suspension or withdrawal 04

No of new

Section 12

Approvals,

133

No of

Section 12

Renewals,

110

No of new

AC

applications

(including

ST6), 109

No of AC

renewals,

285

Medic

Portfolio

(AC), 2

Suspension

or

withdrawal

from either

group, 4

Refusals, 1


London Panel must follow the Secretary of State’s Instructions with

regards to s12/AC Approvals in England (revised January 2016)

The instructions define the eligibility criteria for s12/AC Approval

including professional requirements (as well as period of approval,

suspension/end approval etc)

The Instructions apply in England and Wales but there are some

differences

Sec 12(2) approval transferable between England & Wales but not AC

approval – you must apply separately for this in England and in Wales)

Scotland MHA is different from England

LEGAL INSTRUCTION


Royal College Website:

http://www.rcpsych.ac.uk/workinpsychiatry/divisions/london/resources/section12.aspx

Instruction for S12 Approvals

Instruction for AC Approvals

Guidance for Doctors seeking AC staus via the Portfolio route

Approved Clinician Initial Courses

Approved Clinician Application Form

S12 Initial Courses

S12 Refresher Courses

S12 Application

Change of Details Form

Regional Contact List for Approvals

Common Questions asked about S12 Approval Process

London s12/AC Approvals Panel


http://www.rcpsych.ac.uk/workinpsychiatry/divisions/london/resources/section12.aspx

http://www.rcpsych.ac.uk/pdf/New Instructions for S12 Approval - Amended on 05 January 2016.pdf

http://www.rcpsych.ac.uk/pdf/New Instructions for Approved Clinician - Amended on 05 January 2016.pdf

http://www.rcpsych.ac.uk/docs/NRG-GUIDANCE FOR SEEKING AC APPROVAL BY THE PORTFOLIO ROUTE September 2015.docx

http://www.rcpsych.ac.uk/docs/APPROVED CLINICIAN INITIAL COURSES.docx

http://www.rcpsych.ac.uk/docs/AC Application Form - Revised Jan 2016.docx

http://www.rcpsych.ac.uk/docs/SECTION 12 INTRODUCTORY COURSES.doc

http://www.rcpsych.ac.uk/docs/SECTION 12 REFRESHER COURSES.doc

http://www.rcpsych.ac.uk/docs/S12 Application Form - Revised Jan 2016.docx

http://www.rcpsych.ac.uk/docs/Change of Details form revised Jan 2016.docx

http://www.rcpsych.ac.uk/docs/Regional Contact List for Approvals - January 2016.doc

http://www.rcpsych.ac.uk/docs/COMMON QUESTIONS ASKED ABOUT APPROVAL PROCESS - January 2016.doc

GMC registered medical practitioners with special experience in diagnosis and treatment mental illness and

hold a full registration with a licence to practice from GMC

PLUS:

3.1 MRCPsych

3.2 On GMC specialist register as a specialist in psychiatry) or a person included in the Specialist Register as a specialist in respect of a specialty that the approving body considers to be equivalent to psychiatry

3.3 MRCGP , on performers list, equiv 3 yrs F/T (or equivalent) XP in diagnosis and Rx MD maybe evidenced by diploma/degree PLUS 4/12 must have been in a psychiatric training scheme or RCGP acccreditation

3.5 MRCP – Faculty of Forensic Legal Medicine (FFLM)

3.6 GP who dropped their s12 approval but then reapplied within 12 months

Who is eligible for s12 Approvals – Professional

Requirements/Criteria based on Part 1 Instructions


3.4 Other GP or specialty doctor (‘Portfolio s12 applications’)

Not a doctor who is 3.1, 3.2, 3.3. 3.5, 3.6: but has minimum of 4 years experience (or equivalent) in:

- a psychiatric training post,

- a non-consultant career grade post,

- or a GP post

XP must be substantial in diagnosis and treatment MD and may be evidenced by award/diploma/degree relevant to MH

For GPs – at least 4/12 on a training programme recognised by the RCPsychs OR accredited as a GP with a special interest in MH

Two assessments undertaken within preceding 12 months - supervised by a consultant who is MRCPsych and s12 approved who has provided evidence that the assessments were carried out competently

Who is eligible for s12 Approvals – Professional

Requirements/Criteria based on Part 1 Instructions


1) Completed relevant application form

2) A full up to date CV

3) Satisfactory references – two (one of whom must be a Consultant who is

s12 Approved)

4) Satisfactory ARCP outcome/CPD certificate

5)CRB/DBS

6)Course attendance certificate. (within 12 months of application – 2 day

induction course

7) 2 supervised MHA assessments (except if have MRCPsych)

Documentation required for s12 Approvals


Review of paperwork by administration staff and chasing

references

Scrutiny by two Panel Members

Sign off by Chair/Deputy Chair/London Locality Lead

Timeframe – usually 8 weeks minimum

Processing of s12 application


In addition to satisfying the requirements for all docs (slide 18):applicants for re-approval are required to:

Attend a one day refresher course attendance within 12 monthsfrom date approval expires/application received whichever is later.

