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Independents' Day

Thank you, Dr Bawa-Garba, for bringing us to our senses


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How annoying. There I was, all ready to go with this blog about how, despite UK GPs having 60% more patient contacts each day than the number considered safe, we should forget about the idea of a cap on consultations because it’s an unworkable waste of time, effort and hot air.

I had all the arguments mapped out.

How, if you cap the number of consultations, we’d just work quickly then put our feet up, or if you cap surgery length we’d see a single patient for a very long appointment, or if you hybrid the two we’d game the system by bringing back unnecessary low-stress follow-ups.

How a consultation would defy definition because of telephone, Skype and email interactions. How the post-cap patient overflow would need seeing somewhere and how that overflow would need a cap and therefore its own overflow, and so on ad nauseam.

It’s Dr Bawa-Garba’s horrific and by now well-documented scapegoating that had led me to this realisation

How, if there’s a ceiling, there might be a floor, too, with the concept of a minimum daily number of consultations coming as a nasty shock to some.

And most of all, how, if we’re honest, some GPs don’t want to debate this openly because they are already quietly putting up the ‘full’ sign each day and would rather continue covertly than have any troublesome contractual clarification.

But I can’t do any of that, because I’m wrong. We do have to put a cap on workload, so my column is redundant. Hence me being annoyed. Though probably not as annoyed as Dr Bawa-Garba. And it’s Dr Bawa-Garba’s horrific and by now well-documented scapegoating that had led me to this realisation.

We all know the story and probably, by now, the issues, too: clinical misjudgements become gross negligence manslaughter depending on which way the wind blows, and system/contextual factors are irrelevant. All of which is not conducive to any sort of REM sleep in the foreseeable future.

According to the National Patient Safety Agency, each year, around 10,000 incidents lead to patients dying or experiencing serious harm. And that’s just the ones they know about. Frankly, given how crazy busy it is every Monday, I reckon most of those episodes could be generated by our practice alone. But, of course, it’s the same nationwide, with all of us cutting corners and crossing our fingers just to get through the day and the workload.

Well, now you know. You are just a rotten slice of luck away from being slaughtered in the courts and executed by the GMC. We might as well all turn ourselves in now. And if we don’t, and we soldier on to the point of exhausted dysfunction? The GMC’s view is, apparently, that it’s the duty of doctors not put themselves in a dangerous position in relation to competence and skills. Which is kind of tricky when you’re self employed and you can’t batten down the hatches of safety against a perfect storm of demand.

Which means something has to give, and if it can’t be standards then it has to be workload. Hence a cap. Hence a useless column. Thanks Dr Bawa-Garba. No, really. I mean that.

Dr Tony Copperfield is a GP in Essex


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Readers' comments (21)

  • This article is in very poor taste and disrespectful to Jack Adcock who lost his life as a result of substandard care. The ‘horrific and well-documented’ (to use your emotive phrases) standard of care provided to Jack should be acknowledged (whether culpability was personal or systemic).

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  • Misreported @ above,

    You are not a GP as stated. Please take your lack of understanding somewhere else.

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  • I disagree with misreported. the child died because the system was inadequate to save him, not because a single Doctor was so grossly negligent as to be guilty of manslaughter. Juries, judges and barristers do get things wrong, just as doctors do.

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  • Cobblers

    Utter bollux Misreported.

    I could well say your comment was 'In very poor taste and disrespectful to Dr B-G'.

    Change your cognomen. Might help.

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  • This comment has been moderated

  • @Misreported.
    What I don't understand is your last sentence saying culpability should be acknowledged whether personal or systemic. Are you saying that it doesn't matter who or what is culpable, as long as they hang someone out to dry, and it matters not whether or not they are innocent?
    Don't expect any help if it happens to you

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  • @misreported

    One could argue that the cause of his death was sepsis, caused by a colony of bacteria, viruses or fungi (or a combination of these). From what I read he was given an ACE and within an hour he had a cardiac arrest even though this was not on his kardex. Tragic, yes. Avoidable, maybe. I feel angry and very sorry for this experienced SpR.

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  • This may be insensitive, but was the last link in the cause of death the administration incorrectly of enalapril

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  • @ Anonymous ex gp

    The enalapril was not written up on the drug chart as the doctor intended it to be withheld. The medication was administered by the mother after checking with a nurse on the ward. Hadiza was critisized for not documenting in the notes that the enalapril should be witheld. However most of us would surely assume a drug will not be given if not prescribed on the drug chart.

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  • Re misreported.
    I take it you feel the jury's decision was not influenced by Dr Bawa-Garba's ethnicity or wearing of a headscarf? I can't help thinking that a white, private school educated doc like myself who had exactly the same clinical scenario happen would have had very different treatment from both our regulators and the courts.

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  • In my opinion, Jack was better, his parameters were better. If he was not, how come there was not one single another doctor in this ward to see him, not ONE HO, SHO, REG, Consultant in the ward. What is going on ? Beggars belief.
    It was the ACEI that probably the reason for poor Jack dying. We doctors have to ANTICIPATE that drugs may be given that we did not write up.

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