The utility and effect of the GMC

“It should not require data on suicides, nor Bourne’s extensive survey, to suggest that the system requires a radical overhaul, not expansion. For every doctor who is struck off, at least 50 are put through investigations that can take years. Some receive lesser sanctions, but 83% of the 8278 doctors who had fitness to practise investigations in 2010-13 were exonerated. This contrasts with an 83% conviction rate in the Crown Court.[15]”

Feedback on the NHS Friends and Family Test

All NHS organisations, this winter, have implemented the FFT as demanded by Government, NHS England and the CQC and perhaps others of the Great, Good and Administrata. You might notice the NHS has been a teeny bit busy recently, and wonder whether summer would be a good time to implement new ideas, but this one is so obviously wonderful that it is important to get it going. I’m told.

So in a spirit of feedback on all things, including feedback here is a comment relayed to me. I do have attribution, and I’m reserving that, the patient isn’t mine and doesn’t need interest from newspapers, thanks.

One patient’s views on being given a FFT questionnaire after attending A and E.

“The thing is, the form was not designed to elicit comment on the quality of the medical care as such. There was a tick-box for something called “clinical” something or other, which I eventually concluded was a vague reference to “actual medical treatment,” halfway down the list, in among “waiting times,” “nurse-to-patient communication,” etc. etc. and a bunch of other stuff that was all about general niceness of experience rather than what actually made you better.

My one adult experience of A&E, I wasn’t in there for a nice chat or a positive customer experience. I was in (as it transpired) for enough painkillers to knock a rhino out, and some emergency surgery. I got what I needed.

I woke up the next morning, and my personal health consumer self-evaluation went something like,
“Am I alive? Yes.
Am I in agony? No.
Result. 100% consumer satisfaction.”

If memory serves, the general ambience in A&E did, admittedly, tend somewhat towards the preoccupied, and the nurses and auxiliary staff reminded me of nothing so much as the band off the Muppet Show. I couldn’t have cared less.

Provided they got me the dope, and got me on the slab, which they did, they could have held a Black Mass in Klingon and cursed me in the name of Beelzebub for all I cared.

This is my mental image of the sort of level A&E operates at. It’s not the kind of thing that’s really amenable to meaningful patient evaluation. Positive outcomes are bleedin’ obvious as such, and abstruse clinical decisions are beyond the patient’s competence to evaluate anyway.

A long wait might be a pain in the ass, but it might well have nothing at all to do with the quality of treatment. And on the form you get to complain about the long wait, regardless. If A&E were suitable for people who fancy some dental work or a boob job on the spur of the moment one Sunday afternoon, and feel aggrieved if they have to wait longer than twenty minutes for it, then I can see the point of something like FFT. But that’s not what A&E is for as far as I can see. It’s for emergencies. It’s not supposed to be a nice experience, it’s supposed to be the last ditch attempt to do things like cheat death of another human soul.”

I think this is a sensible remark by someone who you will notice was ill and is greateful that he no longer is. Placing it on the collection box for FFT forms in various organisations, along no doubt with other feedback on the process and on the substnace of care, seems entirely sensible to me.

ANd remember, on almost all forms you may be handed,

White space is available, and may be used.

The BMA resolution on the GMC in 2000

“That this meeting, whilst reaffirming its support for self regulation of the medical profession, has no confidence in the General Medical Council as presently constituted and functioning and calls upon it to initiate urgent reform of its structures and functions in consultation with the profession.”

During the debate on this resolution and others, doctors expressed strong support for the continuance of professional self-regulation and for an increased role for the public in regulating medical affairs.

There was sharp criticism of the current performance and structure of the General Medical Council, particularly the slowness of its procedures. Cases may take up to two years to be resolved which leaves patients potentially at risk from unsafe doctors. For doctors waiting to have a complaint heard, the delays cause great stress and anxiety and a steady erosion of their professional reputation.

Those dissenting from the resolution felt that a “no confidence” vote was too strong and feared that the vote could be misinterpreted as a call for the disbandment of the GMC.

Speakers repeatedly stressed their commitment to working with the GMC to reform its structures and a desire for the whole medical profession to be involved in creating a system that acts quickly and fairly to protect patients.

Speaking after the debate, Dr Ian Bogle, Chairman of Council said:

“I hope that patients will be reassured by this vote. It shows that doctors recognise that there are very real problems that need to be sorted out so that we can have a system of regulation that really does protect patients. The GMC itself is committed to change and the BMA will work with the Council to speed up procedures, reform the election system and make sure that the work of the GMC is open and transparent.”

The question for the GMC might be in what way they have improved since then.

The Times and the NHS again

The Times used to be a newspaper, one of the world’s greatest, and checked its facts and by and large didn’t say things that are not true.

Its leader is reported to me as saying :-

‘GPs bear some responsibility… It is hardly surprising that A&E departments are overrun in areas where they are the only part of the health service open after 5pm or at weekends… Yet the introduction of roundtheclock GP service is being fiercely resisted by claims of insufficient funds… Given their current terms of employment… GPs must earn their generous wages… By doing more to ease the burden on hospitals.’

There are no areas of the country where A&E Departments are the only parts of the NHS open after 5pm or 6 pm or 7pm overnight or at weekends. None. (BTW, the people working in them like to call them Emergency Medicine Departments this century) .

General Practice provides a service around the clock, including at weekends. It is provided by GPs, the same GPs in general who provide a day time routine service.

The service is not identical, expecting to have a routine blood pressure check and advice on treatment from your GP who knows you is sensible, but expecting to have it at 0300 as well as at 1000 hours is not sensible, there is only one of me, I’m a diurnal mammal and I sleep some of the time. If I’m your GP I suggest you see me, not someone random unless you are suddenly ill.

However, if we were to run 24 hour surgeries for all routine work, to which you would presumably arrive on the 24 hour bus or Tube service, by the taxis which run as well at night in all parts of the country as they do in the day, or by walking along the roads which perhaps have their lights turned out to save power at night, there would need to be more of us, or we would need to be less available in daytime.

Also open all the time is the 111 service.

111 sends a lot of people urgently to Casualty (A&E, ED) departments often by ambulance. This isn’t helping.

111 is a franchise, let by the government to various corporations and others, and is only regarded as a great success by those running it, or in positions which would be imperilled by an admission that it is not the greatest thing since sliced processed cheese.

What is the agenda of the Times and its leader writer? And what investigative journalism did they do, and fact-checking? Does the Times still employ a fact-checker?