I wrote to NICE on another guidance some years ago and the response was NICE only offers gold standards advice.
However ivory NICE towers are irrelevant in NHS land. We have to work in partnership with our patients and if the patients prefer a trial of medication to waiting for non-existing appointments and counselling, should we deny and potentially harm our patients because of guidance that is not applicable to reality?
I admit it is more work to take the responsibility for the deficiencies in the NHS and you have no defence if anything happens, but should fear rule how we treat patients?
I was nominated by Adrian Mackie, and contacted by Pulse for a statement, this is what I submitted:
· In your opinion, what have been the significant achievements in your career over the last 12 months? Please list as many as possible. – I have been suspended from the GMC register for two months.
· What was your favourite moment from the last 12 months? – Being able to deliver high quality care until 18 December 2018.
· Would you like to thank anyone in particular for any of your achievements this year? – I have had so much support from so many people, quite unexpected and humbling how much help and altruism there is amongst our profession. Our part time nurse Mamie Bishopp-Schyberg travelled from Kent to Manchester for three days with her husband and 104 year old father to testify on my behalf, without my knowledge. My practice manager approached several patients who wrote letters of support without hesitation. Our staff worked relentlessly to ensure patient care was not compromised. It has reinforced my belief that the great majority of people are kind and generous and evil ones in a small minority.
· What are you working on at the moment, and what’s coming up for you later this year? – I will try to help change the way doctors are investigated, to remove bias and prejudice from the investigations of NHS England, NCAS and GMC, and to try to change the system where Responsible Officers act as NHS England employees on behalf of the GMC. I believe our professional regulator should be independent from our employer. I will continue to try to challenge the increasing administrative demands without evidence base that are marring the delivery of patient care, like nonsensical demands in CQC inspections. I will try to disseminate the benefits of audio files for patient consultations, so we can spend time interacting with patients instead of making medicolegal entries in the patient records, or trying to meet impossible demands of completeness of the written records from NHS, NCAS and GMC.
· What are your current appointments and relevant job titles? – I was possibly already retired as GP in December as I have not been re-admitted to the performers list despite being back on the GMC register since February.
· Where do you practise? – In Kent.
· How would someone close to you describe you? – As an idiot for trying to fight oppression in a system as large as the NHS.
· Tell us a surprising fact about you. – I am 21 years old, and have been 21 for many years now.
its list size was 'too small' to find a new provider
How do you know without advertising?
Following a review, we concluded that the current patient list was too small to advertise
Ah, that's how
Angus, I think the true motivation for the GMC to act as it did was in the last line of the email:
" note that Patient A’s family have been making enquiries as to our position regarding any appeal and that the case has attracted some media interest"
In fear of media interest it was not the confidence in the profession the GMC was defending, it was the public confidence in the GMC.
Removing the people responsible for this act of organisational self interest will just appoint others and the arrogance of the organisation to place itself above the interest of those it regulates and above that of justice will continue.
I see the admission that a mistake has been made as a step in the right direction, the only way the organisation is going to change is if the top recognises what has led to this situation, and hopefully has the courage to make changes in the culture of the organisation to regulate the profession justly irrespective of public opinion or media interest (what MPTS was trying to do on this occasion).
"a lower risk threshold"
Yes this is bad, we should take maximum risk with our patients' health, none of this nansy pansy care stuff, everyone should work outside their area of expertise and let patients come to harm or die, that's what we signed up for.
(COI criticized by GMC for over-referring in 2015)
We all make mistakes. We protect the reputation of the profession by placing peoples heads on stakes. When we follow advice without questioning we are only following orders. Two examples of what I consider barbaric practice from barbaric times in history.
Maybe acts of revenge satisfy the public confidence in the profession (maybe properly staffed wards would?), revenge does nothing for my sense of justice.
Scapegoating Massey is also not helpful, openness about who made what decision on what advice would be better, and without the intervention of ICO, as that just confirms the organisation is protecting itself and has no insight in their failing to be open and transparent.
