Frequently asked questions

What is Major Review?

Major Review is the method that has been developed to enable a team of peers to quality assure all NHS-funded higher education programmes in England during the period 2003-06.

Major Review is part of the Department of Health’s (England) (DH) move towards integrating and streamlining existing quality assurance mechanisms used in healthcare education. It forms one element of the DH’s National Quality Assurance Framework.

Who is responsible for Major Review?

The DH, in partnership with the Nursing and Midwifery Council (NMC), the Health Professional Council (HPC) and Workforce Development Confederations (WDCs)/Strategic Health Authorities (SHAs), has contracted with the Quality Assurance Agency for Higher Education (the Agency) to manage the Major Reviews.

What are the key aspects of Major Review?

• It includes scrutiny of practice as well as campus-based learning.
• Reviewers are drawn from practice as well as academic backgrounds.
• It uses key government initiatives, such as the NHS standards and national service frameworks, as points of reference.
• It addresses regulatory and professional body requirements.
• It considers interprofessional education.
• Reviewers operate as a team, on behalf of all partners and stakeholder groups.
• The review reports document judgements in relation to fitness for purpose, fitness for practice and fitness for award.
• Enhancement is an important outcome of the process.

What does Major Review look at?

For all NHS-funded healthcare programmes Major Review looks at two interdependent areas:

• Academic and practitioner standards: concerned with the appropriateness of the intended learning outcomes (in relation to relevant subject benchmark statements, the qualifications framework and the overall aims of the provision); effectiveness of curriculum design and assessment arrangements (in relation to the intended learning outcomes); and the actual achievement of students;
• The quality of learning opportunities: concerned with the learning opportunities offered to students. Judgements are made against the broad aims of the provision and the intended learning outcomes. The effectiveness of learning and teaching, student progression, and learning resources and their effective utilisation are considered.

Major Review also looks at how the higher education institution (HEI) and partner placement providers work jointly to establish, monitor and maintain effective placement environments.

What is included in a Major Review?

All pre-registration, post-registration and continuing professional development (CPD) taught programmes - at undergraduate and postgraduate levels where the NHS funds the majority.

The disciplines include:

nursing	midwifery	health visiting
audiology	clinical psychology	dietetics
occupational therapy	operating department practitioners	orthoptics
paramedics	physiotherapy	podiatry (chiropody)
prosthetics and orthotics	radiography (diagnostic and therapeutic)	speech and language therapy

What is produced from a Major Review?

The outcome of a Major Review is the publication of a Major Review report and action plan. The report contains the judgements made, the accompany commentary and a list of summary bullet points (identifying strengths, weaknesses and good practice) that need to be addressed in the action plan.

As the report approaches publication the healthcare education providers (HEIs and SHAs/WDCs) prepare an action plan in consultation with Trusts and other partner placement providers to build on strengths identified in the report and to address any aspects to be improved. The action plan will be published as part of the report and form a part of the ongoing monitoring process.

The vice-chancellor and the chief executive/s of the relevant HEI and SHA(s)/WDC(s) must sign off the completed action plan before it is sent to the Agency.

What does Major Review replace?

• SHA/WDC – the quality element of fundamental/contract review.
• NMC - Annual Monitoring for that year of Major Review. The self-evaluation document acts as the annual monitoring report. The NMC will inform the Agency of the 20% of NMC approved provision that needs to be looked at. The review team will include a NMC Visitor. Note, the NMC Visitor is first and foremost a member of the review team. See NMC Quality Assurance Fact Sheet L/2003 The Monitoring Process (England).
• HPC – the HPC is signed up to Major Review in principle but not yet in the position to identify how its quality assurance mechanisms might link with Major Review. The HPC has set up Professional Liaison Groups (PLGs) to take work forward on HPC standards of education and training, approval and reapproval and continuing professional development. As HPC agree how their quality assurance mechanisms will integrate with Major Review further details will be published and these FAQs updated.

What is the Handbook for major review of healthcare programmes?

The Handbook for major review of healthcare programmes (2003) describes the method and procedures for carrying out Major Review in England, the academic and practitioner standards achieved, and the quality of learning opportunities provided.

The Handbook can be downloaded from the Agency's web site or ordered from the distributors Linney Direct

Who has an interest in the Major Review of healthcare programmes?

• Statutory regulatory bodies and professional bodies;
• Higher Education Institutions (HEIs);
• NHS Trusts;
• Strategic Health Authorities (SHAs)/Workforce Development Confederations (WDCs);
• Service users and carers;
• Other health and social care providers;
• The public;
• Students.

What is the self-evaluation document?

The self-evaluation document (SED) forms the basis for a Major Review. For each Major Review the relevant HEI/ SHA(s)/WDC(s) and Trusts, working in partnership, produce a single SED that allows them to reflect on what it does and why, and the methods it uses to fulfil its aims. A team of reviewers analyses the SED, and then visits the HEI and partner placement providers to gather the evidence needed to verify the claims made in the SED and make their judgements.

