New opportunities

Various opportunities are available to retired members that you may not have previously considered, including:

• Second Opinion Appointed Doctor service
• GMC
• Mental Health Tribunal service

Second Opinion Appointed Doctor (SOAD) service

What is a SOAD?

The Second Opinion Appointed Doctor service safeguards the rights of patients detained under the Mental Health Act who either refuse the treatment prescribed to them or are deemed incapable of consenting.

The role of the SOAD is to decide whether the treatment recommended is medically necessary, clinically defensible, and whether due consideration has been given to the views and rights of the patient, and to reach a view on capacity and consent.

As a SOAD you will reach your own independent view of the appropriateness of treatment proposed for a patient. You are not an employee of CQC.

CQC is responsible for the appointment of SOADs and for managing the SOAD service.

What does being a SOAD offer you?

SOADs say that they enjoy the opportunity to use their skills and still have patient contact, but without any continuing clinical responsibility. They can undertake visits wherever they wish, not necessarily their own immediate area, and in particular can largely choose when and where they do their visits, without being tied to any timetable of advance availability. It is therefore possible, for those who wish it, to fit in visits around other commitments be they clinical or leisure.

Those in the role also say that they find the support excellent, that the work is rewarding, contributes to patient care, keeps their brain active and allows them to use their skills in a less hectic manner, and that they see new people and new places, while being flexible so as to maintain a work-life balance that is pressure-free.

SOADs have commented that, if still in work, their experience has enabled them to improve their own practice by seeing other arenas which they would not normally encounter, and visiting a range of practice across a spectrum of quality. Also, they find that they are usually welcomed and valued by the clinicians in the units they visit.

You will have the stimulation of seeing patients in a wide variety of settings – perhaps quite different from those in which you have practiced – and will also see a variety of presentations and conditions. You are not expected to be an expert in the law, or in pharmacology, or in every aspect of every specialty or discipline.

The opinions can be for any location in England, and are approximately split into 80% medication for inpatients, 10% ECT, and 10% CTOs. There are some 16,000 requests for second opinions annually.

There are also additional developmental opportunities linked to roles in scrutinising and audit, training, and other matters depending on your interests and aptitudes.

Numbers and fees

You will see from the figure quoted above that there is no shortage of work. There is ample work to go round, more if you travel. If you do, then the standard fee is supplemented by inconvenience payments for two levels of distance, and there is also a prioritisation supplement if you can reach an ECT location within a short timeframe.

Depending upon the proximity to each other, hence travelling distance & time between them (if any), it is feasible to undertake up to four opinions per day.

The fee per opinion is £200.

We expect you to do a minimum of 40 opinions per year. You may of course do more.

How do I apply?

SOAD vacancies are advertised on (and must be applied for via) the CQC website. Candidates must meet the following criteria to be eligible to apply for the role:

• You must be a Registered Medical Practitioner, with no conditions on your registration, and with a licence to practice – or, if you have voluntarily relinquished your licence as some do upon retirement, be able to regain it (see below for information on appraisal and revalidation support).
• You must be a Consultant Psychiatrist with at least 5 years’ experience.
• You must be a Member or Fellow of the Royal College of Psychiatrists.
• You must be approved under Section 12(2) at the point of application (or, if you have recently retired, have been approved within the preceding 12 months). This is an entry criterion – you do not have to maintain approval thereafter.

Interviews take place episodically in various locations around the country. We aim for an approximate response time of 8-10 weeks between receipt of application and an interview; this will vary depending upon demand and location.

SOADs can be in regular (part or full-time) employment with a provider organisation, be a portfolio doctor, or be retired.

If you are retiring, considering retirement, or considering a new chapter in your career, it may be possible to time the process so that if you wish you can transition relatively seamlessly from active RC to SOAD.

Is there support?

Though the role is individual, there are a number of support mechanisms. At any point you can make contact with a number of experienced SOADs who are available to offer advice should you wish, and there is significant administrative support available by telephone and email from a helpful and experienced team at the SOAD operations base in Nottingham. In addition, a voluntary mentoring scheme is available for newly recruited SOADs which offers options for accompanied visits at the beginning of your new role.

Is there training?

There is induction training for newly appointed SOADs – a one-day intensive course in Nottingham where you will also meet members of the team; this gives you several hours of CPD. There are online and paper-based materials. The first handful of your opinions will be checked in depth and you will have written and/or verbal feedback to ensure you are on the right track with regard to legal and practice issues. Thereafter there are episodic quality checks and audit, and the results are offered to you annually for use in appraisal.

In addition, a training event takes place annually each spring for which CPD certificates are given. Updates are provided by email for any new matters which may arise, and there are very occasional extra ad-hoc training days.

