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At the heart of general practice since 1960

Waiting to be strung up by the state

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There is nothing more unifying in life than fear and threats to your freedom. It is the reason why we often refer to the ‘military family’, and the mental health issues experienced by veterans are likely to be as much related to the break-up of this family as to PTSD.

So it comes as no surprise that doctors, nurses and other members of the healthcare family are all united in fear of one issue – a criminal manslaughter charge. We have had a spate of them in the news recently.

The fear of being caught up in such harrowing medical negligence cases has already driven us to practise defensive medicine

The first, back in May, saw two GPs accused of manslaughter, following the death of a boy with Addison’s disease. Although they were both acquitted, social media went into overdrive. The following month a nurse in Bristol appeared in court after incorrectly inserting a gastrostomy tube, which resulted in the death of a child. She was acquitted. Finally, in July, an optometrist was found guilty of manslaughter through gross negligence after failing to identify signs of papilloedema in a child who died five months later of hydrocephalus.

The fear of being caught up in such harrowing medical negligence cases has already driven us to practise defensive medicine. This trend will only be reversed when there is a successful prosecution for harm caused by too much care, rather than too little. Until that time, the dangers (and cost) of over-investigation and over-treatment are all too apparent.

So what do these cases have in common? It is striking that they all involve children. Of course, it’s natural to feel sadness when we hear of the death of a child, but the Crown Prosecution Service is expected to rise above emotion. This is why we don’t allow vigilantes to take to the streets and why we repealed the death penalty.

The other commonality is that, in each case, there were many factors contributing to the eventual outcome of death. These healthcare professionals are not working in isolation; they are part of a team and a system. A system that is underfunded, unsafe and unfit for purpose. This is why the criminalisation of these individuals has led to despair.

We are currently all working in these toxic environments. We are all aware of the decision fatigue of seeing our 80th patient contact of the day. We all know the sinking feeling when an urgent visit request comes in after we have been at our desk for 10 hours. Or the difficulties in trying to get a patient out of our room in less than 10 minutes because there are four others waiting and we haven’t even started on the paperwork.

We have become the scapegoats for a state that accuses us of negligence while we work under conditions it has sanctioned. It’s criminal for the state to hand us these responsibilities and expect perfection, without furnishing us with the tools to fulfil them. If anyone should be taken to court, it is the state – for corporate manslaughter in the NHS. But it is far easier for them to tie the noose around an individual’s neck. We are being hung by the state and as professionals we need to make a stand.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (10)

  • In Australia you get automatically investigated for overservicing if you see 80 or more patients on more than 20 days per year

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  • the main issues are
    1. complete lack of accountability by people besides front line staff such as doctors and nurses.
    check this out
    http://www.telegraph.co.uk/science/2016/08/30/southern-health-boss-quitsbut-will-still-receive-240000-a-year-a/
    2. probably all professions like dentists, doctors , nurses and others need to cry out loud in UNITY and say enough is enough. no more regulatory nonsense...

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  • I hold Mr Hunt and politicians like him personally responsible for these kind of issues. He and his like strut about dreaming up schemes that 'seem like a good idea at the tie ' and a 'vote winner' and seem to beleave they are above any kind of personal responsibility for the chaos they cause...expecting to be shuffled to another job when they screw up. At least this low life Hunt is still in post ...anyone noticed how little we have seen his well tanned smug face since Brexit. Where is this looser and why isn't HE in court?

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  • It is nobody's else's fault, only our own. We do not define what is safe. How does a DOH person know? So, if we see 80 people, then it is quite simply because we have not defined that 25 is the safe number, as an example.
    I have argued this point in innumerable BMA meetings through the years and never got anywhere.
    To illustrate, junior doctors who are absolutely murdered by rota gaps, keep stating how unsafe their workloads are without defining what normal work should be.
    Let us define safe levels of working for each speciality in hours worked and patients seen.
    Then we can tell the state that its duty of care is unsafe.

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  • the manslaughter cases are the high profile end of the GP vilification but every day the miserable CQC are going about their petty business demeaning doctors by nitpicking tiny issues of paper work and business process. I know you have all suffered like I have and it is demoralising to have them play up such trivial issues when we are coping with severe stress and life and death decisions on a daily basis. Somehow we have to stop CQC from destroying what little job satisfaction is left. any ideas out there?

