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Debate: Can GPs monitor hospitals?

Can GPs systematically monitor outcomes from patients referred to hospital? Two GPs debate whether recommendations from the report into Mid Staffordshire NHS Foundation Trust are feasible

 

NO: Francis’ recommendations for GPs are not feasible

I understand the sentiment of where Robert Francis is coming from, but I just don’t think that it is feasible.

GPs do look at what happens to their patients when they are admitted. I, for example, have frequently raised issues when things have not been done properly, or raised complaints about poor care regarding some of my patients where I felt this is appropriate.

But he is asking for a much more systematic way of doing this. This requires a whole new stream of work and we don’t have any mechanisms by which we can identify these concerns.

This is another example where lots is being put at the door of GPs without any resources. At the moment there are no such systems at all in GP practices. We are totally dependent on, and only see, the patient’s discharge letter.

I don’t have a problem with rethinking how GPs define their role - maybe it is something that we need to be concerned about. But could GP monitoring prevent another Mid-Staffs? Well that’s just conjecture, really. The point about Mid-Staffs is that no one questioned it, and the argument is: ‘Who is best to do that?’

It is possible that CCGs should have that responsiblity, and perhaps could set up systems to do this. The logical thing when you talk about monitoring patterns is that it is going to be the commissioning groups that need to develop that.

If patients are going to do an ‘exit interview’, which hospitals say they are going to be doing, then you might argue that that is something that commissoners need to look at when they make decisions about the hospital.

I would not write the idea off, but it requires a level of analysis and sophistication which is quite complex. We have already got to plan and commission services, let alone monitor them.

Professor Aneez Esmail is a professor of general practice at the University of Manchester whose previous areas of research has focused on patient safety, including the Shipman Inquiry

 

YES: GPs are well-placed to pick up on some safety issues within hospitals

GPs are well-placed to pick up on some safety issues within hospitals. Some problems are only apparent after the patient has left hospital, and our patients often tell us things which concern us.

Two major barriers, though, are time and confidence in the system. We need to ensure the forms for recording safety issues are easy to access and quick to complete for GPs and our teams. And we need to be confident that our safety reports result in improvement for patients.

There’s no point in taking time out of a busy day to complete a form if it doesn’t benefit patients. This is likely to require a massive increase in the responsiveness of local commissioners and national agencies. Evidence shows that people will report safety concerns if they receive rapid feedback and can see that effective action is taken.

I’m optimistic that CCGs will create a much more cooperative and clinically led culture between primary and secondary care. This should help us make much greater progress on improving patient safety.

As far as I can see, none of the lessons from the Mid Staffs tragedy is new. The challenge for CCGs and the national regulators is to put the old lessons into practice.

Dr Robert Varnam is a GP in Manchester and Clinical Lead for Primary Care and Commissioning at the NHS Institute for Innovation and Improvement

 

 

Readers' comments (5)

  • David Bush

    It is finally time to question all the bureaucracy that has built up in recent years. You ask who is best to question the standards of care. The answer is simple - patients and their relatives.
    I have no doubt that during the years of poor care at Mid-Staffs many complaints were received from patients. I am equally sure that these would have been 'processed' by complaints managers and that each patient/relative would have received a lovely letter from the hospital that started 'Can I say how sorry I am that you feel...' and ended '...have reviewed our processes to ensure we maintain our high standards of care etc etc...'
    We all have complaints procedures, but what is lost is that every complaint should be listened to, assessed for veracity, and taken as an indication that all is not well. Stop paying lip service to the consumer, otherwise the whole complaints process is not worth the paper it is written on.
    We do not need a new healthcare regulator. We do not need GP's to be given the role of assessing standards of care. We need to use existing processes properly, and to listen to the consumer. Remenber what your wise old trainer told you - 'listen to the patient when they tell you about their symptoms, because they are usually right'.

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  • Interestingly both parties are on the same page.
    Dr Barnum says the "Gp's are ideally placed to..." but argues for resource to do it .
    Prof Esmail is basically saying "if you do it ,you must do it properly and you won't actually get the time or resource to do it right"

    I have to say I side with the Prof - I feel yet another "more works without resource" imposition.

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  • What a wonderful idea, and a job that so many of us who will retire earlier from clinical medicine than originally planned because of the state of the NHS and imposed contracts, would love to take on.

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  • No we can't
    Next question?

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  • As a patient who has had 4 major operations since 2007, all requiring subsequent out-patient checks and treatments, I agree wholeheartedly with David Bush. I have been extremely fortunate in the general standard of treatment I've received of late, but it's the patient (and their family) who know the score - they're the ones undergoing the experience. And if they have worries or complaints, they may well benefit from the support of a GP, but they don't need to wait until a GP suffers the same experience as an in-patient!

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