Approved Clinician portfolio of evidence

Are you seeking initial Section 12(2) approval?

Compiling your portfolio and Collating Evidence

The use of A.I. (Artificial Intelligence) in any of the documentary evidence in the portfolio is prohibited.

NB: It is important that the Portfolio Contents list is followed in order to set out the Portfolio in the correct order. This will also act as a guide to ensure you have submitted all of the documents required for the Panel to complete their assessment.

Attached, you will find detailed information and guidance to help you compile your portfolio. Please ensure that you read all of the information carefully.

The portfolio must be presented in a folder and be well prepared for presentation to and assessment by the All Wales AC Approval Panel Members.

All contents of the portfolio must be anonymised fully, ie do not use patient initials, use patient A or B. When referring to another doctor, do not use initials, say consultant forensic psychiatrist, staff grade, general adult psychiatrist etc, the same for other professionals. When referring to a relative just say son, daughter, mother etc. No ward or hospital names should be included. The Panel don’t need to know where the patient is hospitalised or where they live. You must include evidence of mentoring and shadowing an AC/RC (Responsible Clinician) shadowing an AMHP for a minimum of half a day, not just undertaking section 12 assessments.

You must include statutory Welsh regulation sample Mental Health Act forms that only an RC can complete, with a reflective commentary on your emotional journey with the patient and your part in the decision-making process. Doctors must include 360 degree feedback.

You must include a reflective role of the AC/RC and how you will use the approval once your become an AC/RC.

Please only include information relevant to demonstrate you possess the competencies required for AC approval. The portfolio must be all your own work. Plagiarism results in a referral to the GMC/NMC/HCPC/SCCW.

All evidence submitted in your portfolio should be the most recent example and should be dated accordingly (month and year). Evidence must not be more than two years old when the Panel assess it.

What sort of evidence is acceptable?

Suitable evidence can be divided into two main categories – direct and indirect.

Direct evidence can include a variety of the following:

• Case Studies
• Your performance being observed by a senior clinician
• Projects or work based assignments
• Personal reports
• Minutes of meetings, action plans, progress reports
• Internal and external correspondence
• Prior qualifications which relate directly to the competencies
• Case discussions
• Reflections on practice – NB these could include reflections on ones own weakness, demonstrating a knowledge of the weakness and of ways to improve this
• Course assessments

Strengthening Evidence

• Case studies describing your part in relation to a specific role can provide evidence to a number of competencies especially when the relevant and anonymised reports/documents are also referenced eg tribunal reports
• Multiple pieces of evidence may be needed for each competency/subsection of competency.
• Attendance at courses is not sufficient to demonstrate knowledge. This can be supplemented by discussion of and reflections on the course and how it will affect practice, copies of any written tests or assignments from the course or written confirmation from the course assessor that you possessed the knowledge relevant to the appropriate frequency. It may be useful to ask a course tutor or experienced colleague to assess your knowledge following the course. Their assessment should detail what has been learned and not simply make general statements.
• Meetings eg MDT, POVA, Risk Meetings, Section 117 planning or aftercare meetings – Make it clear in any discussions that you were involved in the discussion, that your involvement helps to demonstrate the relevant competency and the minutes are signed by another attendee.
• Case discussions – These can be undertaken solely for the purpose of demonstrating the competency. They should be specific to the competency and witnessed by someone involved in the case.
• Witness signatures – When verifying advanced competencies, only use people experienced and skilled enough to be able to verify competencies, for example be wary of using students.

Cross-referencing

It is vital that you cross-reference your evidence to the competencies within the portfolio. There should be an index listing your evidence, each piece of evidence should be numbered and be referenced.

Nine (9) Competencies required for AC approval:

Applicants seeking approval are required to demonstrate a comprehensive overall understanding of the role of the AC, including the specific role of the RC, as well as the legal responsibilities of and the key functions reserved to the RC.

The competencies as outlined in the MHA Directions (Wales) 2018 are as follows:-

1. The role of the approved clinician:

1.1 A comprehensive understanding of the role, legal responsibilities and key functions of the AC and the RC.

2. Values based practice:

2.1 The ability to identify what constitutes least restrictive health and social care for those dealt with or who may be dealt with under the Act.

2.2 Understanding and respect of an individual’s qualities, abilities and diverse backgrounds.

2.3 Sensitivity to individuals’ needs in terms of respect to the patient and the patient’s choice, dignity and privacy whilst exercising the role of AC or RC.

2.4 The ability to promote the rights, dignity and self-determination of patients consistent with their own needs and wishes, to enable them to contribute to the decisions made affecting their quality of life and liberty.

3. Assessment:

3.1 Able to identify the presence or absence of mental disorder and the severity of the disorder, including whether it is of a kind or degree warranting the use of detention under the Act.