The SED must be signed off by the relevant HEI (vice-chancellor) and SHAs/WDCs (chief executive/director) (on behalf of their constituent members) for each Major Review before it is sent to the Agency.

What judgements are made?

• Academic and practitioner standards – ‘confidence’ or ‘no confidence’ - concerned with the appropriateness of the intended learning outcomes (in relation to relevant subject benchmark statements, the qualifications framework and the overall aims of the provision); effectiveness of curriculum design and assessment arrangements (in relation to the intended learning outcomes); and the actual achievement of students;
• The quality of learning opportunities – ‘commendable’, ‘approved’, or ‘failing’ - concerned with the effectiveness of learning and teaching, student progression (in relation to recruitment, support for students, and progression through programmes), and learning resources and their effective utilisation.

Separate judgements are made on the academic and practitioner standards for each of the benchmarked areas. All judgements can be differentiated by programme, mode and level.
Judgements are given in the Major Review report that is published after the review.

What happens on a review?

Review normally happens over a period of six weeks, with normally five visit days to the higher education institution and practice placements. Reviewers explore evidence to verify or support the claims made in the self-evaluation document produced by the HEI/Trusts and SHA(s)/WDC(s). A final judgement meeting is held at the end of the review period.

Example model of preparatory meeting and visit days

The normal model for the review is:

• The SED is submitted to the Agency eight weeks before the start of the review (day 1).
• Preparatory meeting with key subject staff, the Major Review Facilitator (MRF), the Practice Review Facilitator (PRF) and the review coordinator (CR) four or five weeks before the start of the review.
• Day 1 – meetings with subject team, meeting with students identified by providers, review of learning resources on campus, review of documentation eg external examiners reports, module handbooks, programme specifications, student work etc.
• Day 2 practice placements visits agreed at preparatory meeting. The CR remains in the work room and does not go out on visits to practice placements.
• Day 3 practice placements visits based on the review team’s discussion at end of day 2.
• Day 4 – second student meeting, meeting with practice staff, additional meeting with specific staff, review of student work – if required.
• Day 5 – finish documentation/student work/final queries. Hold the final meeting to form judgements and finalise key points. Oral feedback of the judgments alone is provided by the review coordinator to key staff only.

Who undertakes Major Reviews?

Review teams are made up of registered practitioners, from practice and academic backgrounds, led by a (non subject-specialist) Review Co-ordinator with normally two reviewers per discipline. The number of and type of reviewers reflects the size, range and complexity of the education provided. The maximum size of the review team is normally eight reviewers. However for large provision in a single review the team size may be up to 12 reviewers.

Each reviewer is contracted for 7.5 days of work to take account of preparation before the visits, work between the visit days and writing the section/s of the report for which they are responsible. Each reviewer undertakes an intensive three-day training programme.

Further information about becoming a reviewer, including nomination form, can be found here.

How many reviews will take place?

In total we expect there to be about 100 reviews during 2003-06. With approximately 20 reviews taking place in 2003-04, 40 in 2004-05 and 50 in 2005-06.

What documentation do the review team use during the review process?

In addition to the Handbook for major review of healthcare programmes (2003), reviewers use a series of external reference points to help them verify the claims in the SED and make their judgements. The external reference points include:

• NHS policies, for example, Improving working lives;
• NHS frameworks;
• the emerging health professions framework for benchmarking, professional and other regulatory requirements;
• programme specifications produced by the HEI/SHA/WDC;
• subject benchmark statements (see below);
• the Framework for Higher Education Qualifications (FHEQ),
• and the Agency's Code of practice for the assurance of academic quality and standards in higher education, especially the sections on placement learning and programme approval, monitoring and review, assessment of students, external examining and collaborative provision.

Which health subjects have been benchmarked?

Dietetics; occupational therapy; orthoptics; physiotherapy; podiatry; prosthetics and orthotics; radiography; speech and language therapy; health visiting; midwifery; nursing. Statutory regulatory body and professional body standards are included within the benchmark statements. From this work the emerging health professions framework has been developed.

The Agency has also been contracted by the DH to produce six further benchmark statements in healthcare from the following:

• Audiology
• Arts therapy
• Applied psychology including clinical psychology
• Clinical science
• Paramedics
• Professions allied to dentistry
• Operating department practitioners

How is the process managed during a review?

The contract is managed by the Agency's Assistant Director (Major Review) and supported by the Health Team (see below for contact details).

The review team is led by a non-specialist, experienced review coordinator (CR) who manages the review itself.

Acting as the lead point of contact between the HEI and the review team, and nominated by the HEI, is the Major Review Facilitator (MRF) – a non subject specialist (academic or administrator) in a senior position who has an understanding of quality assurance and institutional policy (further details can be found in Annex H of the Handbook for major review of healthcare programmes [2003]).

