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GPs should have obligation to monitor hospital care, says report into Mid-Staffs

GPs should have an independent ‘monitoring role’ to ensure hospitals are providing good quality care, a landmark public inquiry into the failings at Mid Staffordshire NHS Foundation Trust has recommended.

The report says one of the reasons the failures in care at the hospital went unnoticed was because local GPs only expressed ‘substantive concern’ after they were specifically asked by investigators in 2009.

It calls for GPs to develop internal systems so they can spot ‘patterns of concern’, rather than focussing on the care of individual patients. Practices should report any patterns they notice to the CQC or other regulators, the report urges.

It also recommends GPs have a ‘professional obligation’ to follow-up with patients after they have had hospital treatment and recommends that CCGs take notice of GP feedback to improve services.

The report concludes: ‘It will be important for the future that all GPs undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services.

‘They have a role as an independent, professionally qualified check on the quality of service, in particular in relation to an assessment of outcomes.

‘They need to have internal systems enabling them to be aware of patterns of concern, so that they do not merely treat each case on its individual merits.’

They have a responsibility to all their patients to keep themselves informed of the standard of service available at various providers in order to make patients’ choice a reality.’

This inquiry looks at how the NHS should change in the light of the major scandal at Mid Staffordshire NHS Foundation Trust, which saw between 400 and 1,200 deaths above and beyond what would have been expected between January 2005 and March 2009.

The report says no individual or organisation ‘can be singled out for criticism’, but says that because GPs were not explicitly required to report concerns ‘unfortunately it did not occur to any of them to suggest it.’

It goes on to recommend all NHS staff have a ‘duty of candour’ to report any errors and that the CQC should be the body handling these reports.

The £13m public inquiry ran for 37 weeks, concluding in December, and has attempted to note down the important lessons to avoid any future repetition of the mistakes made in Staffordshire.

It has built on the work of the 2010 independent inquiry investigating the care provided by Mid Staffordshire NHS Foundation Trust during the same time period and both have been led by Robert Francis QC.

Prime Minister David Cameron said that while the report found that the responsibility for the ‘appalling suffering’ lay mainly with the Trust board at Mid Staffordshire hospital it had also uncovered much wider systemic failures, including a cultural attitude that patient care was ‘always someone else’s problem’.

Speaking in the House of Commons, he said: ‘Too many doctors kept their heads down instead of speaking out [but the report] says we should not seek scapegoats.’

To the patients and families affected he said: ‘On behalf of the Government and our country, I am truly sorry.’

He said the Government will study all of the 290 recommendations in the report and respond next month.

RCGP chair Professor Clare Gerada said the report showed that it was important to increase the number of GPs so they are able to focus on patient care.

She said: ‘Clinicians, including GPs and their teams, must be given the ability to do what is most important: listening to patients and caring for them.

‘GPs have so far ridden the storm but financial constraints and top-down targets are starting to adversely affect the level of care we can deliver to our patients.

‘We need to reverse this trend by increasing the number of GPs available to provide patient care, and by ensuring they are free to focus their attention on what matters most to patients.’

Following the publication of the report, the Government said it has tasked NHS medical director Sir Bruce Keogh with carrying out an immediate investigation into the hospitals with the highest death rates in the country.