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Independents' Day

GPs should have obligation to monitor hospital care, says report into Mid-Staffs

GPs should have an independent ‘monitoring role’ to ensure hospitals are providing good quality care, a landmark public inquiry into the failings at Mid Staffordshire NHS Foundation Trust has recommended.

The report says one of the reasons the failures in care at the hospital went unnoticed was because local GPs only expressed ‘substantive concern’ after they were specifically asked by investigators in 2009.

It calls for GPs to develop internal systems so they can spot ‘patterns of concern’, rather than focussing on the care of individual patients. Practices should report any patterns they notice to the CQC or other regulators, the report urges.

It also recommends GPs have a ‘professional obligation’ to follow-up with patients after they have had hospital treatment and recommends that CCGs take notice of GP feedback to improve services.

The report concludes: ‘It will be important for the future that all GPs undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services.

‘They have a role as an independent, professionally qualified check on the quality of service, in particular in relation to an assessment of outcomes.

‘They need to have internal systems enabling them to be aware of patterns of concern, so that they do not merely treat each case on its individual merits.’

They have a responsibility to all their patients to keep themselves informed of the standard of service available at various providers in order to make patients’ choice a reality.’

This inquiry looks at how the NHS should change in the light of the major scandal at Mid Staffordshire NHS Foundation Trust, which saw between 400 and 1,200 deaths above and beyond what would have been expected between January 2005 and March 2009.

The report says no individual or organisation ‘can be singled out for criticism’, but says that because GPs were not explicitly required to report concerns ‘unfortunately it did not occur to any of them to suggest it.’

It goes on to recommend all NHS staff have a ‘duty of candour’ to report any errors and that the CQC should be the body handling these reports.

The £13m public inquiry ran for 37 weeks, concluding in December, and has attempted to note down the important lessons to avoid any future repetition of the mistakes made in Staffordshire.

It has built on the work of the 2010 independent inquiry investigating the care provided by Mid Staffordshire NHS Foundation Trust during the same time period and both have been led by Robert Francis QC.

Prime Minister David Cameron said that while the report found that the responsibility for the ‘appalling suffering’ lay mainly with the Trust board at Mid Staffordshire hospital it had also uncovered much wider systemic failures, including a cultural attitude that patient care was ‘always someone else’s problem’.

Speaking in the House of Commons, he said: ‘Too many doctors kept their heads down instead of speaking out [but the report] says we should not seek scapegoats.’

To the patients and families affected he said: ‘On behalf of the Government and our country, I am truly sorry.’

He said the Government will study all of the 290 recommendations in the report and respond next month.

RCGP chair Professor Clare Gerada said the report showed that it was important to increase the number of GPs so they are able to focus on patient care.

She said: ‘Clinicians, including GPs and their teams, must be given the ability to do what is most important: listening to patients and caring for them.

‘GPs have so far ridden the storm but financial constraints and top-down targets are starting to adversely affect the level of care we can deliver to our patients.

‘We need to reverse this trend by increasing the number of GPs available to provide patient care, and by ensuring they are free to focus their attention on what matters most to patients.’

Following the publication of the report, the Government said it has tasked NHS medical director Sir Bruce Keogh with carrying out an immediate investigation into the hospitals with the highest death rates in the country.


Readers' comments (10)

  • I'm not a GP but I do feel for you all that are. Everything seems to end up to be your responsibility!

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  • great , I was looking for something extra to do ,gets a bit quiet midday. This role could be a usefull filler before evening surgery , I could even spice it up and put it in next years PDP! Got to be worht some CPD points too as we mull it over

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  • And there was me thinking that CQC actually had a purpose.

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  • Vinci Ho

    This report has criticised from Top to Bottom. The interesting question is ' Was the top ''leading'' the bottom ?' Or ' was the bottom influencing the top???'
    Furthermore , the concept of primary care led NHS was always a wishing thinking , easy said but never done.
    The report has just come out at the most critical time of the history of general practice in this country.
    This culture of GP battering needs to stop . We need more real time resources in all angles to do real works rather than target chasing and efficiency saving.......

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  • "GPs only expressed ‘substantive concern’ after they were specifically asked by investigators in 2009" ???

    Firstly, as an investigator you should be investigating instead of asking someone else what they thought. The clue is in your job title.

    No single organisation was to blame, except for the GPs who were not at the scene of the crime. AND all Gerada can say is let's have more GPs. Really? What for? To police the NHS? Time for you to resign, again!

    I am not a GP, and I never thought I'd say this but ... GPs should be paid double for taking the blame.


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  • Next time just pay the GPs the £13 million, they'll gladly take the blame and finish the entire enquiry in .... what one hour?

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  • I am a GP and have been one for 30+ years. May I refer the good Robert Francis QC to the case of Arkell v. Pressdram (1971)?

    COI not got too long to go until you can shove your job mate!

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  • I find these reports so sad.
    Did it not occur to the Government to throw the money at improving services rather than yet another 'investigation'?
    The number of times on a ward I have been so stretched that I know my patients could be treated more promptly and efficiently if there were only more doctors. And when you try to tell someone that the response is always the same- work more efficiently. Are you not coping? The blame is pushed back on you.
    Is this report going to fix that?

    Being a doctor seems to mean that you give up your right to be a person- and become a public punch bag. I'm only a trainee and I'm already getting tired of delivering substandard care due to poor staffing levels, working in ridiculous systems (has anyone come across dementia nurses who earn tens of thousands of pounds a year to only ask 'have you been more forgetful'- they refuse to do an AMMT) and being criticised by this Government.
    But we all just take it don't we.

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  • Scandals like this will happen more often in the future as this government is gagging NHS staff by preventing whistle blowing.

    The worst example of this is the requirement now for doctors to revalidate their licence to practice every 5 years for which they will need appraisals from their employer. Doctors will now be discouraged from highlighting patient safety concerns as they will not want to loose their licence to practice medicine due to an unfavourable employer appraisal.

    With the increasing likelihood of doctors working for cost cutting private sector employers in the future, one shudders to think of the potential dangers to patients if doctors cannot highlight safety concerns for fear of loosing their licence to practice medicine.

    These revalidation requirements and other similar NHS staff gagging measures must be scrapped to prevent future patients deaths and scandals even bigger than this fiasco where the authorities also failed to listen to similar concerns raised. They will probably not heed this warning about revalidation either and when more future deaths and scandals occur will ask why no one said anything.

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  • Not long to go now until I retire :))

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