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CQC should review working environment of doctors being investigated, says review

The CQC should scrutinise the systems within the departments of doctors who are being investigated for gross negligence manslaughter or culpable homicide, a new review has recommended. 

The independent review of gross negligent manslaughter and culpable homicide said that the ‘appropriate external authority’ should inspect the departments where doctors are being investigated to find out if there are wider systematic failures. The review’s chair later clarified this was the CQC. 

It said healthcare service providers ‘have a responsibility’ for the environments in which doctors practise. 

The report said: ‘The vulnerability felt by many doctors reflects their sense of working in healthcare services that are under considerable strain and where individuals trying to do their best for their patients can too easily be blamed for mistakes arising from wider system failures.’

The review was commissioned by the GMC following the the prosecution and conviction of Dr Bawa-Garba for gross negligence and manslaughter after the death of a six-year-old patient.

Chair of the review Leslie Hamilton said: ‘The healthcare services have woken up to the need for just and fair treatment of staff, but the practical applications of the principles has so far been patchy, at best.’

It also recommended that the GMC take ‘immediate steps’ to repair its relationship with doctors which it said was ‘severely damaged’ after the case, and reform its policies to better serve doctors and patients.

However, the report said the GMC’s investigation practices were just part of the problem.

It said: ‘The decisions of a regulator when things go wrong are only the final stage of a complex series of processes which begin with the healthcare service provider and which may stretch over many years.

‘These processes often do not serve the needs of doctors or patients and their families.’

Professor Ted Baker, CQC’s chief inspector of hospitals said: ‘This is an important report and we fully support the focus it places on creating a ‘just’ culture where learning is shared when things go wrong and staff are supported to speak up about concerns. 

‘Where we receive information of concern about a registered provider or any of the services it delivers, this forms an important part of the intelligence we hold about that provider and is used to direct our monitoring and inspection activity.’ 

He added: ‘Should we find evidence that standards are not being met or patient safety and quality is being compromised then we will hold that provider to account, using our enforcement powers where necessary to drive improvements.’

‘In line with the recommendations made in this report we will continue to ensure this level of scrutiny going forward.’

The report’s recommendations also included: 

  • Reducing the GMC’s timescales for progressing fitness-to-practise cases to medical practitioner pribunals and removing the regulator’s right to appeal Medical Practitioners Tribunal Service decisions, which was also suggested in the Williams’ review last year.
  • A call on the GMC and other healthcare sector organisations to demonstrate commitment to equality, diversity and inclusion after it found that certain doctors felt ‘particularly at risk’ of investigation, including BAME doctors.
  • A need to ensure doctors’ reflections were legally protected and called on the Government to consider this change in law.
  • That local healthcare service provider investigations should be more consistent across England and Wales in particular. 

GMC chief executive Charlie Massey said: ‘One thing this report and its recommendations make clear is that a just culture requires a lot more than the actions of a single regulator.’

He added: ‘The report highlights the new evidence that the public are acutely aware of the pressures facing UK heath systems, and that this can affect their confidence in the care doctors are able to provide.

‘This reinforces why we must all do what we can to make sure doctors are training and working in safe environments, for the benefit of patients, and why the GMC must work with the system to effect change.’

A Department of Health and Social Care spokesperson said: ‘We welcome Leslie Hamilton’s review and as part of our NHS Long Term Plan we are working to support a just, learning culture that will improve patient safety and better support healthcare professionals, patients and their families.

‘We consulted on proposals to reform the legislative framework of professional regulators and are considering which reforms should be taken forward.’

It follows the news that the GMC has committed to spending the bulk of its resources on supporting doctors, rather than investigating them.