CAA Update Dr Sally Evans Chief Medical Officer, UK CAA AAME, 18 Mar 2017

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1 CAA Update 2017 Dr Sally Evans Chief Medical Officer, UK CAA AAME, 18 Mar

2 Outline Medical Review Who is who at the CAA? Post Germanwings actions EASA Update Medical self declaration AME and Aeromedical Centre (AeMC) Oversight CAA/AME relationship Aviation Health Unit Aviation and Space Medicine 2

3 Medical Review Medical Capability Team and Shared Service Centre (Medical Support Team) Resource reviewed 4 AeMCs external to CAA Funding reviewed Efficiency and Effectiveness Projects Accommodation 3

4 Medical Capability (Technical) Team Chief Medical Officer Head AMS Medical Assessors 2+1V 2x0.6 AMAs 4 Consultant Advisers Psychiatry Cardiology DM Neurology Head Oversight Medical Assessors (Audit) V x0.2 Head Aviation Health Unit Phlebotomist AME Training Project 0.6 4

5 Medical Support Team (Shared Service Centre) Manager Medical Support Team Chief Medical Officer Technical Officer (V) Professional Support Team (4.6) Aeromedical Casework Officers (6.8) Medical Records Officers (6) 5

6 AeMCs X X X 6

7 Funding of Medical 7

8 Efficiency and Effectiveness Programme 2017/18 4 Project Charters 1) Improve the Resilience and Effectiveness of Strategy, Standard Setting, and Advice Provision 2) Improve the Efficiency and Effectiveness of AME Oversight and Development 3) Improve the Efficiency and Effectiveness of Complex Case Management 4) Improve the management of our Medical Records 8

9 Quick wins for AMEs New scanning equipment will ensure all documents correctly orientated Use of contact manager rather than file report manager ECG reporting new online ECG over-read form to be made available download of previous ECG traces - 2 options being looked at, estimated delivery April/May Service Level Agreement for technical support to AMEs in development for release in March Egress Switch encryption Technical writing skills secured to update AME on Line quick user guide Administration training to be on training platform Summer

10 Current Projects MARS/AME on Line Replacement Performance Based Oversight 2-way communication including periodic meetings with AAME/SAAME Information flow of what is / might be coming up Involving AMEs in developing / testing before implementation Encourage development of and support AME support groups Review of Call Centre operation Customer service training Contacting Duty MA/Duty AMA explore option of Skype chat facility Guidance for AMEs / applicants on submitting reports by Clarification for pilots of what my AME will do for me and what the CAA will do for me Fit Class 1 training for AMEs aim is to roll out Summer 2017 EASA Standardisation (MEST) 2017 preparation 10

11 Other Projects ITDM Unfit Class 1 roll out Increase in psychiatry capacity 39 th ICAO General Assembly Sep 2016/ health education Guidance material Age 60 single pilot commercial rule 11

12 Post Germanwings Actions UK Pilot Support Programmes n Authority Civil Aviation Authority Information Notice Number: IN 2017/005 Information Issued: 24 January 2017 Pilot Support Programme Guidance for Operators National Pilot-Peer Assistance Network GMC Confidentiality Guidance amendments (on GMC web site now replaces current guidance in April) Encourage development of AME peer networks (eg holiday cover for urgent aeromedical advice) Random drugs and Alcohol testing 12

elearning Platform Aims to support the continuing professional development of AMEs Refresh and emphasise specific aspects of practice Provide structured training and assessment via a

13 elearning Platform Aims to support the continuing professional development of AMEs Refresh and emphasise specific aspects of practice Provide structured training and assessment via a highly accessible on line platform Enable the recording of aviation medicine CPD (as a replacement for annual returns ) Other content being explored includes fora to encourage networking to 13

14 e Learning Platform Latest news: We have a server host and contract has been awarded Web-based to avoid hardware issues and provide access from different devices e.g. PC, smart phone, tablets Initial content in development includes: - existing material licensed from other providers e.g. RCGP - current CAA AME administration course adapted for online learning with revisions reflecting findings from oversight visits Planned roll-out in summer 2017 AMEs have previously offered assistance with testing and we will be taking some of you up on that. 14

15 Post GW Actions/EASA Update 15

16 EASA Rulemaking ATCO EU Class 3 Dec 2016 Basic Regulation update Part Ops Part MED General Post GW 16

17 EAMR - European Aero-Medical Repository Recommended by Germanwings Taskforce: National Authorities to collaborate and exchange information Pilots increasingly mobile, system designed to eliminate medical tourism Web based system - Class 1 pilots only Currently 14 fields to be populated (6 basic fields, 8 medical certificate fields) Responsibility for the creation of initial record, and subsequently data entry, maintenance and quality lies with each NAA. NAA and their AMEs will require access and require training EASA expect data capture to be complete in months. As each pilot is revalidated or recertified, then the initial record is created (UK: 25,500 records 12 month cycle) 17

18 Medical self-declaration 18

19 Oversight update 19

20 AeMC/AME Current Numbers 3 AeMCs Brookdale Medical Centre Gatwick Centreline London Heathrow Medical Services 202 Active AMEs No significant change 140 UK based Class 1 (130) 35 UK based Class 2 (35) 27 Non-UK based Class 1 (34) (Brackets are figures from a year ago as reported at SAAME/AAME conferences 2016) 20

21 AME Oversight Visits (current cycle) Oversight visit format: practice visit review of selected CAA aeromedical records observe a medical discussion Audits Required Audits Started Apr-15 Jul-15 Oct-15 Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17 Oct-17 Jan-18 21

