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GPs speak out on standards of hospital care

Today Pulse revealed that one GP in seven thinks their local hospital is ‘dangerously substandard'. Here we get your reaction to the story as well as hearing from leading GPs Dr Richard Vautrey and Dr Clare Gerada. Click here to take a look at the full survey results.


‘Dangerous' care and patient deaths


·         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 the quality of our services but not complacent. We have robust processes in place to ensure that high standards of clinical care are delivered in our hospitals. If at any time a GP or patient feels that the standard of care received from our trust falls short of their expectations, we would urge them to raise these through the appropriate channels.'


·         A GP in Norfolk, who asked to remain anonymous, said she could ‘no longer rely upon inpatient care being complete prior to discharge' if patients were treated at the Norfolk and Norwich university hospital.  ‘Discharges are often too early and we have a 1:20 readmission rate, within a matter of hours, let alone 14 days. That is an under-reflection as many elderly patients will refuse to return,' the GP said.

Professor Krishna Sethia, medical director for the Norfolk and Norwich University Hospital, said: ‘Our policy is for patients to be discharged when they are medically fit to leave hospital and the readmission rate at NNUH is in fact the same as that of other University Teaching Hospitals. When clinically appropriate patients may be asked to return for further investigations at a later date.'


·         Dr Peter Livingstone, a GP in Glasgow, said he raised concerns over ‘dangerous' premature discharge from a hospital in the city: ‘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.'

‘What happened was he had been seen, clearly there was a bed crisis or something, they thought he was in a nursing home and they turfed him out thinking a nursing home would look after him but he was in a care home and lived semi-independently. That is the kind of care that is substandard in my view, I would worry that that man may have died.'


·         A GP in Romford, said: ‘My local hospital discharges patients from follow up on criteria which are target driven, not clinical. My re-referral rate has risen from one re-referral in the whole of 2005, to 25% of referrals in 2011. My letters of complaint go unanswered by the chief executive, but result in an internal investigation which almost invariably exonerates the hospital.

‘Consultant opinion is good, but nursing standards are extremely poor due largely to understaffing. Follow up appointments when the consultant says 6 weeks are determined by admin, then cancelled, cancelled again, and again, and I have known a "6 week" review take more than one year. I have written to the chief executive that "if I had my way I would not refer a single patient to her institution".

Barking, Havering and Redbridge University Hospitals NHS Trust Medical Director Stephen Burgess said: ‘We take the concerns of our GPs very seriously and are working with members of our clinical forum on a whole programme of quality improvement to build the confidence of both GPs and patients in our services. We have introduced a new complaints system and restructured our management with an enhanced role for the clinical directors in leading improvements and assuring standards are delivered. Patients on our wards are already benefiting from hourly care checks and other high quality nursing care set out recently by the Prime Minister, and the Trust passed its privacy and dignity inspection by the CQC last year.'


Personal care and communication


·         A GP in the North East said: ‘I felt when my wife went in for surgery she was in a tunnel where she went in one side and came out the other as if on a factory production line. There seemed to be no appreciation of the human side to her care.'


·         A GP in south London, who asked not to be named, said substandard nursing care was common: ‘Patients not being fed, not being washed, the sort of nursing care that none of us would want ourselves or for our patients. It is quite concerning.'


·         Dr Martin Wolfson, a GP in Surbiton, Surrey, said: ‘The local hospital is fine if you are young, fit and articulate, but if it was your grandfather, it wouldn't happen. It's money-driven and it's lost the personal touch.'

A spokesperson for Kingston Hospital NHS Trust said: ‘At Kingston Hospital we uphold high standards of quality care for all patients. This has been reflected several times through CQC inspections and reports. Late last year, a CQC report named Kingston Hospital as one of only 45 trusts meeting the standards of privacy, dignity and nutrition for elderly patients, as a result of an unannounced visit in March 2011.'


·         Dr Tony Brzezicki, a GP in Croydon and member of Croydon CCG, was one of those to say he would not choose his local hospital: ‘The biggest issue is how poor patient experience is. Survey results are poor and have been for a number of years, even if outcomes are good.'

A Croydon Health Services spokesperson said: ‘We are committed to improving patient experience on an on-going basis and we have seen a marked improvement over the past few years with 90% of our patients now reporting a positive experience and 70% rate the service 9 or 10 on a 10-point scale on our trust feedback system.'


·         Dr Adam Skinner, a GP in Kent, said: ‘[I am] very pleased with the Tunbridge Wells hospital at Pembury. I wouldn't send my dog to Princess Royal University Hospital at Farnborough.'

A South London Healthcare NHS Trust spokesperson said: ‘We work closely with our local GPs and most are very pleased that their local hospital trust has gone from having one of the highest mortality rates to lowest in the country, one of the few to recieve a positive CQC assessment on elderly care recently and virtually zero rates of MRSA.'


Discharge delays


·         A GP in Surrey said: ‘Administratively [the] hospital is poor with long waits for clinic letters. Patients frequently complain about appointments being rearranged at short notice and increasingly long waits for outpatient appointments.'


·         A GP in Worcestershire said: ‘Discharge letters [are] not detailed enough and often contradictory regarding follow-up. A patient went into hospital with haematosis. She said she'd had a three-pint blood transfusion but it isn't mentioned in the discharge letter.'·         A GP in Yorkshire, said: ‘The main problem is unreliable and late discharge info, ranging from incorrect medication lists, lack of information about why medication is stopped or started, no results of significant investigations, no mention at all of investigations performed and requests to perform investigations after discharge with no explanation.'


·         Dr Andrew Mimnagh, chair of Sefton LMC, said: ‘It is massively important that GPs get good quality discharge information. It is a perennial issue among many hospitals across the country. We've seen examples of medications being changed but GPs not being told about it. We used to have a lot of delays in discharge summaries locally but the move to link CQUIN payments to a requirement for discharge summaries to be sent to GPs within 48 hours has led to an improvement.'


Praise for local hospitals


·         A Merseyside GP said:  ‘I have recently attended my local hospital for a cancer diagnosis- received efficient speedy service with a histological diagnosis within an hour of arrival at the outpatient unit. I am waiting one week for a CAT scan and hope to be in surgery within a few days. Any wait is difficult for a patient, however the NHS for me is very reasonable.'


·         Dr Paul Richards, a GP in Wickford, Essex, said: ‘I am a patient myself at Basildon. Care so far has been very good.'


·         Dr Alex Barlow, a GP in Stockton-on-Tees, said: ‘I am always impressed when I deal directly with named specialists and juniors. I lose confidence when my patients are passed between consultants, or the care is delivered by an unnamed specialist.'


Reaction from leading GPs


·         Dr Richard Vautrey, GPC deputy chair and a GP in Leeds, said: ‘If GPs have concerns about the standard of care their patients receive in hospital it is important that they raise these either with the hospital directly or via their LMC who can represent their worries both to the hospital management and the local PCT/CCG.  If we want the best care for our patients we must not stay silent when issues arise but be prepared to be their advocate.'


·         Dr Clare Gerada, RCGP chair and a GP in Kennington, said: ‘We need to heed these concerns that have been raised by GPs and locally the GPs need to have conversations with their hospital managers or consultants to try and sort this out. But what I wouldn't like to see is us having a divide between GPs and hospital doctors - this is what happened under fundholding and it divides us to the detriment of patients.'