Peer Reviewers Role Profile March 2018

Peer Reviewers Role Profile March 2018 Contents 1. Purpose of this document 2. Primary audience 3. Background 4. Introduction to the NCYPD Programme 5. Benefits of the Programme 6. What are the characteristics of a Peer Reviewer? 7. Roles in the Peer Review Team 8. What can peer reviewers expect from us? 9. Terms and conditions 10. Application and assessment process 11. Person specification NCYPDQP Peer Review role profile March 2018 Page 1 of 15

1. Purpose of this document The effectiveness and credibility of the NCYPD Quality Programme Peer Review process is highly dependent upon the skills and approach of the members of the Peer Review team. This document outlines the role profile and person specification of a Peer Reviewer. It covers the requirements of the reviewer in the following areas: Qualifications Experience Skills Knowledge Attitudes It also sets out the tools, training and resources available from the College to support Peer Reviewers in this work. 2. Primary audience All current and potential Peer Reviewers including: Paediatric reviewers Nursing reviewers Dietitian reviewers Psychology reviewers Parent/Carer reviewers Others who may be interested in this document include: Those employing, line managing or appraising current and potential peer reviewers Network managers and chairs Those being interviewed as part of the peer review process Children and Young People with diabetes and their families

3. Background To continue with the ongoing improvement in paediatric diabetes outcomes in England and Wales over the last eight years the National Children and Young People s Diabetes Network has established in England and Wales the NCYPD Quality Programme comprising Self Assessment and Peer Review alongside a Quality Improvement Collaborative. The programme is intended to roll out from April 2018 subject to funding agreement with local Trusts and Health Boards, The Peer Review programme builds on the Department of Health s Diabetic Quality Improvement Network System (DQuINS) which peer reviewed 134 Paediatric Diabetes Units in 2013/4. This was a popular and successful process amongst unit teams, requiring self-assessment against a set of standards, followed by a visiting team of diabetes professionals examining the units processes, team working, governance, outcomes and engagement with patients and families. The scheme was migrated to the Quality Surveillance Team (QST) within NHS England and the web access removed. A second round of self-assessment and external verification took place 2015-16. The NCYPD Quality Programme will involve more of the MDT as peer reviewers and expand the remit of the programme to include formalised Quality Improvement Collaboratives developed by the RCPCH, based on evidence of success from Sweden 1, which has reduced its HbA1c levels markedly in recent years, 1 http://onlinelibrary.wiley.com/doi/10.1111/pedi.12467/abstract

4. Introduction to the NCYPD Quality Programme Peer Review The model is based on a standardised approach followed for many current and recent peer review programmes and will involve around 160 multidisciplinary teams (MDT) in over 140 health organisations in England and Wales. The programme will supplement the National Paediatric Diabetes Audit (NPDA) and units will be encouraged to use their NPDA data and information gathered about their clinical service during Peer Review to drive improvements in care and outcomes. The model for peer review will consist of three components: Self-Assessment Each network, health organisation and multidisciplinary team (MDT) will be invited to complete online self-assessment every year. The measures were developed by the National CYP Diabetes Network with the support of NICE and were subject to external consultation. They complement other data reporting such as NPDA, are aligned to the CQC Key Lines of Enquiry, are embedded in the CSQM reports, and will provide evidence to support the payment of Best Practice Tariff. Submission will be via a web-based platform similar to NPDA, and will require sign-off by the clinical lead in each PDU along with the Trust or Health Board s Medical Director. This process will be overseen by the RCPCH NCYPD staff team, working with the regional network managers to enable consistency, accuracy and completeness of submissions. Data Scoring and External Verification The self-assessment responses will be scored and a process of internal validation and External Verification (EV) will take place each year. EV will be selective using an algorithm to identify around 20 submissions to examine in detail; all teams should be able to provide evidence for their submissions on request.