3.2 Able to undertake a mental health assessment incorporating biological, psychological, cultural and social perspectives.

3.3 Able to assess all levels of clinical risk, and the safety of the patient and others within an evidence based framework for risk assessment and management.

3.4 Demonstrate a high level of skill in determining whether a patient has capacity to consent to treatment.

4. Care Planning

4.1 Possesses the skills and knowledge necessary to undertake safe, effective and efficient care planning, being able to:

• (a) involve patients and (where appropriate) their families and carers in care planning;
• (b) assess patients’ needs;
• (c) formulate individual care plans to meet identified needs;
• (d) ensure that care plans are implemented as agreed;
• (e) review and evaluate care plans (and revise as necessary),

5. Treatment

5.1 Has the skills and knowledge necessary to harness the specialist treatment expertise of the multidisciplinary team, for the benefit of the patient. Specifically, must be able to understand the roles and specialist competencies of the various members of a multidisciplinary team, in relation to specific treatments and therapies.

5.2 Broad understanding of all mental health related treatments, i.e. physical, psychological and social interventions.

6. Leadership and Multi-Disciplinary Team Working:

6.1 Possesses the skills and knowledge necessary to:

• (a) lead effectively a multi-disciplinary team in the delivery of co-ordinated programmes of care, in order to meet the needs of patients for whom he or she is responsible;
• (b) take into account the views and opinions of patients and (where appropriate) their families and carers when developing programmes of care involving the team;
• (c) consider objectively the professional opinions of other colleagues within the team when formulating programmes of care, so as to ensure that care and treatment decisions are multi-disciplinary and based on sound evidence.

6.2 An advanced level of skills in making and taking responsibility for complex judgements and decisions, without referring to supervision in each individual case.

7. Equality and Cultural Diversity:

7.1 Demonstrates an up-to-date knowledge of race equality legislation and other equality issues, including disability, sexual orientation and gender.

7.2 Has a broad grasp of issues of social exclusion.

7.3 Understands the need to promote equality and diversity.

7.4 Aware of how cultural factors and personal values can affect practitioners’ judgements and decisions in the application of mental health legislation.

7.5 Ability to identify, challenge, and where possible redress discrimination and inequality in all its forms in relation to approved clinician practice.

8. Mental Health Legislation and Policy:

8.1 Up to date working knowledge of;

• (a) the Mental Health Act;
• (b) relevant NICE Guidelines;
• (c) other relevant related legislation (including the Mental Capacity Act 2005, the Mental Health (Wales) Measure 2010, the Mental Health Review Tribunal (Wales) Practice Direction, the Human Rights Act 1998 and Children Acts;
• (d) All other relevant codes, national policies and protocols related to mental health;
• (e) Case law relevant to the practice of approved clinicians and responsible clinicians.

9. Communication:

9.1 Able to communicate effectively with professions, service users, carers and others, particularly in relation to decisions taken and the underlying reasons for these.

9.2 Consideration of the needs of individuals for whom Welsh is their language of choice.

9.3 Able to demonstrate appropriate record keeping and an awareness of the legal requirements with respect to record keeping.

9.4 Ability to compile and complete statutory documentation and to provide written reports as required of an approved clinician.

9.5 Ability with regard to effective report writing.

9.6 Ability to competently present evidence both verbal and written, to courts and tribunals.

How may an applicant acquire or demonstrate that they have the competencies required for AC approval?

In demonstrating competence, applicants may draw on a range of evidence, but as a minimum, should provide:-

1. An index-contents page referencing each item submitted including an appendix referencing evidential documents and reports.

2. Documentary evidence of your professional qualification.

3. Evidence of current full registration with the regulatory body for your profession.

4. An up to date Curriculum Vitae pertinent to this application. It should include:-

• All employment which must be presented in the format of: name of current and previous roles in chronological descending order. The name of current employer and postal address, date employed ‘from’, title of role and description of senior clinical duties and responsibilities must be included. All previous employment must also be documented utilising the above format and include dates the previous employment ended. All Curriculum Vitaes must include the dates of employment FROM and TO in the format of day, month and year (not just the month and the year).
• Periods of shadowing you have undertaken; which service you have worked in and the name/s of the AC/RCs who have been involved in shadowing and mentorship (see Testimony form Appendix B).
• Qualifications, including if MRCPsych has been achieved (medical applicants).
• Detail of Section 12(2) approval (medical applicants).
• Periods and nature of on-call work (medical applicants).

5. A summary of your experience and skills and experience relevant to each competency, how these were acquired and cross-referencing the supporting evidence.

6. Evidence of completing an accredited statutory “initial training” course for approval as an AC within the two-year period immediately preceding the date of the application.