Acting as the lead point of contact for the SHA(s)/WDC(s) and linking with the MRF is the Practice Review Facilitator (PRF). The PRF should be a senior member of SHA/WDC staff with a strategic role (see annex E, Handbook for major review of healthcare programmes [2003]).

What happens if a HEI contracts with more than one SHA/WDC?

The SHAs/WDCs should, between themselves, identify a ‘lead SHA/WDC’ from whom the Practice Review Facilitator (PRF) can be nominated. The remaining SHAs/WDCs should then identify a ‘key person’ in each SHA/WDC with whom the PRF can liaise.

How has the Agency identified the HEIs/WDCs to be reviewed and the provision to be included?

Each HEI and SHA/WDC has completed a scoping and preference form which has collected information about:

• which SHA(s)/WDC(s) commission the provision from an HEI;
• the programmes delivered (including level, mode, student numbers);
• where the programmes are delivered;
• the organisations/Trusts providing the placements;
• the preferred date for the Major Review.

From this information a draft schedule has been put together identifying, in the first instances, the term and year of the review for each HEI and SHA/WDC. Note, where the provision covers more than six professions, or the HEI/ SHA/WDC has given a specific reason, two reviews might take place. Consideration has also been taken into account of when other Agency review methodologies, for example, Institutional Audit, are taking place and other professional, statutory, regulatory body visits are taking place.

Prior to the review there will be an opportunity for the HEI/SHA(s)/WDC(s) to update the Agency on any new provision that needs to be included in the review.

When do visits to practice placements take place?

Visits to practice placements will normally take place on Day 2 and Day 3 of the review. The reviewers will visit, in pairs, a series of practice placements that help in the verification of the claims made in the SED.

How are visits to practice placements selected?

The placements visited will be selected in negotiation with the HEI/SHA(s)/WDC(s) and can be in the private sector as well as in Trusts. Guidance for reviewers about visits to practice environments can be found in Annex H of the Handbook for major review of healthcare programmes (2003).

As a practice placement might take students from a range of HEIs, a list will be kept of placements visited to prevent duplication of visits.

Where placements are spread over a large geographical area the relevant reviewers might visit a placement(s) at an appropriate time outside the visit days.

How does Major Review fit into the work of the DH?

Major Review is one part of the DH’s National Assurance Framework and links with work on ongoing quality monitoring and enhancement, approval and reapproval of programmes, subject benchmark statements and the evidence base (figure 1 below). For further information see the publication Streamlining quality assurance in healthcare education – Purpose and action


Figure 1 Five Elements of the National Quality Assurance Framework (Department of Health 2003)¹

Has the Major Review methodology been tested?

During 2002, the Agency conducted six prototype reviews in six HEIs in England. This work was done under contract with the DH, in partnership with the NMC, the HPC and the SHAs/WDCs.

An example report was developed from the experience of the prototype reviews to show how the reviews might be reported in Major Review. This example report reflects the issues and outcomes from reviewing healthcare programmes; it is longer than ‘normal’ review reports in order to provide a wide range of issues for discussion and debate.

The prototype review reports are currently being converted into Major Review reports and will published on the this web site in due course.

Were the prototype reviews evaluated?

A range of evaluation activities were undertaken and informed the development of Major Review. The Agency undertook a detailed internal evaluation process. The subsequent report can be found here. The DH commissioned an independent evaluation report.

The evaluation activities also informed the roles of each stakeholder in the move toward integrating and streamlining the procedures for monitoring quality.

In preparing for Major Review a series of consultation activities with the partners and key stakeholders involved, have taken place including the Major Review Working Group and Reference Groups.

Further information

Handbook for major review of healthcare programmes (2003)
Evaluation report on the prototype reviews (Dec 2002)
Example report prototype reviews (Dec 2002)
Health Professions Council web site
Nursing and Midwifery Council web site for quality assurance
Department of Health (England) Learning and Personal Development Division
Department of Health (England) Quality Assuring Nursing, Midwifery, Allied Health Professions Education

Health team contact details:
Assistant Director; Patricia Le Rolland; tel: 01452 557018; email: p.lerolland@qaa.ac.uk
Development Officer; Elaine Harries Jenkins; tel: 01452 557120; email: e.h.jenkins@qaa.ac.uk
Project Officer; Dawn Blackwood; tel: 01452 557112; email: d.blackwood@qaa.ac.uk
Project Officer; Sam Emanuel; tel: 01452 557121; email: s.emanuel@qaa.ac.uk
Administrator; Sam Wootten; tel: 01452 557111; email: s.wootten@qaa.ac.uk

¹ Department of Health (2003) Streamlining quality assurance in healthcare education: purpose and action.

Return to document