This approach provides a check of consistency of self-assessment, an opportunity to identify any systemic errors during submission and to check whether appropriate evidence has been collected. Peer Review Visit At least once in three years each MDT will receive a Peer Review (PR) visit exploring in more detail the functioning of the PDU and identifying any blocks to clinical service improvement. The visits aim to stimulate enquiry, discussion, and sharing of good practice examples and whilst they will check and use the evidence from the SA/EV the findings of the PR will not influence the in-year scores and should not be viewed as punitive. The Review team will include at least two clinicians (doctor, nurse, dietitian, psychologist) plus a parent/carer representative. The team will be supported by a review manager, Reviewers will need to apply for the role and undertake induction training prior to attending a review visit; they will usually be assigned from the same or a neighbouring network to minimise cost and time for travelling and increase partnership working and ongoing collaboration. Peer Review will cover around one third of units in each region each year, selected on agreed criteria which may include indicators arising from NPDA and/or Self-Assessment scores plus other factors. Peer review is not competitive it is aimed to support units to make best use of information and their team skills to support improvement in outcomes. The visit will take place on a single day although the reviewers may arrive / meet the evening beforehand. The day will be clearly structured with advance notice of the key issues to be explored, and a review handbook for units will be available online. www.rcpch.ac.uk/diabetesquality All PDUs will be kept informed of progress either directly or through their networks and the RCPCH programme delivery team will maintain a webpage and documentation and handbooks to accompany the process. www.rcpch.ac.uk/diabetesquality

5. Benefits of the programme The true benefits of peer review are mutual, with reviewers and those under review being challenged and stimulated to learn from colleagues and develop their own practice and team. The programme as a whole will deliver the following benefits: For commissioners and the national programme Guidance to support CCGs to manage payment of BPT and enable reduction of variation. An opportunity to benchmark unit performance Potential to demonstrate internationally a highly regarded integrated process. The SWEET 2 collaborative is in dialogue to use the Self-Assessment measures developed in England and Wales in Europe. For specialist services, the NHS England Quality Support Team will use selfassessment data in their initial assessments and may utilise the RCPCH peer review programme for any required visits. For Trusts and Health Boards Better evidence to monitor improvement and efficiency Access to continued BPT funding The opportunity to improve expertise, reputation and skills of the team Potential for trickledown of funded training in peer review techniques Encouragement about progress and celebration of achievement For MDTs The opportunity to work together better with a shared purpose Development of QI skills amongst MDT members applicable in other work Provision of improved data to inform development and requests for resources Opportunity for CPD and recognition of progress Incentive to resolve gaps and reduce variation in service provision Improved awareness by senior managers of the needs/ achievements of PDUs 2 SWEET is an acronym derived from Better control in Paediatric and Adolescent diabetes: Working to create CEnTers of Reference

Data is entered once and shared widely to reduce burden. Links with other data sources and information in public and professional domains. A focus on patient outcomes and the factors impeding their improvement The opportunity to visit and learn from other units and team Enables networks to benchmark For patients and parents/carers Improvement in communication and processes of care through better monitoring of compliance with standards Data about the unit will be available through CSQM so patients can compare units and prepare accordingly. 6. What are the characteristics of a Peer Reviewer? A Peer Reviewer is an individual who: has great communication skills can manage interviews effectively can identify what information they need to review the service can validate information received through cross-checking and seeking evidence to substantiate or refute any assertions can deliver fair and constructive feedback at an appropriate time is objective and non-judgmental is able to work collaboratively and effectively in a peer review team, understanding their unique role in that team can make difficult judgments (with the support of the rest of the team) based on standards and statutory requirements (where applicable) Has experience in negotiating Can ensure the written report provides the service under review with all the information it needs to make changes and improvements Peer Reviewers work in this role on a voluntary basis on behalf of the RCPCH and must have time to carry out the role with the agreement of their organisation and line manager

