Guidance

Peer review framework guidance

Published 18 May 2023

1. Overview

The NHS Newborn & Infant Physical Examination (NIPE) Screening Programme has produced the NIPE peer review framework to support NIPE screening practitioners to record and maintain the practical skills required to perform the NIPE newborn screening examination.

NIPE screening practitioners can use the peer review framework to:

• demonstrate evidence of good clinical screening practice in line with current guidance (NIPE screening programme handbook clinical guidance and NHS NIPE e-learning module)
• demonstrate evidence of lifelong learning and continuing professional development
• enable local providers to demonstrate quality assurance across their NIPE screening programme
• promote consistency in practice across all disciplines (medical, midwifery and nursing)

The peer review framework is intended to be used by fully qualified NIPE practitioners as defined in section 12 of the NIPE screening programme handbook, and a peer reviewer. This can include medical, midwifery and nursing staff. Due to the clinical nature of the peer observation and review, the nominated peer reviewer must also be NIPE qualified.

Further information relating to each of these roles is provided in section 4 below.

2. Recommendations

Peer review is recommended by the national NIPE programme team (part of NHS England) to provide assurance that NIPE examinations are being completed in line with the NIPE screening programme handbook clinical guidance and the NHS NIPE e-learning module.

The regularity of peer review for NIPE newborn screening practitioners is a local decision. Providers have an organisational responsibility to ensure a safe and competent workforce.

Peer review could be used in the following scenarios (this list is not exhaustive, and below are examples only)

• at specified time intervals (for example annually or biannually)
• as part of a development programme
• in response to an incident
• on commencement of employment for newly qualified midwives or neonatal nurses

Local decisions regarding the requirement to complete peer review, or the frequency of completion, should form part of relevant local guidelines and policies.

Providers should have a local process in place for the escalation of any concerns regarding the practice of a NIPE newborn screening practitioner identified during peer review.

3. Training, maintenance of skills & continuing professional development

Please refer to the NIPE screening programme handbook for current information regarding training and maintenance of skills.

4. Requirements and expectations

This section sets out the requirements and expectations for NIPE screening practitioners and peer reviewers

NIPE screening practitioner requirements:

The NIPE screening practitioner must:

• hold a professional qualification (General Medical Council (GMC) or Nursing and Midwifery Council (NMC) registered, or be a physician’s associate)
• be a fully qualified and practicing NIPE screening practitioner as defined in section 12 of the NIPE screening programme handbook

NIPE screening practitioner expectations:

NIPE screening practitioners have a professional responsibility to keep up to date and maintain their skills in relation to the NIPE newborn screening examination. This includes engaging in continuous professional development.

Peer reviewer requirements:

The peer reviewer must:

• hold a professional qualification (GMC or NMC registered, or be a physician’s associate)
• be a fully qualified & practicing NIPE screening practitioner as defined in section 12 of the NIPE screening programme handbook
• be confident in undertaking and reviewing the NIPE newborn screening examination – ideally achieved by engaging with the NIPE annual learning framework and NIPE peer review framework.

Peer reviewer expectations:

The peer reviewer should meet the following expectations:

Impartiality – Peer reviewers must offer impartial review, providing unbiased consideration to each newborn screening examination they are asked to observe, and avoiding any conflict of interest.

Equality – Peer reviewers must approach each peer review process without regard to the race, religion, nationality, gender, or seniority of the NIPE screening practitioner.

Confidentiality – Peer reviewers must maintain confidentiality and refrain from sharing information with anyone outside of the peer review process. Local pathways should be in place for escalation of any concerns regarding the practice of the NIPE screening practitioner.

Approach – Peer reviewers must remain constructive and supportive throughout the peer review process and provide comprehensive feedback to the NIPE screening practitioner following their observations.

5. Completing the NIPE peer review framework

The peer reviewer should ensure they are up to date with current clinical guidance in the NIPE screening programme handbook and the NHS NIPE e-learning module prior to the review being undertaken.

The peer reviewer should use clinical observation to provide support and feedback to the NIPE screening practitioner, with the aim of:

• highlighting good practice
• noting any practical skills gaps/learning points which may require agreed actions

The peer review framework has 3 sections, as follows.

NIPE peer review checklist (newborn examination)

The peer reviewer should use the checklist during an observation of a routine NIPE newborn examination by the screening practitioner. Consent should be gained from the baby’s parent or carer by the NIPE screening practitioner prior to peer review.

If a NIPE screening practitioner meets all the requirements of a peer reviewer see section 4 above, it is also possible to do a peer-to-peer review, where each participant observes the other during subsequent routine NIPE newborn examinations.

Each point on the checklist (insert link) should be completed with one of 2 categories:

The screening practitioner performs the skill or procedure competently, independently, and safely

Learning points identified and agreed actions documented

NIPE peer review: good practice, learning points and agreed actions

Following the clinical observation, set aside time for the peer reviewer to provide verbal feedback to the NIPE screening practitioner.

Highlight any good practice points. Examples of good practice include:

• building good rapport with parents or carers, and using effective methods of communication and/or explanation
• identifying and addressing any potential inequalities. This could involve:
  • using interpreters effectively
  • offering written information in the appropriate language where available
  • using ‘easy read’ screening information for parents or carers with a learning disability
• optimising conditions for the screening examination and using good clinical techniques to complete the 4 screening elements (in line with current guidance in the NIPE screening programme handbook and NHS NIPE e-learning module)

The peer reviewer should discuss any identified learning points in a supportive manner, and document them within the framework alongside agreed actions. Examples of learning points include:

• gaps in clinical knowledge and understanding
• not recognising own limitations
• improvements with routine checks/manoeuvres suggested
• incorrect use of equipment

Any good practice or learning points can be used as an opportunity for shared learning across the organisation (ensuring confidentiality is maintained).

The PR and practitioner should set a date for a final discussion and review of the agreed actions. All actions should be completed prior to the final discussion and review.

Final discussion and review

The final discussion and review should be used as an opportunity for the NIPE screening practitioner and PR to revisit any agreed actions documented within the framework and ensure they have been satisfactorily completed.

Any matters remaining unresolved or requiring further escalation should be dealt with locally as agreed by the organisation.