22 Findings 81% of visits result in no findings or only Level 2 findings Most findings arise in circumstances where doctors are not familiar with Part MED or with the CAA guidance material written in support of compliance with Part MED AME produces action plan to address findings and completes corrective actions 22

23 Part MED (Google EASA regulations Click here Consolidated version of Regulation (EU) No 1178/2011 (Annex IV is Part MED) 23

24 Significant findings From information declared by an applicant, the AME makes an assessment that is not compliant with Part MED 34 AME does not perform a satisfactory examination 3 Applicants not required to provide AME with a completed application form Other Regulatory Non-Compliance e.g. not notifying CAA of GMC investigation or sanctions, issues relating to the transfer of records/medical confidentiality

25 IMPORTANT AME Recertification We re in the process of re-certificating around 70 AMEs whose current certificates expire on 31 st March 2017 all annual returns received. We conduct an internal check to ensure compliance with the recertification requirements (Part MED.D.030) (a) registered and licenced to practice (b) 20 hours aviation medicine CPD during the period of the certificate (ie within the last 3 years) (c) performed at least 10 aero-medical examinations per year (d) if had audit visit then all findings closed or target date beyond 31/03/2017 Evidence for (b) comes from annual returns and so if we have not received these and have no evidence that an AME meets this requirement we will not be able to re-certificate. We still await 49 Annual Returns (deadline was 6 Mar 17). 25

AME Centric Overview Overview Demographic information AeMC / AME Journey Enquiry Application Training Extension of privileges Retired, Revoked, Resigned,

Maintenance interaction Audit Status Audit Cycle Booking Preparation Audit Visit Audit Report Action Plan Audit Closure / Followup Policy and procedure

26 AME Centric Overview Overview Demographic information AeMC / AME Journey Enquiry Application Training Extension of privileges Retired, Revoked, Resigned, deceased Status on AME journey Maintenance Contact Checklist Quarterly Invoicing Premises MARS / Token allocation Annual Return Recertification Stationery Maintenance interaction Audit Status Audit Cycle Booking Preparation Audit Visit Audit Report Action Plan Audit Closure / Followup Policy and procedure (Reference) Library, Oversight Manual, All AME comms Link to GMC registration (dynamic if possible) Technical Rebook Monthly, quarterly management information 26

27 CAA/AME Relationship AAME Survey Regular AAME/SAAME meetings Attendance at AME Network meetings Training for changes: Regional seminars for fit C1 Request: Venues? ( Call Centre Review AME views, CAA staff views, usage, hours, expectations, scripting for consistency, customer service training Service Level Agreement for AoL technical support Learning modules including case scenarios Request: Topics? ( Information on pilot s record: abandoned file tab only visible to CAA only Clarification of modern AME role (CAA, not GP or OH, decision maker, managing Conflict of Interest, year round aeromedical advice) 27

28 Pleas to AMEs Send information to CAA when requested: Annual returns (49 outstanding) Action Plans post audit Move casework off the tracker within a few days (10 days max) NB to inform Licensing Authority of a pilot s unfitness if non-uk licence holder. The LA will need to know why unfit and has the responsibility to make fit again. Guidance Material let us know if out of date ( medicalweb@caa.co.uk) Information on CAA web site let us know if obsolete ( medicalweb@caa.co.uk) 28

29 Telephone calls to CAA Mutual expectations around access to advice, response time, appropriate issues, what to prepare in advance, what to enter on contact management, ensure clarity of decision maker Preparation before the call (eg ensure have sufficiently detailed consultant report be prepared to revert to pilot s consultant for more detail) Discussing on line chat support facility 29

30 What to Leave on a Voice Mail Message Should include: Name of AME Ref No of pilot Whether return call Urgent within an hour or Non-urgent within a few hours or Low Priority routine enquiry. AME s Tel No Preferred time period for return call AME s alternate Tel No if alternative period for return of call Please be Clear, Slow, Concise and Speak in a Good Volume! 30

31 Projects, involvement and communication 31

32 CAA/AME Workshop Either 19 or 24 April To develop proforma for use before calling CAA To develop standardised referral form (from AME to medical assessor) for use by AMEs To discuss how CAA can encourage AME support networks To develop guidance for AMEs on use of contact management To consider buddying of new AME with experienced one We would like reps of AAME/SAAME, AeMCs, airlines, individual AMEs approx 10 in total Ideally we will continue to hold workshops periodically on emerging issues 32

33 Responsible Officer/Suitable Person Role is NOT related to CAA certification it relates to whole of medical practice Suspension or revocation of an AME certificate RO/SP will from now on be informed UK GMC only 33

34 Aviation Health Unit Zika virus Cabin Air issues Volcanic ash Space weather Passenger fitness to fly Advice to health professionals Pandemic preparedness planning Also cabin crew assessments 34

35 Specialty of Aviation and Space Medicine From 1 April 2016 GMC approved curriculum Specialty Registrar 4 year training programme CESR vs CCT 35

36 Any questions? 36

Comment: Not always appropriate for the medical assessor to issue a medical certificate. Combine (c) and (d)

Comment: Not always appropriate for the medical assessor to issue a medical certificate. Combine (c) and (d) EASA Comment Response Tool You can save this page as HTML and then open it in Microsoft Word for further editing. Title Updating Part-MED and related AMC and GM NPA Number NPA 2017-22 UK CAA (European.Affairs@caa.co.uk)