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GPs buried under trusts' workload dump

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

Copperfield

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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)

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  • Vinci Ho

    This is the reason why we all study history carefully:
    (1)One of the recommendations in the fifth report of The Shipman Inquiry, which was published in December 2004, was for the adjudication stage of fitness to practise procedures to be undertaken by a body that is independent of the General Medical Council .
    In July 2011, the GMC approved proposals to separate its presentation of fitness to practise cases from their adjudication. The adjudication would become the responsibility of a new body, the Medical Practitioners Tribunal Service.
    In June 2012 the MPTS assumed responsibility for medical tribunals, with their panels given the power to remove or suspend a doctor’s ability to work within the UK.
    Hence , in simple terms : While fitness to practise (FTP) procedures are under the jurisdiction of GMC , the final judgment lies with MTPS.
    (2) Then this happened :
    114 doctors that had died during 2005 and 2013 inclusive and had an open and disclosed GMC case at the time of death.This was followed by GMC’s own internal review with eight recommendations on current GMC practice as well as a section on MPTS
    ‘’Doctors who commit suicide while under GMC fitness to practise investigation
    Internal Review
    Sarndrah Horsfall, Independent Consultant
    14 December 2014
    Executive Summary’’

    On MPTS , it read:
    ‘’If the matter is referred to a hearing, the MPTS may also request a health assessment if this has not been carried out during the investigation. At the end of a hearing, the MPTS panel may close the case with no action, issue a warning to the doctor, place restrictions on the doctor’s registration (when these are imposed by a panel they are called conditions), or suspend or erase the doctor from the medical register. If the concerns relate solely to the doctor’s health, and not to performance or misconduct, then a panel cannot remove a doctor from the register.
    Although MPTS hearings are generally held in public, matters relating to a doctor’s health are considered in private session. Outcomes of hearings where doctors are found to have impaired fitness to practise are published against the doctors’ names on the online medical register and any warnings remain in force for five years. However, any matters relating to a doctor’s health are treated as confidential and are not published or disclosed by the GMC or the MPTS. ‘’

    (3) This was like Donald Trump versus FBI between GMC and MPTS.
    In March 2015, changes to the Medical Act mean that the GMC gained the ability to appeal against decisions made by the MPTS.
    Dr Bawa-Garba was convicted in November 2015. One can easily postulates that GMC could not wait long to fire this new missile to appeal against MPTS’ decision.
    (4) It is now extraordinary for CPS to consider charging the Hospital trust seven years after the poor child died .
    (5) This complex , contradictory relationship between GMC and MPTS needs to be re-examined openly with clear transparency. The superhero-protector of people mindset of the GMC will , if allows itself to be ruthless, challenge every decision made by MPTS in the future .
    I will argue the lesson of the death of those 114 doctors was never learnt.

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  • medicine tastes awful

    The Health and Safety Executive (HSE) has brought charges against Mid Staffordshire NHS Foundation Trust over the deaths of four elderly patients between 2005 and May 2014.

    Remember the headlines - HSE should be brought in on this.!!!

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  • Just Your Average Joe

    https://petition.parliament.uk/petitions/211232

    Make GMC a tax-payer funded organisation and not to be funded by doctors.

    Please consider signing and forward to like minded people

    Many thanks

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  • Read James Reason's Swiss Cheese model of incident analysis.
    Of all the many slices in this disaster, the individual doctor's role was not the major part. But it's easier to blame only the doctor, than to look at all the causes in this shocking and regrettable "conspiracy of unlikelihoods".

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  • As 'No Nonsense' says, "Have you heard of displaced guilt? The proximate cause of death was his mother administering enalapril...."
    Agreed, and I suspect that the family's public expressions of satisfaction at Dr Bawa-Garba being struck off are at least in part because it reduces the mother's understandable feelings of guilt.
    That this highly significant factor seems not to have been more rigorously considered in the case really beggars belief. One wonders if that was due to concern at upsetting the family, together with anticipated repercussions, both public and legal, of blaming a bereaved mother.

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  • well stated grumpy old hector

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  • Misreported is clearly not a GP. If you are you are not a patient facing one. Strange no one commented on the significance of the ACEI given by Jack's mother which clearly has caused the arrest or precipitate it at the very least. I thought all medication are supposed to be removed and given by nurses during admission. The GMC wants a whitewash and for us to exposed to this ongoing unacceptable risk.

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  • Council of Despair

    This why Hunt is panicking - once a detailed analysis of the case is made during the appeal all these factors will come to light. There are ramifications for the state as well as us on issues such as safe workloads for doctors and even culpability of the family. And no it isn't in bad taste - why did the family give the ACE? why didn't they ask the staff first? If we are liable for things that patients do without us knowing then we are all at risk. It's also interesting thast the CQC, NHSE, BMA, and royal colleges are very quiet and not kicking up a fuss. It shows where their values lie especially the CQC - you know the safety champion and the guy who cries over the state of the NHS or Prof Keogh who is so worried about patient safety. This case has exposed the double standards of those at the top and I'm glad that Hunt is panicking and hope that we don't let this case go. It concerns all of us.

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  • No doubt "misreported" feels that it is reasonable for a parent who has lost a child to celebrate, with a bottle of champagne at her son's graveside, the fact that a decent human being has been convicted of manslaughter for her son's death. That sounds like vengeance to me. But the greatest tragedy of all is the loss of trust between doctors and their patients over the past 30 years, much of it encouraged by politicians, the press,the GMC, CQC et al. The GMC's role is particularly disgraceful in that their motto reads "supporting doctors, protecting patients". I remember the witchhunt against the GPs who signed the part 2 cremation forms in the Shipman case even though it should have been the coroner in the dock. All were later exonerated though their careers suffered. How many whistleblowers have been silenced and even driven to suicide by the actions of the GMC. The GMC is not an independent regulatory body but a political body bending to the will of government and failing in its duty to treat doctors in a fair and supportive manner. It is time it was replaced and in the interim I would suggest that all doctors should consider a national subscription boycott.
    The interesting thing about the posts I have read is how few doctors are prepared to identify themselves. I can only assume that this is because they are concerned about the effect their freely expressed opinions may have on their careers or even whether they may be victimised by the GMC should they ever come before a disciplinary panel.
    In the interests of openness my name is Austin(Aussie) Connor and I am a GP in Hartland ,Devon. I have been a doctor for 37 years and will retire in 11 weeks time. My naive enthusiasm to do my best for others has been gradually eroded by many factors but most of all by the erosion of trust between us and our patients. Much of this has been beyond my control---government policies(e.g commissioning), the press(e.g. The Daily Mail) underfunding,staff shortages, internet misinformation, disclocation of society in general,ambulance chasing lawyers, blame culture,the internal market, irrelevant targets etc etc. The GMC have done nothing to help doctors cope with these seismic changes except to apportion blame to individuals rather than the systems that have made our jobs so complex and distract us from our primary duties of caring for our patients. It is time that the BMA asked us to ballot on a vote of no confidence in the GMC. Not only have they let doctors down but most importantly they have let patients down.
    Now I'm off to do the joke that is my appraisal.

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