Retired consultant rheumatologist
I have had a different lightbulb moment. Why offer appointment times at all? All it does is tie you to inflexibility. If you let them all sit and wait, first come, first served, any doctor will do, then the heartsinks will be balanced by the quickies. That's how it was back in the 1950s and 60s when my mother was a GP. Those who didn't really need to be there soon realised that turning up too often was simply wasting their time.
Only joking. Or am I?
I remember my father at the time of Powell's speech saying he thought the language was rather inflammatory but he had much sympathy with the sentiment. As an immigrant from India (and and ex-communist to boot) he was no fascist, indeed the last person one might expect to hold such views; they were perhaps coloured by the fact that he was stabbed during a race riot in Mumbai - by a Muslim as it happened, and this was in the 1930s. His view (and mine) is that the way to undermine prejudice, racism and all the other evils of the world is to engage in debate.
Furthermore if you look in the wider world you see reality; what about the plight of white farmers in Zimbabwe who have been threatened, dispossessed and even murdered? And while I cannot disagree that black rule is right (I was a fervent anti-apartheid supporter in my youth) one has to concede that there were rivers of blood there. Then there's Protestants against Catholics, Muslims against Christians, everyone against Jews, Muslims against Hindus... we'll end up with nothing to debate. As for Brexit...
Maybe global warming will reduce snowflake formation. Listen and rebut (or possibly change your views if you discover you are wrong. You need open ears and open minds. BTW in response to the suggestion, ironic I trust, that Clare Marx be de-platformed, she didn't join the GMC until after the Bawa-Garba case so cannot be blamed for the sins of her predecessors.
Many years ago I pointed out that the proposed development of an Independent Treatment Centre for musculoskeletal work in the north-west would threaten the existence not only of existing cold orthopaedics and rheumatology departments but also, as a consequence, emergency trauma care. The plan was dropped. If you have a finite budget, then to pay Peter you must rob Paul. You don't need to be a financial wizard to see this. I would seriously suggest that the CCG resigns en masse after declaring itself bankrupt. There is a good precedent; the Fracking Czar has fallen on her sword on the basis that government policy has made her job impossible.
No correction was made for alcohol consumption or smoking so the study is worthless.
Next thing we know they will be trying to put it in the drinking water. Let's be clear; statins work, but not very well, and their cardiac effects are NOTHING to do with cholesterol, lowering of which is an epiphenomenon. And anyway - what actually is the absolute risk reduction they found? If it's
The most extraordinary paradox is that the GMC is contesting the rulings of its own tribunal service. This says two things: (1) it does not trust the MPTS and (2) as it only appears to contest MPTS rulings which it deems too lenient, it is biased. Given that it is also prepared to invoke the courts it would appear that doctors are at risk of triple jeopardy. This has to stop.
Anon2016 has a good point - but there may be two ways of proceeding. I still believe, despite the Court of Appeal's judgement on the criminal case, that she should not have been found guilty, and on that basis a further appeal to the Supreme Court might be justified. However if that is turned down then I agree there is a case for a corporate manslaughter charge. Other people have raised the issue of whether it was appropriate for there to be no consultant cover because the supposed on-call person was double-booked; also whether the pathology computer system failure was acceptable. I have always said that any doctor is likely to make one mistake every year that will seriously compromise a patient, or even end their life. If that is truly the case - and from my own experience such mistakes occur through ignorance, fatigue, lack of supervision or simply having tramlined thinking to the wrong diagnosis - then almost all of us should have been, or will be charged with gross negligence manslaughter. What a prospect!
The ruling appears to confirm that the High Court's judgement was based on incomplete evidence. The question now is whether sleeping dogs should be let lie or whether the criminal conviction should be appealed.
A population of 380,000 is bigger than most hospital trusts...
The GMC's questioning of the decisions of MPTS tribunals is nothing less than an admission that it doesn't trust its decisions or its panel members. Perhaps it should now identify which panel members have the worst records of "leniency" and sack them. It will soon find no-one is prepared to become a member.
Meanwhile I still consider that a High Court appeal is required in Dr Bawa-Garba's case, on the basis that relevant evidence was not heard by the original jury (nor, for that matter, included in the Trust's whitewash report).
This indictment of the GMC is appalling, but welcome. It has overstepped the mark and should be ashamed.
However there are still concerns over the justice of Dr Baba-Garwa's conviction, and an appeal must be pursued on the grounds that important evidence was withheld from the trial.