Appraisal and revalidation support

Some 2/3 of the SOADs are in regular employment and link to a Designated Body in the usual way. The remaining 1/3 have the opportunity to link voluntarily, subject to meeting some basic criteria, to the Principal SOAD who is a GMC appointed Suitable Person – an equivalent to a Responsible Officer for a defined cohort of doctors with a common link based upon what they do.

Annual appraisal is arranged with a network of appraisers, using the MAG form with which most will already be familiar. Quality Improvement information and audit is provided for and with you, and there is a network of SOAD peer groups across the country. CBDs can be done in peer groups or in the annual training event. A bespoke 360 feedback tool meeting GMC requirements has been developed for this niche role. All of these services are at no cost to SOADs.

Who do I contact?

You can have an informal discussion on any aspect of the role by emailing Andrew Easton, Principal SOAD or Craig Jennings, Operations Manager for the SOAD service. You may already know one or more SOADs in your area – we can put you in touch with current SOADs who would be happy to talk with you.

You can apply to become a SOAD on the CQC website, or if you have any further queries, please email recruitment@cqc.org.uk.

Other jurisdictions

SOADs appointed by CQC may only work in England.

Wales

For information about how to apply to become a SOAD in Wales, please contact Health Inspectorate Wales.

Scotland

The role in Scotland is significantly different, the broad equivalent to a SOAD being the Designated Medical Practitioner; as will be well-known the legislative framework differs, as do the eligibility criteria.

For more information, please see the Mental Welfare Commission for Scotland website (under 'Becoming a DMP') or email mwc.admin@nhs.scot.

GMC

The GMC recruits for medical associates to help them deliver some of their key roles where medical expertise is required. The GMC has a range of associate roles available and more information is available on their website.

Each associate role will have a different level of time commitment each year but will range up to around 20 days per year and full training and induction is provided.

You can register an interest in working as an associate by emailing associateservices@gmc-uk.org. You will then be sent an email about vacancies as and when they are advertised. There are usually two stages; an online application form and an interview/selection exercise.

Mental Health Tribunal service

Why become a mental health tribunal doctor?

There are several reasons that experienced psychiatrists may choose to work for the mental health tribunal service. You will continue to use your skills, earn money and see the view for the other side of the table. If you continue to work, visiting other hospitals and services that you may never have had the opportunity to visit (brain injury units, units for challenging patients with dementia, CAMHS services, high secure hospitals) helps to protect against burnout – you take evidence from teams and interview patients, but have no continuing responsibility. The legal knowledge you will acquire at induction and ongoing training is also a new area for most psychiatrists.

What is the role?

Most psychiatrists are experienced at presenting evidence to the tribunal panel; tribunal medical members give an opinion on the following to the legal member and specialist lay member and contribute to the reasons writing:

• Specialist clinical information to the tribunal regarding statutory criteria.
• Appropriate treatment.
• Capacity, if the patient isn’t represented.
• Order of evidence.

What are the Judicial Appointment Commission (JAC) requirements to apply to become a Tribunal Doctor?

Applicants must:

• be a registered medical practitioner (but are not required to have a Licence to Practise)
• have held a full-time or part-time appointment as a consultant psychiatrist for at least three years, one of which should normally be within the last five years; this can be a long term locum
• be aged 65 or less at time of application (so can offer at least 5 years of service)
• have membership of the Royal College of Psychiatrists at any of the following levels:
  • Member
  • Fellow
  • Specialist Associate (not Associate Specialist/SAS Dr)
• have unconditional registration with the GMC
• be able to offer (currently) 20 days per year and attend 2 training days

What is the fee?

As of March 2019 the fee is £488 per hearing day (sitting fee) plus £183 per pre-hearing exam (when done).

What training is provided?

There is a two day paid Medical Members Induction, three observations of tribunal hearings before sitting, a mentor for one year after appointment and an online discussion forum for MMs who have just been inducted.

Ongoing training is two paid days per year (counts for CPD), information is circulated about any case law, and there is elearning for any new legislation.

Considering my career plans, when should I apply?

If you are still working (NHS/independent), make sure you can offer 20 days per year. The process from advertising to completing observations/induction is about one year. Recruitments have been held in 2010, 2012, 2013, 2014, 2016 and 2018, so on average every two years.

How to I apply?

Create an account on the Judicial Appointments Commission (JAC) website and register an interest.

You will then be sent an alert when the process begins. There are two stages: an online application form which must be completed according to JAC requirements and an interview/selection exercise.

For further information and an informal discussion for posts in England, contact Dr Joan Rutherford, Chief Medical Member.