7. Reports and commentaries:-

• a) A maximum of two relevant, succinct and anonymised, statutory reports, eg two Mental Health Review Tribunal (Wales) reports or two Hospital Managers Hearing Reports or a combination of both reports, which you have prepared. The two statutory reports may be hypothetical (ie they may have been prepared solely for the purposes of the AC application and as though for a statutory purpose), but must be based on your actual personal contact with a patient.
• b) Two anonymised, concise, case commentaries relating to your 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 Wales MHA Code of Practice. These commentaries could relate to the same cases as the above statutory reports.

8. Two references from suitably qualified professionals in a senior role who can validate your aptitude for the AC role, one of whom must be an AC. Your mentor/s could provide such testimony.

9. A 360 degree appraisal or equivalent that should, as a minimum, include your immediate line manager/supervisor, multi-disciplinary team colleagues, an AC and, if practicable, a service user, carer or advocate (IMHA).

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

11.Evidence of shadowing and mentorship: Please note that shadowing and mentorship should include a sequence of observing, participating in, and being observed to have demonstrated capability for the competency and for executing decision. Evidence is required for each of the nine competencies and especially for the decisions reserved to the RC. This should be in the form of written confirmation from the AC/RC you are shadowing and/or who is the RC who holds actual responsibility for patients that you are looking after, that you have – on more than one occasion – shadowed the AC/RC and have undertaken the competency sequence of observing, participating in, and being observed to have demonstrated capability.

You must provide a log of experience and the associated AC competency affirmed by the mentoring RC(s). The Testimony of Demonstration of Competencies pro-forma (Appendix B) is suitable for that purpose.

12.Evidence of CPD such as registration for CPD with the Royal College of Psychiatrists, and a certificate of good standing from your professional or statutory body.

Medical applicants must be professionally up to date. Psychiatrists are usually registered with the Royal College of Psychiatrists CPD scheme for which a certificate of good standing should be provided with their application. Psychiatrists who are not registered with the Royal College should be participating in a local CPD peer group, which should meet the same standards as the Royal College of Psychiatrists.

Psychiatrists: Please check the link below to check current CPD guidance issued by the Royal College of Psychiatrists. Submitting your CPD | Royal College of Psychiatrists (rcpsych.ac.uk) Applicants from other eligible professions will be required to provide evidence of CPD appropriate to their professional role and in keeping with the CPD requirements of their regulatory body. It is recommended that ALL applicants complete the pro-forma in Appendix C suitably adapted for their professional group.

13. In addition:
a) include anonymised examples of documentation, other than the case commentaries and statutory Wales MHA reports, in which you have taken a lead role without necessarily being under supervision/mentorship. The documentation should demonstrate your further understanding of a particular AC competency and the guiding principles of the Wales MHA Code of Practice and make meaningful reference to pertinent local, national and international policy or guidelines.

Examples of documentation may include descriptions of the MDT management of complex patients that evidence AC competencies, such as:

• Care plans, CTP documentation, CTP assessments, service specifications for patients being discharged, pre-admission assessments, case-based discussion, capacity assessments, SOAD request forms, clinic letters, risk assessment documentation and case note entries.

The documentation exemplified above could, for example, constitute evidence of:

• Competency 8: an applied knowledge of relevant mental health legislation, policy and guidance; and/or
• Competency 5: treatment; and/or
• Competency 6; clinical leadership.

b) It would also be useful to include completed Wales statutory MHA forms of an anonymised and, if necessary, fictitious nature, such as CO2, CP1 (CTO), CP3 (CTO extension), CP5 (CTO recall), CP7 (CTO revocation), S2/S3/37 as well as non statutory Section 17 leave internal forms. All forms should be coupled with an explanatory commentary that demonstrates your understanding of the issues involved and highlights the competency for which you are offering up evidence, for example:

• Competency 1: a comprehensive understanding of the key functions of the AC and RC; and further evidence of
• Competency 3: applied knowledge; and/or assessment

c) The anonymised care plans and reports should provide evidence that you have considered and assessed the specific needs of the patients discussed with specific regard to any disabilities they may have or with regard to any of the protected characteristics such as gender, sexuality, age etc. Any cultural issues or needs should also be addressed and evidenced:

• Competency 7: Equality and Diversity

d) You are encouraged, with the permission of the hospital managers or MHRT Wales/First Tier (Mental Health) Tribunal (FTT), to attend hospital managers’ reviews and Tribunal hearings and to present the evidence on behalf of the RC (with the RC in attendance) for renewal of detention or discharge. Where this has been possible, the RC should provide written confirmation that you have presented the case soundly and competently. Where hospital managers or the Tribunal are in agreement with your evidence, this should be highlighted as it provides good direct assurance of this competency:

• Eg Competency 9: communication

e) You should provide evidence of attendance on courses and of training undertaken, which may be pertinent to any of the specific competencies, but not certificates of CPD without reference to a competency