The Francis report places an emphasis on candour. My local consultants are already used to me contacting them – I regularly write to say, ‘Did you know this is happening?’ But the response can be mixed.
Some will write back honestly and say, ‘No, actually I didn’t but I’ve looked into it and we’ve sorted it out’. Some you never hear back from, while others write back and say something completely inappropriate.
Recently I experienced things from the perspective of a relative, as my mother was admitted to my local trust. I noticed some problems, such as the dose of one of her medications being wrong. In addition, it took me three days to find which consultant she had been admitted under so that I could speak with the team and find out what was happening. When I raised this with the medical director, who I happened to see at a meeting, he just said, ‘Well, that’s the way we do things.’
However, it would be disproportionate to have to report every problem to the CQC or GMC. We have to keep a balance – the usual response should be letting the relevant organisation know and giving them a chance to respond, and only reporting if there is no response or if it is inappropriate.
There is still a question over what duty is going to be placed on GPs. If it is to notify whoever we believe is the appropriate person each and every time we find a problem, and to have to actively monitor patients when they are in hospital, we can’t do it. We don’t have the resources.
Recently I completed insurance forms for the family of a patient who had died of disseminated cancer. Looking through the hospital records, I found a chest X-ray from six months before that showed he had metastases in the lungs then – but the hospital had not acted.
I ensured that the hospital were aware. But does this mean I should look through hospital records every time a patient comes out of hospital? It isn’t feasible – we don’t have the capacity to oversee everything that is done.
Here in Coventry the CCG is trialling a system whereby practices report any concerns over a patient’s care using an online form. The CCG can then collate the information and if a pattern emerges they can report it to the hospital. It could be a positive step to have this tool, although due to concerns regarding confidentiality and the potential for abuse, we will have to see how it works in practice.
Dr Grant Ingrams is a GP in Coventry