Exclusive: One GP in seven regards a local hospital department as ‘dangerously substandard’ according to a major survey providing evidence that in a significant minority of hospitals patients are dying because of failings in care.
As many as a third of respondents to the in-depth survey of 500 GPs, conducted by Pulse with sister title Practical Commissioning, said they believed a patient had received care which was dangerously poor at their local hospital in the last year.
Some 10% of GPs said one of their patients had died in the last year potentially as a result of substandard hospital care, with complaints over missed diagnoses, dangerously early discharge and poor emergency care. A third of GPs raised concerns with their local hospital in the last year, in some cases with letters to clinical standards teams, but fewer than half felt confident that concerns would be acted upon.
Overall, 64% of GPs rated hospitals’ clinical care as ‘good’ or ‘very good’, but only 38% did so for communication and personal care. Problems included substandard nursing care for elderly patients, delays to follow-up appointments and patients discharged so prematurely GPs could ‘no longer rely upon in-patient care being complete’.
Some 78% of GPs would still recommend their local hospital to patients, but 20% said they had confidentially warned patients about its care in the last year, and 21% would not trust it with their family. Some 15% said whole hospital departments were dangerously sub-standard, with A&E departments most often cited.
A GP in Oxford, who asked to remain anonymous, said their practice raised the alarm over three ‘serious’ missed diagnoses by the gynaecological department at the John Radcliffe Hospital, including one of ovarian cancer. ‘I think the patient with cancer has died,’ the GP said. ‘We wrote a letter. All we wanted was something saying let’s look at this. Instead we got a five-sentence reply saying under NICE guidelines “we did nothing negligent”.’
An Oxford University Hospitals NHS Trust spokesperson said: ‘The trust is confident about our services, but not complacent. If a GP feels our care falls short, we would urge them to raise this.’
Dr Peter Livingstone, a GP in Glasgow, said he raised concerns over ‘dangerous’ premature discharge: ‘A patient had been admitted on Saturday and discharged on Sunday. A chest X-ray had found left broncho pneumonia. When I saw him he was unresponsive, his pulse was running too fast, he had a fever and his blood pressure was down. They turfed him out thinking a nursing home would look after him. That is substandard care – I worry he may have died.’
A GP in the East Midlands blamed an elderly patient’s death on substandard care: ‘He fell out of bed and fractured his hip. It wasn’t picked up, complications set in and he died. The patients who don’t do very well are the elderly.’
A GP in Romford, south London, said his practice now re-referred a quarter of patients due to his local hospital discharging them on ‘target driven, not clinical’ criteria: ‘I have written to the chief executive to say if I had my way I would not refer a single patient to her institution.’
Barking, Havering and Redbridge University Hospitals NHS Trust said: ‘We take GPs’ concerns very seriously and are working with our clinical forum on a quality improvement programme.’
Dr Richard Vautrey, GPC deputy chair, urged GPs to sound the alarm with hospitals or via LMCs: ‘We must not stay silent.’
The Department of Health said: ‘Unsafe care will not be tolerated. We are developing patient safety measures which will show the outcomes of care.’