Each Peer Review requires some time in advance of the visit reviewing evidence and contributing to a pre-visit teleconference. The main review visit takes one day conducting interviews (although travel the evening before may be required). After the visit the reviewer will contribute to the report which is drafted by the RCPCH Review Manager. 7. Roles in the Review Team Clinical Lead Reviewer A clinical lead reviewer is an experienced paediatric, nursing or dietetic reviewer with overall responsibility for the successful delivery of the peer review and signing-off of the final report on behalf of the College. They work with the RCPCH Review Manager to ensure all members of the team are sufficiently supported and able to perform their roles effectively. They will have overall leadership of the review, leading meetings and interviews whilst managing the expectations of the PDU under review, the participants and the Peer Review team. They ensure decision making is sound and supported. They require excellent organisation, leadership and communication skills. NB: a separate document is under development for Clinical Lead Reviewers, which will be available on the webpage www.rcpch.ac.uk/diabetesquality Paediatric Reviewer A Paediatric Reviewer is a consultant or SAS paediatrician with an interest in CYP with diabetes. They have leadership experience and an understanding of service delivery and improvement. They are fluent in the application of relevant standards, regulations and guidance relating to paediatric diabetes. Within the review team they will bring specialist medical expertise and may also perform the role of clinical lead reviewer. Nursing Reviewer A Nursing Reviewer is a senior Paediatric Diabetes Specialist Nurse who brings their clinical expertise and leadership experience to explore issues affecting patient care and nursing provision. This includes compliance with nursing standards, staffing projections, training and supervision and liaison with other teams and agencies around the child or

young person s care. They will bring specialist nursing expertise and may also perform the role of clinical lead reviewer. Dietitian Reviewers A Dietitian Reviewer is an experienced Paediatric Diabetes Dietitian 3 who is a member of the paediatric diabetes MDT. They bring to the Review specialist expertise and skills in monitoring the effectiveness of the dietetic support for children, young people and families, identifying areas of notable practice and providing peer challenge and encouragement to the service under review Psychology Reviewer A Psychology Reviewer is usually a Clinical Psychologist with an interest in paediatric diabetes who use their clinical expertise to review elements of the service associated with the mental health and wellbeing of the children young people and families. This includes compliance with relevant standards, availability of psychology support and interrelationships with other services. In some teams, there is a multidisciplinary psychological service which may include psychotherapists and psychiatrists as well as clinical psychologists. Where these clinicians are members of the Core paediatric diabetes team they are welcome to apply to be peer reviewers. Parent / Carer Reviewer A Parent Carer Reviewer does not usually have a clinical background; they bring their experience of managing paediatric diabetes within the family and of using the NHS, along with their ability to understand the wider context of service provision and the standards o care that families should realistically expect to receive. Within the Review they provide a focus on the needs and experiences of patients and their families including information and how well teams work together around the child or young person. They also have a key role in ensuring the peer review team s recommendations are based on robust evidence and have oversight of the independence of the peer review process. 3 http://www.cypdiabetesnetwork.nhs.uk/files/7014/7514/2510/paediatric_dietitians_curriculum_for_diabet es.pdf

NCYPD Network Manager The 11 National CYP Diabetes Networks in England and Wales are each supported by a Network Manager who works with the Network Chair and unit-based clinicians and parent/carers to share good practice and maintain high quality standards. The NCYPD Quality Programme includes Self-Assessment/Peer Review of Networks as well as units and Network Managers play a key role in supporting the rollout of the programme. RCPCH Review Manager This is a member of the RCPCH staff team who will have responsibility for project management, liaison with the PDUs and peer review teams, seeking and processing evidence, establishing meetings (where required) and development and delivery of reports. 8. What can Peer Reviewers expect from us? Peer Reviewers will receive ongoing support in their responsibilities by the other members of their peer review team, the Clinical Lead for the NCYPD Quality Programme and the RCPCH staff team. Full induction training will be provided for Peer Reviewers upon appointment, and attendance at a one-day training session is required prior to their first visit. Peer reviewers will receive reimbursement of reasonable expenses incurred for travel and subsistence, and the induction is expected to be approved for CPD. Joining as a peer reviewer also brings the opportunity to work with and learn from colleagues across England and Wales and to develop QI skills. 9. Terms and conditions Period of appointment and accountability Peer Reviewers are appointed by and are accountable to the NCYPD Quality Programme Board. The term of appointment of a Peer Review reviewer is not restricted to any maximum period but reviewers are expected to participate in at least three Peer Review visits following training to ensure consistency of approach across all reviewers, and to