I used to teach trainees that they would be likely to make at least one, if not two serious mistakes every year. I did. There are multiple explanations; fatigue, inadequate information, test results not back or misinterpreted, ignorance (particularly for rare-as-hen's-teeth conditions), failure to seek advice because you didn't realise you were out of your depth, delay are but some. I would challenge any doctor in practice to deny that they ever made, or make mistakes. Unfortunately the law is now clear that there is no mitigation.
I was personally sued once in my career (by a private patient whose claim was spurious, but nonetheless dragged on for over a year) and another patient brought an action for serious harm due to a series of mistakes, some mine and some not. Had that patient died I suspect I could have been prosecuted for manslaughter by a vindictive relative; as it happened, the patient and I had a full discussion about what had happened and I suggested she brought a compensation case, which she won, but she continued to see me as a patient. This points up the inconsistency which may result from patients being greedy and vindictive on the one had, and fair and forgiving on the other. But who is to know which is which? It's a no-win situation for which the only defence is not to work.
The crucial part of Dr Bradshaw's apparently reassuring article relates to reflective statements: "...but a doctor can choose to provide them if they demonstrate that they have shown insight."
What purpose could that possibly serve? Let us suppose that a doctor has made a mistake which results in serious harm or death. In their reflection they acknowledge the mistake and show that there was not only a reason why it was made, but insight into how it was made. That does not alter liability, so it is pointless to consider allowing the reflection to be considered by a court but even if it is not', as another respondent has pointed out, if the reflection has been shared then the person with whom it was shared may, in court, be forced to reveal it under oath without the permission of the person who told it to them. In the eyes of the law there is no mitigation; someone who makes a mistake which results in death remains culpable. I was involved in a court case where this principle held; fairness is trumped by justice as, sometimes, is the truth.
No one submitting an appraisal containing any analysis of errors will be safe. There will be no defence against honest mistakes and no mitigating circumstances will help. While the court verdict is unequivocal and probably unappealable the GMC's attitude has in my view been heavy handed and vindictive. Yet when I raised serious concerns on an issue it not only did nothing but did not even bother to tell me why. It has lost its way and if it continues on its present path the medical profession should be very afraid. Perhaps if every doctor refused to be revalidation it might come to its senses; it couldn't suspend everyone.
This is not the future - this is the past! We are back to 1984.
Someone has seen common sense over peer review of referrals! There are too may more important (and properly researched) things that need doing.
Suppose there is another hack and computer systems go down, as earlier in the year. E-correspondence depends on the systems working.
My own experience from the other side (ie as a hospital consultant) was that referrals going through "Choose and Book" were so difficult to view, and even more difficult to re-prioritise, that I gave up trying and just let the system put patients where it liked. The risks, of course, are enormous. Receiving a bunch of paper letters meant that I could stack them appropriately. Regrettably few GPs were consistent in judging urgency, and removing that filter is dangerous. I would have had no objection to receiving emailed referrals but was told the system was too insecure to allow this.
Of course, in the opposite direction, I would dictate onto a tape, my secretary would type the letter into her computer, run off a print copy, send this to the GP, whose staff would scan the letter into their computer and shred the hard copy. Total waste (and postal delay). The answer is to give every patient a data stick on which everything about them is stored. But it might fall into the wrong hands, you say. So might a credit card, but the risk doesn't stop cards from being a Good Thing!
There remains an obsessional belief that statins are invaluable and that they work by lowering cholesterol. neither is likely to be true. The absolute benefit from statins in terms of reducing CV risk is around 1-2%. They probably produce this (small) benefit by virtue of their anti-inflammatory effects.
It is time that NICE and everybody else understood that the whole basis of the cholesterol-heart hypothesis is a lie. Ancel Keys cherry-picked his results to include only the data that fitted his theory and there is a growing realisation that Yudkin was right - it's sugar, not fat, that is the villain. Indeed if you exclude trials done before 2000 then statins probably do not have any effect at all. Ally that with the trials of PCSK9 inhibitors, which drastically lower LDL cholesterol but have no effect on cardiac mortality (or indeed may worsen it) and you demolish the entire argument for statin use based on serum cholesterol. I still wish to know why the proponents of statins, whose language when confronting the sceptics is becoming more strident, will not release the raw data from their trials for independent analysis. Surely it cannot be because they have something to hide?
So the wheel finally turns full circle! When I started as a consultant in 1983 hospitals and GPs were all under the same umbrella, called the Area Health Authority...