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A faulty production line

GMC guidelines need to reflect the current pressures of general practice

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In the run up to the junior doctors’ aborted stike, the GMC ‘reminded’ GP trainees that they may be investigated if their actions put patients at risk. Good medical practice clearly states that all doctors must ‘Make the care of your patient your first concern’. I have a radical proposal to make this clause workable. Let’s make it ‘Make the care of your patients your first concern’.

There are huge issues with the GMC insisting in its guidance that we should make the care of the patient in front of us our first concern. The simplest, of course, is the patient who wants to spend 60 minutes going through her list of complaints while a queue of patients is outside. I think it’s clear that if you make that patient your ‘first concern’, you will either give the other patients a poorer level of care or you will burn out or run extremely behind.

We do ourselves a disservice if we don’t push for our regulators to acknowledge the realities of the multiple demands on our time and attention

But even if it’s your last patient of the day, there are other concerns which I think GPs should take into account. The obvious example is population health. It may be in the patient’s best interests to have their purely cosmetic but highly distressing skin lesion removed on the NHS, but we know that rationing decisions have to be made, which result in patients receiving poorer care than the patient would like.

Which then leads us to the difference between ‘adequate care’ and ‘excellent care’. In this age, when waiting rooms are heaving, and the GP is a rare and highly sought after resource, we need to maximise our efficiency to help the most numbers of patients. This leads to us using gut instinct (surprisingly well evidence-based) and not ticking every box that NICE would have us tick. This is standard every day medicine, which we know keeps the NHS afloat and actually gives the best quality primary care in the world (perhaps because we don’t over investigate and overtreat as much as other countries where clinician time isn’t at such a premium).

However, when something goes wrong, it seems that the rule of ‘what a body of peers would do’ no longer applies. I know there’s a body of peers who wouldn’t take a temperature for every single child with a runny nose. However, I doubt that would be heard in the courtroom. They would expect the GP to have followed NICE guidance to the letter.

We need the GMC to review good medical practice to protect medical directors of acute trusts and CCGs, as well as us coalface GPs. We may mourn the passing of the golden age of the NHS when clinicians could just focus on one patient at a time, but we do ourselves a disservice if we don’t push for our regulators to acknowledge the realities of the multiple demands on our time and attention.

Dr Phil Williams is a First5 GP in Lincoln, and former RCGP National Lead for the First5 initiative 

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Readers' comments (6)

  • Spot on.

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  • I disagree.

    We should not sacrifice our high standards just because we work in a 3rd world health system.

    What needs to change however is the institutional apportioning of blame to the one holding the bomb when it goes off.
    Adverse event investigations need to be able to take into account the organisational failures and multiple individual mistakes that led to the coal face clinician comitting an error. Work load and funding issues are NOT independent from this. Statement from HUNT causing the Hunt Effect ARE important when investigations occur. Sanctions on clinicians need to be proportionate and take into account the working environment.

    Unfortunately the GMC and the legal systems prefer a game of pass the parcel, where the person holding the package when the music stops gets a nasty surprise.

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  • Make your own survival and that of your family your first concern. Your do this by being totally risk averse and investigating and treating at a much lower clinical suspician than your gut tells you. This will save you being hauled in front of the GMC who does not care about how much you saved the nhs, helped the whole nhs or how good a doctor you really are. They will ensure there is a witch hunt and every stone is overturned to try and catch you out. Then the family and their lawyers will go after you. If that fails you will still be referred to the ombudsman. Worst case scenario the police will be at the door and you could end up in court and behind bars. None of this is worth it. Practice defensively and safely. Think american levels because it costs you nothing from your pocket if you do, but if you don't you can lose your livelihood.

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  • 56. You must give priority to patients on the basis of their clinical need if these decisions are within your power.

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  • GP partner 10:54 well said

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  • 10.54 is spot on. Managing uncertainty is over. Killed by the GMC and litigious patients. This is social change and everybody needs to get with the programme. Refer and investigate if ANY doubt. The governemnt could have chosen to continue with a cost effective NHS by supporting gp but they chose the more expensive option.Do not consider the wider NHS - you are a moron if you do- consider yourself and your family.

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