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Ombudsman must make clinical standards clearer for GPs, says MDU

The MDU has urged the Parliamentary and Health Service Ombudsman to clarify their clinical standards for GPs.

In a response to the ombudsman's review of its own clinical procedure, the MDU said the ombudsman's assessment of clincial judgements made by GPs are 'problematic'.

This comes after the ombudsman updated its clinical standard framework in August, requiring GPs undergoing investigation by the ombudsman to detail, which clinical guidelines they followed when making relevant decisions.

The change to the complaints investigation process 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’.

However, the MDU has said in a statement that the revised standards have not addressed the Court of Appeal’s concerns. 

MDU head of professional standards and liaison Dr Michael Devlin said GPs 'need an assurance that the procedures will be fair and transparent' when under investigation by the ombudsman.

But he added: 'One area that has proved problematic from a GP’s perspective is how the ombudsman assesses their clinical judgements... It is not enough to say there should be ‘good clinical care and treatment’ and that relevant standards and guidance may be used as benchmarks.

He called on the ombudsmand to 'define a consistent, reproducible standard that can be understood and applied easily'.

BMA Committee chair Dr Richard Vautrey said GPs may 'not be able to comply with the standards unlike other medical specialties, particularly in the context of dealing with complex conditions in the early stages of a patient’s illness'.

He added: 'This focus on clinical and scientific guidelines that are often not based on the reality of primary care sits completely at odds with the how general practice operates, and we are particularly concerned that GPs are working in an environment where they might be found in breach of these new standards despite providing appropriate care.'

A spokesperson for the ombudsman said: ‘We have recently consulted on the clarity of our Clinical Standard as part of a wider review of how we commission, use and present clinical advice in our decisions. We are carefully considering all feedback, including from the MDU, to see if improvements are needed and we will publish a final report next year.’

Readers' comments (2)

  • As SIGN states: Guidelines do NOT represent the standard of care so cannot be used to determine whether a GP acted appropriately or not.

    This guideline is not intended to be construed or to serve as a standard of care. Standards of care are
    determined on the basis of all clinical data available for an individual case and are subject to change
    as scientific knowledge and technology advance and patterns of care evolve. Adherence to guideline
    recommendations will not ensure a successful outcome in every case, nor should they be construed as
    including all proper methods of care or excluding other acceptable methods of care aimed at the same results.
    The ultimate judgement must be made by the appropriate healthcare professional(s) responsible for clinical
    decisions regarding a particular clinical procedure or treatment plan. This judgement should only be arrived
    at through a process of shared decision making with the patient, covering the diagnostic and treatment
    choices available. It is advised, however, that significant departures from the national guideline or any local
    guidelines derived from it should be fully documented in the patient’s medical records at the time the
    relevant decision is taken.

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  • The Ombudsman should be closed because there are already to many regulators. They clearly don't know what they are doing and cannot apply fair judgement to general practice. The whole complaints industry needs streamlining into something more rational.

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