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Dear CQC - I think you've got some mythbusting to do

Letter from Dr Paul Cundy, Wimbledon

Dear Professor Steve Field,

I writing another open letter having not had any response to my last. I note your recent observations of the importance of PowerPoint presentation skills for practices achieving outstanding results in their inspections. I am sure you will agree that one of the fundamentals for any presentation in whatever form is factual accuracy.

I therefore draw your attention to the mythbusters found on your web site. These are to be welcomed but as with any large body of documentation errors can creep in. I have identified two significant ones; one on a point of law and the second an inconsistency with the relevant GMC requirements.

Mythbusters 19 and 57, PGD and PSDs

Mythbuster 19 contains the statement that a Patient Specific Direction '…. must be written and signed by the prescriber'. It goes on to categorically state that a verbal direction does 'not' have legal authority. Both these statements are wrong and need correction. There is no statutory definition of a PSD; the law allows for 'Prescriptions', 'PGD's and 'directions', the first two being tightly proscribed. The term Patient Specific Direction is a generic term that can encompass all three. The relevant Act allows for a 'direction' to be verbal and there is case law to support this. Nowhere in the Act does it state that a 'direction' cannot be verbal. You will know that I have brought this to your attention before. Following a detailed external review of the legislation the BMA has recently updated its guidance to reflect this subtlety. Regulations 214(1), (2), (7), 215, 217 and 223(1) of the Human Medicines Act 2012 refer.

This error is repeated in Mythbuster 57.

Mythbuster 49, Consent Minor Surgery

Your Mythbuster refers to the relevant GMC statutory requirement and states: 'In the case of relatively minor procedures, for example joint injections, consent can be recorded in the patient’s records. In the case of more invasive procedures, for example excisions, written consent should be obtained'. I am afraid this is at odds with the referenced GMC guidance which states at para 46 that for 'minor' treatments implied or verbal consent is acceptable, there is no need for any written record. The GMC only requires written recording of consent if (paras 47 – 49):

'a) the investigation or treatment is complex or involves significant risks. Or

b) there may be significant consequences for the patient’s employment, or social or personal life'

I suspect most GPs and the GMC would not categorise cryotherapy, curettage, the removal of skin tags, sebaceous cysts or ingrowing toenails as being particularly complex or dangerous. Furthermore the GMC confirms that the record of the consenting process may be captured either in the patient’s records or on consent forms, the latter not being mandatory

The CQC was contacted for comment, but declined to respond

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Readers' comments (7)

  • Well said on the point about consent for minor surgery. We were pulled up about this and told it was mandatory.

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  • Clearly Quite Clueless.

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  • This is very important, I hope the BMA will take this up.

    Its mission creep for tick boxing CQC which allows and encouraged these myths to cause damaging change to clinical practice

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  • No wonder they can't stick to budget - too busy counting widgets they didn't need to.

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  • this would be funny if it were not true. The CQC, and especially Steve Field, beileve themselves to be above criticism, complaint or discussion. Time to burn them to the ground

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  • Nigel Sparrow says he has already responded directly to Paul Cundy as the author of this myth buster letter

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  • In our Minor Surgery revalidation course, we were advised that written consent (with a cooling off period) was mandatory. I actually think that it is your medical defence organisation that should guide you.

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