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GP careers: Advising the ombudsman

Dr Paul Gray describes a day helping to make decisions on complaints to the health ombudsman

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Profile: Dr Paul Gray

Roles: GP partner, Sale, Manchester. Medical adviser to Parliamentary and Health Service Ombudsman (PHSO), Manchester

Hours: Eight hours every Wednesday at PHSO. Eight clinical sessions over four days at the practice

07:30 I arrive at the Parliamentary and health service ombudsman (PHSO) offices in central Manchester after the 20-minute commute. I go through emails, then check and approve reports submitted by lay assessors. I’m one of four clinical advisers in general practice and largely my role is to advise on medical aspects of a complaint made against a GP or practice.

08:30 I start preparing for ‘documented discussions’ where I meet with assessors to go through cases. The PHSO makes determinations on maladministration and service failure, rather than medical negligence. We provide advice based on professional standards and clinical guidelines; where none exists we go by established good clinical practice. This differs from medical negligence cases tested in court, which use the Bolam/Bolitho principle (the ‘reasonable body of clinical opinion’).

One case this morning is that of an elderly woman who was found dead two days after her GP prescribed antibiotics for a UTI during a telephone triage assessment. Her son has complained that the GP refused a request for a visit. I find a widely used LMC guideline, which indicates it was reasonable for the GP to do telephone triage in the circumstances. In addition I look up NICE guidelines on uncomplicated UTI, which confirm the GP did not need to take a urine sample, and that he prescribed the recommended antibiotic. I conclude he acted correctly.

Researching a case makes you much more aware of some conditions and guidelines 

09:30 Once I’ve prepared the background for each case, I discuss it with the assessors, and provide information and references for their report. Researching a case makes you much more aware of some conditions and guidelines and provides an element of self-directed learning.

10:00 We hold ‘pop-overs’ for the next two hours or so – informal surgeries for assessors to run a decision by us, or get a steer. Today for instance, I’m asked about a case where a patient has complained that their GP refused to provide them with a prescription while they were in prison. The GP had – quite rightly – refused because the patient had to be deregistered while in prison. The assessor wants to check that the GP was right to remove the patient and refuse to prescribe; I am able to reassure her.

12:30 I nip out for a walk and pick up lunch from a café. I always take a proper lunch break at the PHSO, which makes a nice change from spending it at my desk or in a meeting, as often happens at the surgery. I’m careful not to check in with the practice while I’m here. That said, I might get a call if a locum hasn’t turned up and they need me to do evening surgery, or there is an urgent query.

13:20 I spend the afternoon on quality assessment of recent cases – peer review – to make sure our processes are consistent and to deal with appeals. Today I look into an appeal from a GP who, as part of an upheld complaint was told he had failed to do an adequate patient assessment. The MDO has provided evidence on the GP’s behalf showing that a referral letter sent on the same day gave much more detail than the GP record, which proved that the GP had taken a reasonable history and examination; as a consequence I decide his appeal should be upheld.

15:30 I head home to a free evening. I’m usually able to leave the office promptly and it’s great to be able to complete tasks within my hours and leave the work behind until next week. It also gives me spare time to do ‘normal’ things like taking the dog out, or going to a football match.

Being able to have a day without seeing patients gives me a sense of release. I don’t think I could keep up a full five-day week of clinical work, given today’s demands. The ombudsman work has re-energised me. It is also well paid, with good terms and conditions including a civil service pension, so I feel the work more than offsets any reduced drawings from cutting clinical sessions.



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Readers' comments (6)

  • ‘Researching a case makes you much more aware of some conditions and guidelines and provides an element of self-directed learning.’

    If even ‘you’ have to research to find the guidelines how the hell does a normal GP do this when being forced, through lack of time, to manage masses of varying clinical issues that require very rapid processing and actioning every single working day?

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  • I was always concerned that one individual can comment with 'authority' on the actions of another, you might get a divergence of opinion very easily and two assessors might have quite different views on the same case. In addition, assessors seems to stick to guidelines rather than being pragmatic and using common sense to tell what is reasonable. I am concerned that guidelines for a simple UTI had to be looked up by someone working 8 sessions a week.... guidelines are exactly that..... does it mean if someone doesnt follow guidelines then they are automatically guilty in some way? It would be interesting to know how often these assessors concur that someone who has varied from guidelines still made reasonable decisions.

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  • Being an expert is knowing when to vary from the guidelines safely..... is over reliance on guidelines being detrimental to our profession?

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  • The number of weird, counter intuitive findings of the ombudsman worries me. Nice to hear someone is trying to review them, but they seem dissociated from reality and less interested in facts than in conciliation. Not reassuring what standard of care are being set though.

    One recent example: £15k recommended to be awarded to a mum who let her 5 year old wander out of the consultation and out of the practice?!? Are we really to provide proactive emergency child care now?!?

    Ombudsman get your act together. And stop recommending financial awards for heavens sake!

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  • Dear researchers

    No Sierra Hotel india tango sherlock!
    Did you really have to waste research funds to come up with that!?
    Come and spend a day in the real world

    With love

    Dr C

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  • And now the Ombudsman has been found to be incoherent, unreasonable, irrational, inconsistent, biased and unlawful by 2 Lords Justices of the Court of appeal.

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