consultant appointments

The crucial task of taking on a new consultant has been eased at one trust by a competency framework and mandatory training for those on the interview panel, writes Ian Brownrigg and Paula Potter

The appointment of consultants is governed by statutory instrument, which states who must be involved and the processes that must be followed. The regulations governing the appointment of consultants were changed in 1991 with the formation of trusts and the specific involvement of chief executives from that time. Further guidance was issued in 1996.

Preston Acute Hospitals trust has been directly responsible for the appointment of its consultants since its formation in 1994. The appointment system originally in use was that inherited from the regional health authority and there had been few changes since.

The chief executive had participated in several consultant appointments and thought the process could be managed better. Appointing a consultant represents a huge investment by a trust, and it was thought that our way of assessing candidates against our needs was not consistent.

Most consultants who were being asked to help appoint senior medical staff had very little practical experience of doing this. In addition, people involved in the interview process often feel they are good at it without that necessarily being the case. Consultants are no exception.

The trust required managers involved in making non-medical appointments to have formal training in recruitment and selection techniques before they could chair an interview panel.

The mere acquisition of technical knowledge does not qualify someone to be a consultant. The assessment process which specialist registrars experience ought to ensure that the practitioner is skilled in a wide range of medical techniques. But there are aspects of personal behaviour which should also be assessed. This trust places some emphasis on the extent to which individuals are team players.

The regional postgraduate dean issued an edict that no one would be accepted as a member of an interview panel for specialist registrar posts unless they had attended recruitment and selection training.

We obtained the dean's agreement for the training to be done in-house. Through small group sessions and one-to-one coaching we exposed the participants to a structured approach to the subject.

We now run four-hour workshops for consultants involved in appointments. These include the design of job specifications, reading application forms and CVs appropriately, and using a competency framework. We also run two- day workshops covering the same ground in more detail.

This approach has given us an opportunity to ask our consultants to take part in some introductory training in recruitment and selection techniques. Consultants were initially sceptical, but most have now reported that they find the training useful.

We adopted a competency framework for appointments. This assesses attainment and levels of competence in areas such as research, audit, getting published, specialist knowledge, understanding of the NHS, teaching experience, organisational and communication skills, as well as personal attributes such as conscientiousness, balance and initiative.

This approach can meet the needs of an employer for any post, and the trust is developing it for non-medical appointments. We had not previously considered its use for senior medical staff, probably because of their sensitivity in matters affecting their employment.

A look at the person specification showed that most of our requirements of any consultant were identical, no matter which specialty was involved. This included both the personal characteristics and the professional attainments.

The framework uses four levels of competence and we took care to provide a description for each level for each element on the person specification. Some initial thoughts were tested with the medical director and a final working draft was then produced for comment. At this stage, we also involved the dean's office and the response was positive. But we realised we had to provide guidance to interview panel members on this new approach.

While the regular members of the panel would soon become used to the process, consultants would need some help, as most will attend such interviews very infrequently. Anyone from outside the trust, including the college assessors, would also need to be advised of our internal processes. We have produced a document which can be used for constant reference. In this way, we can ensure that the general information gleaned from courses on recruitment and selection techniques can be put into practice.

The guidance includes advice on shortlisting and interview technique, along with sample questions.

Experience to date

The revised arrangements have been in use for around six months, and in that time there have been 15 consultant appointments. All members of the interview panel now receive an eight-page document on the competence framework and associated guidance.

We have said that any candidate assessed at level one for any essential criteria would not be suitable. Any candidate assessed at level two - restricted - for any essential criteria would be a borderline candidate who might only be appointed if other factors are favourable. The guidance can therefore be used during the shortlisting process as well as in the interview itself.

The chair uses the framework in the discussion before the interview to ensure that all aspects of the person specification will be covered and that questions are designed to explore the candidate's ability to meet our requirements.

The clinical members of the panel will form an opinion of clinical competence and will explore different aspects of clinical knowledge and experience.

It is interesting, as a lay person, to see how experienced panel members can probe candidates for reasoned argument to support their opinions. Discussion of candidates after the interview has been focused, and we believe that the framework has been of intrinsic value in fostering that discussion.

The success or failure of individual candidates to meet our requirements can be examined more objectively. And it may be that the examination and assessment processes in medical education can be used as yardsticks of clinical competence. In the final analysis, we usually have to make a choice between candidates, and objective reasoning is essential for this.

It is, if anything, even more important when there has been only one candidate to interview. The trust is not afraid to make no appointment if that is felt to be the right course of action, and it certainly helps if the panel members are able to articulate the reasons why the candidate is unsuitable.

Several college advisers have congratulated the trust on its approach, and at least one wishes to use it in his own hospital.

The postgraduate dean has developed our approach to interviews for specialist registrars and is contemplating extending it further to senior house officer posts.

It would also be logical for the trust to continue with the same type of approach in other aspects of consultant life, such as the whole cycle of performance appraisal for consultants, including assessment of learning needs. There seems to be no reason why it could not be applied to the subject of clinical governance.

The appointment of any member of staff has to be taken seriously - all the more so when a consultant is appointed. They are, after all, the fee earners of the hospital. The regulations provide a framework and the central guidance is of assistance, but these documents have to be translated into reality.

That reality must include the style of management at the trust and the relations between the chief executive and senior medical staff, as well as good practice in the recruitment process.