I fail to see the logic in the sentencing. Dr D thought at the time of his/her actions that there were sufficient safeguards and was acting safely, 6 month immediate suspension. It would have been 3 months deferred by a month if they thought at the time they were acting recklessly (?), and the additional punishment is for thinking at the time that they were acting in the best interest of the patients instead of providing poor care?
How can you change the way you weighed up a situation? Not every doctor is issued with a TARDIS. And how is the additional punishment going to correct this thoughtcrime??
Thanks for the additional comments of support from you all and anon2017 for the impact. There is an additional impact for single handers, that the GMS contract is terminated. In Kent no contracts have been awarded to single handed practices since 2003, mine was the one but last in 2001. The application form for performers list is 32 pages and includes requirement to have a DBS subscription and a language test (after 25 years of working as a GP and producing numerous audio recordings on the practice website and two videos on youtube)
I have not had the inclination to review all that went on since 2007, when I was first reported to NCAS by NHS England and the multiple investigations since 2011 when the local RO office told me she would make life so difficult until I complied with every demand from NHS England.
I have slept without waking at 3am in a cold sweat for the last month, and thinking of all the obstacles pointed out by anon2017 and the thought of being a salaried or locum in the current NHS primary care, no inclination to work, every inclination to draw my pension this year. It seems a shame, to abandon a job I think I am good at, and see the NHS deteriorate, to stand by while patients suffer, but I don't think I can take any more.
Good luck to you all, you will need it.
The primary care funding is inequitable, Welsh practices receive 12% less global sum than an identical English practice. NI and Scotland were given a different indicator in the formula so the funding cannot be directly compared.
For clarification: I made a video of my presentation to the CQC in March 2016. I published this on youtube in November 2016 after the CQC rated the practice inadequate.
I had also audio recorded the rest of the day because of bitter experience with NCAS and NHS England taught me there are elements that cannot be trusted.
Requests for recording meetings and procedures were always turned down, followed by false minutes and reports. Audio recordings cured my disability of ‘mishearing’ and ‘misunderstanding’ the contents of meetings and assessments. Against my own beliefs I had to make the decision in 2014 that I could not continue to place my trust in unscrupulous elements in the NHS and record meetings without asking for permission.
The video recorder used to tape my presentation to the CQC was in a cupboard to try and get above the audience, not hidden but also not in plain view. The same place as the 2017 presentation. There is no law against taping your own presentation in your own building. In the MPTS building a few weeks ago I did not notice for 8 days there were smoke glass domes in the corridors, presumably making covert video recordings of me without anyone asking or pointing them out. The photo's published in the daily mail were taken covertly as I was crossing the street. No problem.
I underwent an assessment by the GMC in 2015, and the GMC covertly audio recorded the visitors (including two doctors) and my staff giving ‘third party interviews’ in our surgery, maybe they also covertly audio recorded other parts of the assessment, I do not know. So there is no problem with covertly audio recording meetings, even if you are in someone else's property.
In 2016 the CQC failed to admit (both in email and on the 2016 video) that the inspection was targeted. After the publication of the CQC report I made a SAR request for the CQC information and received 75 heavily redacted documents, confirming amongst other things that the inspection was targeted and instigated by NHS England. I published these on the website in January 2017 as additional evidence to challenge the inadequate rating of the practice, and expose some of the practices of the CQC. I had given the 75 files nicknames to keep them apart, which were then included in the icons on the webpage (boohoo, now this is censoring, etc).
I think the tribunal’s finding is that I should not have published the evidence challenging the inadequate rating of the CQC in 2016 with my comments attached, so I am planning to republish after reviewing the comments and file names.
