Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
regulation of doctors
- Robert M Milne (3 March 2007)
-
Clinical governance can become oppressive
- D B Double (5 March 2007)
-
Regulation of health professionals - time for a culture shift.
- Maurice Conlon, Damian Jenkinson, Nick Lyons (9 March 2007)
|
|
|||
|
Robert M Milne, general medical pactitioner west lothian,EH29 9AS
Send response to journal:
|
It is frequently stated and shown in polls for years, that the vast majority of British people trust their doctors, and do not trust their politicians very much, so it puzzles me that those who are not trusted think they have to regulate and inspect those who are trusted? The NHS has moved into the blame culture,actively and openly encouraging people to complain. In your centrepiece today "The big question" it does not surprise me that the presidents of the GMC and the Royal College of surgeons of England, are in favour of the latest white paper, they have a vested interest in self preservation, and money will flow into their coffers. Adam Pringle (GP) and James Johnson of the BMA have got a better sense of proportion in their comments; Joyce Robins of "patient concern" questions the objectivity of those who work within the health service, maybe so, but I question even more the objectivity of lay people who actively want to sit in judgment upon doctors.What do I know about it all? A partner in the same GP practice for almost 31 years,a trainer for twenty of those years, and now a GP appraiser in Scotland for the past two years, I must confess I see revalidation as a sledgehammer to crack a nut. Appraisal can do the needful, with minor changes to include a summative element, we are already scrutinised enough in primary care, with prescribing costs analysed externally, hospital referrals analysed, patient satisfaction surveys open to the public, quality and outcome framework visits, it must be almost impossible to deviate from the norm without being noticed and pulled up, is there anyone else out there who agrees with me that enough is enough? Robert Milne MB ChB FRCSEd FRCGP Competing interests: None declared |
|||
|
|
|||
|
D B Double, Consultant Psychiatrist Norfolk & Waveney Mental Health Partnership NHS Trust, Peddars Centre, Norwich NR6 5BE
Send response to journal:
|
David A. Bruce mentions the climate of fear and the culture of defensive practice created by the increasing regulation of doctors.1 The government white paper, Trust, assurance and safety – the regulation of health professionals in the 21st century, on which his editorial is based, recognises that there has been managerial over-reaction in NHS Trusts.2 It also concedes that more needs to be done to ensure clinical governance structures can facilitate fair and effective action at local level. Clinical governance must be implemented in a facilitative and non-oppressive way. In the recent book Clinical Governance in a Changing NHS, James Reason notes that the belief that medical errors are necessarily manifestations of incompetence, carelessness or recklessness for which naming, blaming and shaming are appropriate responses is perhaps the single greatest obstacle to improving patient safety.3 In addition, Hittinger & Fielding observe that NHS organisations can become idiosyncratic, self-serving and autocractic which means that they react to problems in arbitrary and sometimes capricious ways.4 Furthermore, these authors go on to suggest that "such organisations are not necessarily easy to identify, because they may contain persuasive individuals who are practised at statements of intent (where words such as 'collaboration' and 'partnership' are heavily used with ideological correctness), but where these qualities are not evidenced or observed". Independence may not be sufficient to limit the potentially oppressive nature of governance when things go wrong. For example, homicide inquires in mental health services too often become destructive.5 Maybe the term 'clinical governance' has become so tainted with this failure to improve clinical care that it needs to be replaced. The government needs to support a credible and effective quality improvement system that meets the needs of both patients and health professionals.
Competing interests: None declared |
|||
|
|
|||
|
Maurice Conlon, Associate Director, Appraisal and Revalidation Lead NHS Clinical Governance Support Team, St John's House, 30 East Street, Leicester LE1 6NB, Damian Jenkinson, Nick Lyons
Send response to journal:
|
Sir It is encouraging to see the balanced view expressed in Bruce’s editorial , on the White Paper Trust, assurance and safety(1) , and the constructive responses by Catto, Pringle, Johnson and Robins(2) . Catto says “we must begin re-licensing and recertification as soon as practicable”(3). Relicensing is to rely on a “revised system of appraisal”, whereby “explicit judgements are to be made against standards for generic medical practice”(4). However, neither Trust, assurance and safety, nor the Chief Medical Officer’s publication Good doctors, safer patients(4), suggest what these standards should look like, nor how they should be devised. Moreover, no mechanisms are proposed for bridging the gap which currently exists between appraisal and the needs of relicensing. Fortunately, we are not starting from scratch. In February 2007, delegates at the national conference on appraisal (co-hosted by the NHS Clinical Governance Support Team and the National Association of Primary Care Educators), overwhelmingly approved a conference position statement on essential evidence for appraisal(5). The statement sets out a standard means by which clinicians can demonstrate their personal reflection and learning arising from evidence they present. It sets out clear requirements for evidence, whilst recognising the disparities which exist between employing organisations, and circumstances of employment. Use of Structured Reflective Templates will allow clinicians to review personal, local or national data, to relate them to their own practice, and to demonstrate learning. Whilst some will view the White Paper proposals as intrusive scrutiny, most will see their potential as a lifeline of support. By accepting scrutiny and supervision we move from an era of unsupported independent practice into one where clinicians can expect supported learning from medical school to retirement. Other high risk industries have made this culture shift(6) - it is time for healthcare to follow suit. Maurice Conlon Associate Director, Appraisal and Revalidation Lead NHS Clinical Governance Support Team maurice.conlon@ncgst.nhs.uk Damian Jenkinson Acting Medical Director NHS Clinical Governance Support Team Nick Lyons Vice-chair National Association of Primary Care Educators (1)Bruce D. Regulation of doctors. BMJ 2007;334:436-437 (3 March), doi:10.1136/bmj.39135.619410.80 http://www.bmj.com/cgi/content/full/334/7591/436 (2)Secretary of State for Health. Trust, assurance and safety – the regulation of health professionals in the 21st century. London: Stationary Office, 2007 http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4143132&chk=gxBiUz (3)Catto, Pringle, Johnson and Robins. Will we be getting good doctors and safer patients? BMJ, Feb 2006: 450-451. http://www.bmj.com/cgi/content/full/334/7591/450 (4)Chief Medical Officer. Good doctors, safer patients. London: Department of Health, 2006. www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4137232&chk=KW63va (5)NHS Clinical Governance Support Team Evidence for medical appraisal: essential/optional. Statement of the NAPCE/CGST Conference February 2007 http://www.appraisalsupport.nhs.uk/files2/Evidence%20for%20Appraisal%20Leicester%20Statement%202007%20CGST%20NAPCE%20Final.pdf. (6)Flin R. Safe in their hands? Licensing and quality assessment for safety-critical roles in high-risk industries. University of Aberdeen, 2006. http://www.abdn.ac.uk/iprc/papers%20reports/Safe_In_Their_Hands_Revalidation_Report.pdf Competing interests: None declared |
|||