This site is intended for health professionals only

At the heart of general practice since 1960

GPs defending patient complaints to be asked which guidelines they followed

GPs undergoing investigation by the Parliamentary and Health Service Ombudsman (PHSO) due to patient complaints will be asked which clinical guidelines they followed when making relevant decisions.

The change to the complaints investigation process, which has come into force this month, was implemented after a court ruling in a recent GP appeal case noted that the ombudsman’s standard for judging quality of care was ‘incoherent’.

But GP leaders questioned the new process, arguing that doctors need to be able to exercise 'professional judgement' when treating patients.

The updated Ombudsman’s Clinical Standard says the PHSO 'will ask the clinician or organisation complained about to tell us what, if any, standards or guidance they based their practice on, whether they followed them or departed from them in the situation complained about and why'.

It says: 'If there is a relevant standard or guidance and the clinical decisions, actions and judgements do not appear to have been in line with it, we will consider what evidence there may be to explain this.'

It adds that in deciding 'whether there has been good clinical care and treatment' the ombudsman 'will consider the explanations of those complained about and balance them against the relevant standards or guidance'.

Where there is 'no established standards or guidance', the PHSO will expect a 'rationale or justification for the care or treatment provided'.

In the foreword to the new standard, the PHSO said: 'When we look at a case, we begin our scrutiny of the health service that has been complained about with the expectation that good clinical care and treatment can be demonstrated by reference to standards or guidance.

'Good care and treatment will incorporate professional and health service standards and guidance and may incorporate the most up-to-date scientific evidence, for example, regarding the effectiveness of treatments.'

The PHSO argued the new standard would make the judging process 'more transparent'.

A spokesperson said: 'Our new clinical standard gives greater clarity and predictability to how we consider the appropriateness of NHS clinical care and treatment in England. 

'This will offer those complained about an earlier and clearer opportunity to explain how they reached decisions about care and treatment, and make our approach more transparent for the people who use our service.'

But BMA GP Committee chair Dr Richard Vautrey said: ‘GPs treat their patients as clinically appropriate, based on the best evidence, taking into account local and national guidelines.

'However consultations are often complex and patients require a holistic approach with a good degree of professional judgement required to deliver the most appropriate outcome.'

He added that the BMA 'will be seeking a meeting with the Ombudsman to talk about the implications of this statement for GPs to ensure they fully understand the challenges GPs face in their day-to-day care of patients'.

The news comes as the role of clinical guidelines has been a topic of debate for GPs and policymakers, with NICE previously having said their clinical advice is 'guidelines not tramlines'.

The Ombudsman’s Clinical Standard

  1. When we are considering complaints about clinical care and treatment we consider whether there has been 'good clinical care and treatment'. We aim to establish what would have been good clinical care and treatment in the situation complained about and to decide whether the care and treatment complained about fell short of that.
  2. We will seek to establish what constituted good clinical care and treatment on the facts of the case by reference to a range of material, including relevant standards or guidance, the accounts of the complainant and the clinician or organisation complained about and any other relevant records and information.
  3. Relevant standards or guidance we may consider include NICE guidance, clinical pathways, professional regulators’ codes of practice and guidance, guidance from royal colleges, local protocols or policies, and published research including clinical text books or research reported in peer review journal articles.
  4. In deciding whether a standard or guidance was relevant in the situation complained about we will consider factors such as whether it was in place at the time of the events complained about and whether it was applicable to the care and treatment the person received and to the setting in which the care and treatment took place.
  5. We will ask the clinician or organisation complained about to tell us what if any standards or guidance they based their practice on, whether they followed them or departed from them in the situation complained about and why. If there is a relevant standard or guidance and the clinical decisions, actions and judgements do not appear to have been in line with it, we will consider what evidence there may be to explain this. We will reach a decision about whether there has been good clinical care and treatment. In doing so we will consider the explanations of those complained about and balance them against the relevant standards or guidance.
  6. We will also consider the ‘Principles of Good Administration’ insofar as they apply to the clinical context.

Source: The Ombudsman’s Clinical Standard

Readers' comments (53)

  • Rogue1

    Ok, so give me 1/2 hour appointments. That way I can dig out and correctly reference every single decision I make in a day! What an absolute farce, we act in the patients best interest at every contact, and things are compromised because we take a holistic approach not simply following a guideline. On that point they are guidelines not required treatments, there is a difference they seem to fail to grasp!

    Unsuitable or offensive? Report this comment

  • So we are expected to follow 'guidelines' in the ten minutes we have for a consultation.

    For every condition there are a plethora of guidelines, some conflicting. Also patients usually have more than one condition. They may be presenting with a symptom rather than a condition.

    The NHS are paying for a trabant but judge us as if they had purchased a Rolls Royce. Glad I am leaving early.

    Unsuitable or offensive? Report this comment

  • Doctor McDoctor Face

    And they wonder why there is a recruitment crisis......

    Unsuitable or offensive? Report this comment

  • Guidelines? Or Protocols? Guidelines aren’t to be followed , ther are there as a guide to options, to be consulted as a support to clinical decision-making. Here comes the danger so many have spoken of with over-reliance on ‘guidelines’ and their institutionalisation- the workers took becomes the stick with which to beat them...

    Unsuitable or offensive? Report this comment

  • So, lets look at cancer guideline.

    There is no longer any reference to timescale on change of bowel habit. We currently exercise clinical judgement and tell pt not to worry about a week's Hx of constipation.

    Under above ruling I can't produce evidence to say why I've "deviated" from NICE guidnce. So I can happily refer every Pt I see and flood the fast track clinic.

    Is this what we want?

    Unsuitable or offensive? Report this comment

  • ‘Gut feeling’ executed. ‘Here goes neighbourhood!’

    Unsuitable or offensive? Report this comment

  • Because common sense is not enough, I guess !

    Unsuitable or offensive? Report this comment

  • What next, know how Promethius felt, getting his liver pecked out each day only to have it grow back . Just those with no clue of the job, deciding the parameters by which we should be judged. If it was so simple that a guideline would always suffice, no need for intelligent free thinking professionals, might as well use an app.....

    Unsuitable or offensive? Report this comment

  • Quoting guidelines in 10 minute appointments?

    So glad I left GP training!

    Unsuitable or offensive? Report this comment

  • Scottish GP correct- the sentiment that GP's are useless tossers and need to be babysat is rife and its about time we played them at their own game- if all GP's decided to only follow guidelines for a week we would soon be getting begged to use our valuable but highly underrated clinical acumen skills again

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say