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End of attachment training surveys – what’s the point?

I seem to have to fill in two of these now, one for the Deanery and a national one for the GMC.  The questions cover current NHS and training hot topics – level of responsibility, senior accessibility, teaching, hours, handover, and then in the national one, a direct question about whether I’ve had concerns about patient safety – yes or no? 

So what do concerns mean?  One assumes that if you’ve fleshed out answers in the topics already covered – eg. I’ve regularly had to make decisions beyond what I feel are my capabilities due to lack of senior support – then this has already been covered.  As an aside, the question above is a subtle way of influencing culture as we’re less likely to ‘man up’ as was the old way of NHS working. 

Presumably they’re fishing for the systemic failure systems we’re, sadly, being forced to focus on nationally. 

Which immediately leads one to a dichotomy of dilemma.            

If you say no, what happens if you happen to be working in the next national headline?  Will you be culpable for being quiet?  The Francis Report recommendations included legal, not just professional, responsibility to report, but concern has been raised, including by the RCGP, that this policy would further dissuade whistleblowers. 

You say yes, possibly with a modicum of cynicism included (which immediately makes you wonder whether it’s worth putting your head above the parapet), there are then more boxes to fill in (further dissuasion), and the implications are unclear. 

Am I going to be rung up and forced to attend a GMC hearing?  Will your Chief Executive be on the phone asking why he’s heard about this from the GMC, not internally?  Don’t be ridiculous!  This won’t make any difference whatsoever.  And anyway, why does the GMC want to know about system failures?  But equally who else is asking me for this information?

There are so many negative things said about whisteblowing in the NHS that I find myself instinctively wanting to avoid before starting.

A few constructive thoughts. 

First, we do have a professional duty to report, but it may be beyond our responsibility, seniority or skills to sort.  Just because you can’t provide a solution doesn’t mean you shouldn’t report to an overseer.  Second, if you were designing the feedback system, would you have a combination of voluntary and direct questioning (a little like the PRN and regular side of the drug chart)?  Probably.  The GMC can send the information on to a relevant body if you’ve sent it to the wrong place.

Third, the Situational Judgement Tests in our selection process probably has made us all better discriminators of what should be highlighted and where. 

Finally, be glad your opinion is being solicited.  It does reflect some sort of democratic, open culture. 

Yes the NHS is rubbish at feeding back on the impact of the information you feed the machine with, and acknowledging the impact the situation is having on you.  This is bad leadership.  There aren’t excuses for this.  But there is a counterweight.  If you feed into a national survey, it is going to be more difficult to feedback individually, because a national survey is looking to triangulate evidence in matters of such significance that they intervene with their weight. 

While you may have reason to feel cynical with these surveys, it may just be that you are making a difference.  As a minimum you are making a culture of responsibility and trust.  The old adage still stands – would you expect the doctor to do it for your granny?

Dr Alex Thomson-Moore, an ST2 in the Severn Deanery.