Saturday, 5 November 2011

GMC Reform vs Revalidation of Doctors & Nurses

What we want to ultimately achieve is patient safety.

The Daily Mail details how a mentally ill patient was discharged early from the Queen Elizabeth Hospital, in Woolwich,  and went on to kill a grandmother an hour later. A local GP explained to me that this hospital has a large mental unit.

I sit on the Department of Health payment by results panel and they propose fining NHS hospitals if they keep patients in too long and fining hospitals who overspend, ie 2 deviations from the mean. Next meeting is coming Tuesday. This emulates the US RAC attack. Here the US hire private companies to audit hospitals medicare charges and if deemed to overcharge, the hospitals are fined
in the multimillion dollars range!
This is what happened again at the Queen Elizabeth Hospital on 27 October 2011. Understaffing and £1m cuts lead to further risk to the public as a missing mentally ill patient wanders off out of hospital into the public!

This is the same hospital that consultant urological surgeon Mr Ramon Niekrash was suspended for whistleblowing to executive management that his cancer patients were not being seen by him for months, as their appointments kept being cancelled by the hospital. He is now appealing for damages after suspension which led to loss of income. He suffered £180k in legal fees for standing up in
an employment tribunal and challenging the suspension. Better if management had included his input as to how to better provide and improve patient services at Queen Elizabeth Hospital.

Neighbouring Queen Mary in Sidcup closed its large accident and emergency department due to NHS funding cuts. Is it safe for patients to continue to close and cut services?

So how do we ensure patients are safe? Bad GPs are already referred up to the PCT or GMC by all doctors, nurses and patients. In fact the GMC has seen a surge in doctor referrals as everything from swearing, wagging a finger, shouting, seems fit to be referred up instead of dealt with locally.
Who was to blame for Shipman? Shipman was caught self prescribing a narcotic pethidine which is an injection and not a tablet and was found to keep passing out. He too was referred early to the GMC. Any doctor would know this was a serious red flag concern that a doctor was dangerous!  The GMC failed to strike him off. Had they removed his license, he would not have proceeded to be responsible for 216 confirmed cases of patient deaths. If he got a warning, how many of his patients know to check their GP's GMC number to see whether a warning for 5 years has been placed on his medical license?

Would revalidation identify Shipman? No. Paperwork is paperwork. All you need is a good medical student to come to your surgery and type up the paperwork, fill in the boxes, compile a practice audit, hand out patient surveys, ask your staff to rate you their boss (conflict of interest) and suddenly the public think they are reassured their GP is not a Shipman?

What is needed to ensure patient safety? reform of the GMC. I am so pleased the GMC now reports to Parliament's Health Committee but who sits on this committee? MPs? What about
doctors who know what pethidine means? Or that propofol which killed Michael Jackson is a drug for hospital anaesthetists to inject, anaesthetise a patient for surgery in an operating room, intubate and then monitor and chart vital signs every few minutes as there is no antedote to propofol as there is to pethidine if picked up in time. Perhaps a system by which referring doctors may appeal GMC cases where they think the public are still at risk of a dangerous doctor the GMC have let off?

Monitor is now the regulatory body for NHS hospital trusts. Poor management have hit the gross misconduct dismissal or GMC referral button instead of sit down with difficult doctors who fight for better service and treatment of their hospital patients. Consultant paediatrician Dr Kim Holt
refused a £120k payout and spoke up that her community clinic was understaffed and vulnerable children in Haringey were being put at risk from under resourcing. Better to have worked with her, a positive deviant, to find a way to provide a service with limited NHS resources than pay for 4 years of 'garden leave' to keep her away from the hospital premises. Baby P could have been saved.

Need to further delay revalidation as systematic bias has been identified by the Peninsula Study on patient surveys against locums, GPs, and non UK trained GPs...we need time to revisit how to properly ensure public safety. The IDF revalidation pilot is also still in progress.

Many doctors may not complete the GMC consultation response papers which ask all sorts of personal details at the end, name, address, job, and so on and so forth so it is hardly anonymous. If it is the GMC who need reforming, who will dare give out personal details and complain about revalidation? The GMC has now come up with a 2012 draft guidance for doctors which contains 82 rules! 82 ways that GPs may be referred to the GMC and includes private life activities too!

NHS Whistleblowers live in fear of a malicious GMC referral. Hospital consultants keep silent over hospital mishaps (missing patients as there are so many patients admitted and moved from ward to ward to ensure same sex policy that they do not know who they are covering, etc.) for fear they will be referred by poor management to the GMC. How does that ensure patient safety if doctors are afraid to work with trust management based on what they see happen to their brave and noble colleagues?

In the States, medical regulation is decentralised to individual state board panel of doctors. The GMC has been given too much power and too many lay panellists. Better to allow GP consortia to regulate their own profession as they can better identify what is good and bad practice. Better to let good hospital management deal with employment issues. Better to have local Deaneries deal with GP trainee issues. Better to have medical schools discipline their own medical students.

The fault lay with the PCT who did not act all the time when bad doctors were referred to them by doctors and patients, as they were lay managers who do not know what the difference is between self prescribing salbutamol vs pethidine. Lansley scrapped PCTs! Wonderful, too much NHS funds spent on bureaucracy and lay managers. Now GP consortia who do have doctors in charge can receive complaints about GPs and know the difference between a malicious referral and a patient safety one. A GP consortium is best suited to identify a bad practice and act swiftly to remove the practice from the consortium and you have to belong to a consortium to get paid! Brilliant! The NHS commissioning board regulates consortia if a practice needs to appeal.

So I conclude by saying, my life has been all about teaching 4,000 UK GPs to be smart, up to date and caring so that patients do not die at the hands of doctors, but when I see a paper exercise being paraded by the GMC as proving a doctor is safe, I have to speak up. When I see £1billion of NHS funds being spent on appraisals and revalidation pilots, whilst brave NHS consultants speak
up about staff shortages leading to dangerous risks in hospital to patients and NHS hospital closures, I have to speak up.

It is not 230,000 doctors including 20,000 EU doctors who need further regulating with nurses next on the chopping block in 2014, but the GMC monopoly who need reforming as currently doctors feel stifled by the immense control and regulation over their lives. We are asking doctors to triplicate paperwork for annual appraisals, CQC registration and now revalidation. They all have the same
headings...statement of roles, audits, complaints, patient surveys, health, research etc. Yet because the 2 organisations do not communicate with each other, they do not even realise they are all asking to triplicate the same paperwork!

Devolve power from the GMC. The GMC should be akin to a High Court and only see cases of clinical negligence or patient deaths. Send back any employment issues to management and suggest ACAS mediation or employment tribunals. The GMC should be for clinical negligence not bad manners.

So please, please defer revalidation which will only pocket organisations who stand to profit from revalidation by offering eportfolio toolkits or patient and colleague surveys x 230,000 doctors every 5 years.

It will cost the NHS up to another £billion every 5 years to deliver, a billion that could have been used to ensure your family are seen sooner for cancer treatment, your streets are kept safe from early discharged mentally ill patients, your local A&E and maternity wards are kept open and not closed. The public lose out on NHS money that could have been spent to keep their local NHS hospital delivering safe medicine and saving lives.

Please please do a proper cost benefit analysis instead of asking doctors to triplicate paperwork questions for each annual appraisal, cqc registration and now revalidation. Ensure patient safety is what we ultimately want to ensure. Spend NHS money on frontline services, care and staffing as the Coalition Government promised to do to ensure patients safety and a great medical service.