Demonstrate on-going involvement in the diagnosis or treatmentof mental disorder in one or more of the following roles/activities(note except for short term locum doctors all the below areconfirmed by applicant and referees on application and referenceforms):

S12 Re-approvals


a) Acting as a Medical member of the First-tier Tribunal (MentalHealth).

b) Undertaking assessments as a SOAD

c) Preparation of independent expert reports for Courts

d) Undertaking at least two Mental Health Act assessments withinthe previous calendar year.

e) Confirmation of having acted as a RC, or an AC in charge ofthe treatment of a patient.

f) Confirmation of employment in a clinical post with substantialresponsibility for the diagnosis or treatment of mental disorder.This is likely to be within a specialist mental health setting.

S12 Re-approvals


CPD or ARCP condition for usually 6 months max 1 year (varies

nationally) (i.e. agreed they will be s12 approved on condition that they send

in CPD or ARCP form by 6 months)

DBS condition for usually 6 months (varies nationally)

For doctors who work independently or in a locum/temporary post an

additional CPD and further reference condition may be given at half way of

their 5 years period of approval (2.5 years) to monitor their CPD activity

(varies nationally)

Possible (time limited)conditions on S12

renewal


Instructions for AC approval from the SoS for Health

New Roles Guidance 2007

Psychiatrists on the specialist register – straightforward application

Doctors not on the specialist register – Portfolio Route

Psychologists, OT’s, Nurses, AMHPs – Portfolio Route

Who is eligible for AC Approval? Professional

Requirements


Completed Application form

2 day AC Introductory Training Course within two years of receiving the application

CV, ARCP, CRB/DBS (under 3 years old), CPD registered or local London CPD form, Evidence on GMC Specialist Register

If training has been abroad then steps the applicant has made to familiarise themselves with services in England or Wales

Two References: One from MD/TPD/CD or equivalent

Required Documentation for First Time AC

Approval


Portfolio with support from their employer - does your consultant supervisor consider you to have the competencies required to become an AC?

7 years WTE years of psychiatry with 4 years being preferably at a level more senior than core trainee.Posts less than 3 months would not normally be accredited

Expectation of having S12 Approval for a minimum of 12 months. (NRG March 2016)

AC Portfolio Application


Two testimonies from suitably qualified professionals in a senior role who can validate your aptitude for the AC role, one of whom must be an AC.

A 360 degree appraisal or equivalent that should include your immediate line manager/supervisor and multi-disciplinary team colleagues.

Confirmation from your AC/RC mentor that you regularly take a lead role in managing a significant number of patients; including complex cases.

AC Portfolio Application


Two relevant, succinct, and anonymised, statutory reports(e.g. a First Tier Tribunal, Managers hearing or Section renewal report) prepared by the applicant (reports must follow the MH Tribunal Practice Directions)

Two anonymised, concise, case commentaries relating to the applicant’s involvement in the care of a detained patient, which should demonstrate your awareness, understanding and reflection on key areas of applied AC competence, and the guiding principles of the Code of Practice.

Evidence - Reports and Case

Commentaries


Portfolio may take 6-24 months to compile/process

Annex E (20 of the MHA 2007 New Roles Guidance provides a framework and examples of how aspiring ACs may develop and demonstrate competencies

PLEASE follow the guidance given by the London Panel and the new (draft) National framework guidance for AC applications by the Portfolio route

Portfolio Guidance


Comprehensive understanding of the AC role, legal responsibilities and key functions of the AC and RC role

Applied knowledge of legal and policy framework/codes of practice/Nice guidelines

Assessment

Treatment

Care Planning

Clinical leadership & MDT working

Equality and Diversity

Communication

8 AC Competencies


New Roles guidance

DH Instructions (2015 version to be published soon)

MHA 1983 (as amended2007)

MCA 2005/DoLS & interface with MHA

Practice Direction: First-Tier Tribunal: Statement and Reports in Mental Health Cases

Children Act

Trust & LA Safeguarding policies

Role of CQC and the SOAD

Care Act 2014

Essential Reading


Contents page referencing each item submitted including an appendix referencing evidential documents and reports

Evidence must be comprehensive, coherent, and of sufficient breadth and depth for the assessing Panel to make an assessment of each competency

Content of the portfolio must be consistent with the applicant’s declared skills, knowledge and experience – it must be your own work

Declaration to agreement to comply with the conditions of approval (DH Instructions – Part 2)

Evidence


Find an AC mentor

Shadow an AC/RC and also include if practicable, shadowing an AMHP

“Shadowing” – this includes a sequence of observing, participating in, and being observed to have demonstrated capability for the relevant competency and for executing any requisite decision

It must include clear evidence that the applicant has demonstrated all of the key decisions reserved to the RC

