The death of a patient is tragic in itself, but potentially devastating if a police investigation for manslaughter follows. This is an issue which is facing more doctors, GPs included.
Fortunately, while there are an increasing number of manslaughter investigations, in the MDU’s experience 10% or fewer result in a criminal prosecution. And only about 25% of those cases prosecuted (around 2.5% overall) result in conviction.
The investigation alone can be lengthy and invariably take a considerable toll on the GP involved emotionally and professionally and on the practice. Police investigations rarely take less than six months and can take a number of years. During that time, because of the seriousness of the allegations and the nature of primary care, GPs can usually expect to have restrictions on practice imposed, by the GMC and by NHS England, at the very least.
While it’s not unusual for a tragedy to occur following a combination or sequence of mistakes, coupled by system failures, sadly, it is often the conduct of an individual doctor which is scrutinised.
The following steps can help GPs to reduce the risk of facing a criminal investigation or to know how to respond if the worst happens:
1. Work within your capabilities. If you’re not sure about something, seek advice or supervision.
2. Understand and follow any local procedures that are part of the clinical governance framework. Be prepared to justify any deviation from national guidelines.
3. Conduct and document a full and complete clinical assessment of patients that will include negative as well as positive symptoms and signs. It’s easy to miss something when under time pressure.
4. Think about patient safety in your CPD planning. Some of the mistakes that lead to prosecutions have happened before, and raising your personal awareness of them will have obvious benefits, so seek out courses, conferences and initiatives relevant to general practice.
5. Be flexible in your thought processes. When treating a patient be ready to stand back and consider all available information. If something doesn’t seem quite right it probably isn’t and you may need to consider a wider differential diagnosis, or a referral.
6. Embed patient safety initiatives in your practice, and encourage colleagues to follow suit. Join the NHS England ‘Sign up to safety’ campaign which has five principles at its heart – putting safety first, continually learning, being honest, collaborating (take a lead role in collaborative learning) and being supportive (helping others to learn why things go wrong, and how to put them right). One example could be prescribing systems designed to identify and flag up potential drug errors or interactions, such as cross referencing with patients’ known allergies.
7. Flag up systems or practices you believe are unsafe and address them. For example, if there aren’t enough resources or poor system design means you cannot provide a safe and effective service to patients, raise this formally at your practice meetings and take a personal interest in ensuring there is progress.
8. Make sure serious incident investigations are properly conducted, with accurate minutes that deal with the relevant issues. Identify the problem and solution, rather than the blame. This will help the whole practice team to learn any lessons from serious incidents in the interests of patient safety. It could also help to preventing a recurrence of mistakes that could lead to a manslaughter investigation.
If something does go wrong and a patient dies or is seriously injured
- Get advice from your medical defence organisation at the earliest opportunity.
- Don’t try to produce a statement/information for any investigation without the notes or advice from your medical defence organisation or a solicitor instructed by them.
- Never make the mistake of thinking that the police won’t know the subject matter. Any interviews will likely be conducted by skilled officers.
- For the best of reasons you are very unlikely to have experience of a police interview. Be ready to ask for and follow your solicitor’s advice. It is your right to consult your solicitor and it does not make you look guilty if you do.
Dr Beverley Ward is a medico-legal adviser at the MDU