justify investment in training. The first visit should take place within the first year from induction training. Peer Reviewers who are no longer able to fulfil their commitments may resign from their role via formal notification to the Clinical Lead and RCPCH team at any time. Time commitment Each review visit usually comprises 1 full day for the site visit. An additional day in total will be required for, preparation prior to the visit (e.g. reading documents) and contribution to producing the report following the visit. Conflicts of interest When invited to take part in a review an individual should declare any current investigation or medico-legal complaint against themselves in which they are involved. This is important to maintain the credibility of the programme. In addition we need to know any material involvement with the healthcare organisation or any individual from the healthcare organisation involved in the review which could lead to a conflict of interest or challenge to the report. There will be an opportunity to provide this information when reviewers are being allocated to visits. Confidentiality Reviewers are required to comply with the NCYPD programme protocols on confidentiality as set out in the Guide for reviews (see www.rcpch.ac.uk/diabetesquality ) 10. Application and assessment process Applicants should complete an application form and seek the agreement of their organisation/line manager to participate. Applications will be assessed against the criteria set out in this role profile, and final selection will be ratified by the Steering Group /Programme Board. The aim is to involve as many MDT members as possible, at least one from each MDT. If you have any questions about the role, or the application process, you can contact one of the RCPCH staff team on 020 7092 6091 or diabetesquality@rcpch.ac.uk

11. Person specification This sets out the requirement for peer reviewers working with the College. Most areas are essential to the role however some may be developed through training (see those sections highlighted. All applicants should undertake induction training prior to undertaking any reviews. Qualifications / membership / registration Has completed RCPCH NCYPD Peer Reviewer training (this is not required prior to application but must be completed prior to undertaking a review) Paediatric reviewer Other clinical reviewers ParentCarer reviewer Holds ordinary membership or Fellowship of RCPCH and is in good standing Has current registration with General Medical Council / Nursing and Midwifery Council / Health and Care Professions Council (as applicable) and is not subject to any sanctions Experience Is currently working in active clinical practice in the NHS 180305 Peer reviewer - role profile March 2018 March 18 Page 15

Has at least 3 years working in active clinical practice within the NHS as a: Paediatric reviewer Other clinical reviewers ParentCarer reviewer Paediatrician with special interest in diabetes Paediatric Diabetes Specialist Nurse Paediatric Diabetes Specialist Dietitian Clinical psychologist with interest in paediatric diabetes Is up to date with continuing professional development Has direct experience of a paediatric diabetes service as either a patient, parent or carer or their representative Skills Has good interpersonal and communication skills, with tact and diplomacy, the ability to listen and engage effectively Can conduct interviews sensitively using careful questioning appropriate for the audience Is able to see beyond their own experience, and can think broadly about issues encountered during a review Has good organisational and planning skills and can meet deadlines Works within own limits of competence and understands sources of potential support and expertise and how to access this 180305 Peer reviewer - role profile March 2018 March 18 Page 15

Paediatric Other clinical reviewer reviewers Is able to seek out, interpret and reference relevant standards and guidance ParentCarer reviewer Is able to judge the relevance of information collected during a review and is able to give weight to (prioritise importance of) relevant information collected Is able to foster, contribute to and promote a collaborative team environment Is able to remain impartial, non-judgemental and objective Can provide clear and logical feedback Is able to record accurately information obtained during interviews Is able to judge / review against a standard Has intermediate IT skills (e.g. email management, document editing/proofreading skills) Knowledge Understands the role and scope of a peer reviewer and is prepared to work within it Understands the current political and managerial structures within the NHS and policies which underpin them. Has up to date knowledge of relevant service standards, guidelines and publications, and their application 180305 Peer reviewer - role profile March 2018 March 18 Page 15

Paediatric Other clinical ParentCarer reviewer reviewers reviewer Knowledge of mechanisms for service user involvement Knowledge of outcome measures for service delivery and design Knowledge of the requirements of information governance Attitudes Is motivated and conscientious Is aware of their own and others biases / prejudices. Demonstrates objectivity and neutrality whilst conducting a review and is able to develop their own strategies for dealing with potential challenges to this Demonstrates respect of and for colleagues Is resilient and objective particularly in situations of conflict Is committed to keeping up to date and fit to practise in the role of a peer reviewer Other Reviewers would normally be resident in England or Wales. Is prepared to travel outside their local area Understands NHS information governance requirements (will be covered at induction training) 180305 Peer reviewer - role profile March 2018 March 18 Page 15