During the 2016 inspection my manager came to my room in tears 10 minutes after the arrival of the lead inspector, as she told her that we were in breach and not licensed to provide contraceptive services straight after walking in. This was retracted later in the day. We have heard of many other practices where staff were in tears during CQC ‘visits’ and many practices where the findings and ratings do not seem to correspond. There is no consistency in the approach, and with the Chief briefing publicly against small practices, publicly justifying using gender discrimination against small practices I felt I had to take a stand.
This came at the end of a 10 year period of repeated investigations and referrals by the local NHS England team, and without the audio recordings I made to challenge the 2014 NCAS inspection we would have been closed four years ago. It came at the end of three years of emails to CQC to try and improve their use of public data in their ‘intelligent monitoring’ reports published on the internet. I was at the end of my tether and decided to fight back against what I perceived as another unjustified inspection and another unjustified report, it happened to be the CQC coming back to inspect us for the second time, a second targeted inspection as we were in the first 500 practices after the CQC were appointed as regulator in 2013.
I did not intend to target individuals, I do believe that representatives of organisations should accept responsibility for the organisation, just like I take responsibility for the practice and like I expect my staff to accept responsibility for any policies they enforce, or otherwise challenge me on any policies, which should be possible in an organisation (this has happened many times, and I have changed many policies thanks to input from my staff). We put our staff on the letterhead and on the website, it strikes me as odd that the CQC wants to keep staff anonymous and not accountable, I would not feel comfortable with that.
To clarify matters I would be happy for the CQC to publish the unredacted 75 files they supplied to me so that we can all be clear about the procedures and justification of our 2016 inadequate rating. Maybe the magazines/press could request these if the CQC does not want to supply them to me.
Compare patient satisfaction between Mapperley park and Bellevue practice in Birmingham.
Maybe the BMA Wales could address the 12% funding deficit of Welsh GMS practices when compared to identical English practices?
Not a surprise that (1) managed practices cost more and (2) that in Wales GMS is even cheaper as the practices are underfunded by 12% compared to identical English practices.
Clarify, you are not charging for access, but to recover your copying costs, so your invoice should reflect this.
Since 2012 we are not dealing with solicitors, we deal with patient direct, so all records are collect from base.
GDPR states you cannot charge for access (the £10 access fee) and it states you have to give information that you have in writing you should supply in writing (i.e. not verbally only) but it does not specify you have to give it printed (emails and files are written), and it does not oblige you to deliver it by golden coach to Timbuktu either.
So we now offer patients to come down with their camera, this was always an option under DPA, or offer to make copies for the copying charge.
It has not been tested in courts, and any complaint would have to go through ICO, who are snowed under and take a year to reply. Solicitors know this so will happily pay so far.
If you enter into a contract with solicitors a far way from home (same for mail order companies) and you have to recover costs, you have to travel to their local court, same vice versa. Any dispute with your patient can be dealt with in the local court for both parties.
I had a dispute over £50 and had to travel to Manchester for the case from Kent (2012, and then still lost as it is a civil case and it matters who sounds the most plausible not what is true.
This happens in every case where the accused has been kept from working by suspension, the minute the case is concluded the suspension continues as the accused has been off work too long (through suspension).
Even if the loss of income and pension could be claimed from the other party (GMC in this case) or the legal costs, it is in the end doctors paying for it through registration fees and not the people responsible.
It is a sick system.
OK, this link is to the GP patient survey, comparing Dr Madan to our 1,800 patient practice.
OK, this link is to the GP patient survey, comparing Dr Madan to our 1,800 patient practice.
I have been (audio) recording consultations since September 2014 and 99% of patients think this is a good idea.
They are part of the patient record with access rights.
If your consultation cannot stand the light of day, maybe you should be looking at your consultations.
If video or images are used for sexual gratification or comments, this is nothing to do with the consultation but it is simple sexual harassment, and should be dealt with as such.
The thin end of the wedge, none of the 4 procedures are performed in any case for the indications listed.
What should be made clear is whether the NHS constitution for a comprehensive service is being upheld?