Mentorship and Shadowing


Include anonymised examples of documentation, other than the case commentaries and statutory MHA reports, in which the applicant has taken a lead role without necessarily being under supervision/ mentorship:

- Descriptions of the MDT management of complex patients - Care plans, CPA documentation

- CTT assessments, risk assessment

- Pre-admission assessments

- Case-based discussion,

- Capacity assessments

- SOAD request forms,

- Clinic letters

Evidence


Completed MHA forms of an anonymised or, if necessary, fictitious nature, such as s17, T2, S2 with an explanatory commentary that demonstrates your understanding and highlights the competency for which you are offering evidence

There should be evidence of reflective practice e.g. reflective practice logs or reflection on case based discussion. There should also be a reflection on the key decisions reserved to the RC

Evidence – reflective practice


All portfolios have an administrative check as soon as they are received (many are returned to applicants due to a lack of sufficient evidence or the evidence does not meet the required standard)

Following scrutiny by the London Approvals Panel, the portfolio will be scrutinised by at least 2 Panel members, Approvals Lead and the Chair/Vice Chair and then goes to the Panel Chair for sign off if it is approved

Portfolio Scrutiny


Following approval, the applicant will receive a formal Approval letter from their approving body and their details will be added to the National Database

Approval is always time limited, S12(2) up to 5 years, ACs for 5 years

If a Doctor is AC approved in Wales, this does not give them AC approval in England; they must seek separate approval

If you change any contact or work details, you are required to inform your approving body – condition of Approval (detailed on your approval letter)

You will receive a reminder of your AC renewal date approximately at 9, 6 & 3 months. At 3 months the MD is also copied in. Applicants must attend refresher training one year before AC expiry

Once AC approved, your Sec 12 approval date will linked with your AC date

Approval


GMC may suspend a registration or impose time limited conditions – This can affect the status of an approval

The Panel can suspend an approval under certain conditions & approval period will continue to run whilst suspension is in place

If an approval lapses, the applicant can reapply for renewal within one year otherwise a new application is required

If you go abroad & relinquish registration, your approval will be withdrawn until your registration is reinstated

Suspensions


I am a Staff Grade psychiatrist. Am I eligible?

I am a locum consultant or retired from the NHS. Can I get

approved?

I have worked overseas as a Consultant Psychiatrist. How soon can I

be approved in this country?

How long does it take for me to get my approval?

I have not attended a course. Can I be approved?

How do I register for CPD?

The panel have refused me approval. Can I reapply later?

Common Q&A: S12 Approvals


Yes. Approval may be considered for psychiatrists without MRCPsych in non-training grades (eg Staff Grade, Speciality doctor)

You must have a minimum of four years full-time experience in psychiatry (preferably in training posts and/or completed structured training equivalent to MRCPsych)

A full CV is needed

Completed relevant application form

Satisfactory references

Satisfactory ARCP outcome/CPD certificate

CRB/DBS

Course attendance certificate

2 supervised MHA assessments

I am a Staff Grade Psychiatrist. Am I eligible?


Yes. Doctors not in permanent NHS employment or in locum

posts must include evidence of CPD compliance, certificate of

attendance at a Section 12 course and contemporary

references. (for reference requirement – please see the

Instruction)

Approval may be time limited to the duration of a specific

locum post or for one or two years.

I am a Locum Consultant or retired from the

NHS. Can I get approved?


Your psychiatric qualification should be MRCPsych equivalent

in addition to the Section 12 Introductory Course requirement

and relevant documentation

Evidence is required of recent mental health practice in the UK

of at least three months duration including attendance on at

least two MH Act Assessments (forms can be obtained by email

request to [email protected])

I have worked overseas as a Consultant Psychiatrist.

How soon can I be approved in England?


If all your application is in order and you meet the criteria it

should take between 8 to 12 weeks

We normally allow for a two week turnaround with your

references and another two to three for the panel to scrutinise

your application and make a decision

We ask you to contact us from time to time by email to find out

where the delays are and to chase referees where necessary

How long does it take for me to get my

approval?


No. It is a national requirement HSG(96)3 that applicants for

approval must have attended a two day Mental Health Act

(Section 12 Approved) Training Course

Your papers may be processed before your course attendance

to avoid further delay provided you let us have evidence of

your course booking

I have not attended a course. Can I be

approved?


You can register for Continuing Professional Development

with the Royal College of Psychiatrists. This is free to those

who have passed their MRCPsych Part 2.

The telephone number to call is: 0207 235 2351

Doctors in non training grades must be registered for

CPD/peer group certification required before approval is

granted

How do I register for CPD?


Yes. Approval may be considered for psychiatrists without GMC Specialist registration

You must have a minimum of seven years full-time experience in psychiatry and worked in a senior level for a period of minimum four years

Application is by the Portfolio route

I am not on the GMC Specialist Register – am

I eligible to become approved as an AC?


Any questions

[email protected] or 0208 869 3515


mailto:[email protected]

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