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  • Thanks for bringing this issue to the mainstream. For those that haven't seen it, GP Survival have also written a letter campaigning on this issue and have collected 231 signatures to date:

    Dear Sir,

    GP Survival is increasingly concerned about the growing list of doctors being prosecuted for manslaughter. We represent over 5500 members, many of whom have signed this document. We feel that the way in which the doctors, are being persecuted by the crown prosecution service has crossed a boundary of injustice.

    You will be aware of a number of high profile cases over the last few years where doctors have found themselves being prosecuted in cases where there was a perceived neglect in the quality of patient care. Whilst we would not wish to comment on the particulars of any one case, one common feature seems to be that it is a lack of intervention, rather than a deliberate or malicious act, which proved fatal. GP Survival does not support poor or reckless care, but we feel that a proportionate approach is required when an error has occurred. A further wrong will not make human tragedy more bearable nor quell the grief of loss.

    There is a growing feeling within the medical community that the treatment of doctors in this regard has become detached from the reality of what it means to be a doctor in the NHS. It is entirely understandable that patients and families are angry when things have gone wrong and demand answers. However, there needs to be some acknowledgement of the enormous, and increasing, pressure doctors are under currently. We are dealing with an ageing population and more survivors of serious, complex disease. These problems are further compounded by pressures within the NHS: scarce resources, chronic unsafe staffing and no sign of reprieve. The crisis in general practice is becoming increasingly obvious. Where there are systemic failings and pressures, it is inappropriate to penalise the staff working in that system when errors occur.

    Doctors now practice in a sea of risk, most of which is beyond our individual capacity to influence. Each doctor is now making so many important decisions on a daily basis, that the odds of being right all the time are constantly diminishing. This requires an open and honest systems analysis to reduce risk, not a blame culture which harms staff and patients alike.

    We believe the situation is now out of control and the continued use of criminal law against doctors, who are making difficult judgement calls in good faith, is both disproportionate and intolerable. We see little public interest in attempting the prosecution of doctors in cases where death is from natural causes even if (with the benefit of hindsight) an intervention resulting in the prolongation of life might have been possible. Such practice promotes a culture of fear over the more pressing need within the medical profession (and, by extension, in society at large) for a culture of learning.

    Whilst we appreciate that it is the role of parliament to make law and it is difficult to change a statutory processes, we are concerned more about the culture of clinical negligence law and the toxic effect these prosecutions are having on medical practice in this country.

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  • We should practice safely and decline any work that we consider unsafe in terms of time, place, patient complexity or our expertise.

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  • It's just as bad, if not worse for pharmacists. Any dispensing error where an incorrect medicine is dispensed is automatically an absolute criminal offence. DH and Govt. said 6 years ago that they would support changes in law but have done nothing whatsoever and now demand candour! Never mind the fact that the policies of Osborne, Cameron, Lansley and Hunt will indirectly prolong suffering and increase premature deaths by their recklessly negligent management of the NHS, they'll never be held to account, indeed Lansley's gross incompetence and lies have got him a nice little earner in the House of Lords

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  • Dear Dr. Nabi,
    I am NOT a GP, nor indeed a doctor of any sort, but an SRN, MTD, HV. So I am deeply sympathetic towards all doctors regarding the emotional & moral dilemmas you have to face in making daily life & death decisions, particularly with the increased pressures of the present NHS demands.
    BUT, surely there HAS to be SOME supervision & accountability for the medical profession ! Avoidable mistakes ARE sometimes made whether by culpable criminal negligence or poor judgement or training or quite simply tiredness & if nobody is ever held to account or found responsible & accountable, there would never be any progress or improvement in medical practice standards. It is surely morally right that we should all be responsible for our actions ? Every other member of society is trained, supervised, appraised & held accountable for their actions & behaviour &, sadly, has to sometimes accept that they were at fault & accept the consequences, why not doctors, particularly as they ARE dealing with peoples' life & death situations ??
    I am sincerely sympathetic but confused, what is so
    different about doctors that these moral laws should not apply to them as they are to us all ?

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  • Dear Sessional/Locum GP @4.44pm,

    Hunt WILL be challenged in the High Court Judicial Review by the courageous Junior Doctors 'Justice for Health' (Crowd Justice) on September 19/20th !!
    Give them your support, they are fighting for the same principles as you are, the right to practice good patient care !!

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