The lost video

Last month, the Post Office lost the video of a GP registrar's consultation. To many, not intimately involved in general practice training, this may sound almost trivial, bearing in mind all the important challenges now facing the NHS. But to me, the GP registrar concerned, his trainers and course organiser, and the whole GP education network, this was anything but trivial.

He had no job and no income and faced an uncertain future

Let us start at the beginning. Since 1998, all those wishing to enter general practice as independent practitioners must complete a package of assessment known as summative assessment at the end of their training. This is to prove that they have reached a level of minimum competence. This package has four elements, each of which must be passed by the GP registrar. There is the traditional multiple choice questionnaire to test factual knowledge; the audit to test the written element of the assessment; the trainer's report to testify that the registrar is competent; and finally a video of the registrar's consultation to prove that he or she has the necessary consultation and clinical skills to become a GP.

This consultation tape is then marked by two assessors who, if not satisfied with the registrar's performance, can refer the tape to another two assessors who, in turn, if still dissatisfied, can refer the tape to another two assessors for a final verdict on whether or not the registrar should pass. To ensure safety and speed of delivery, all these tapes, with all their supporting documentation, which is quite formidable, are always dispatched by Royal Mail Special Delivery.

On this occasion the tape never reached its intended destination and, therefore, could not be marked. That meant that the registrar, though he had passed all the other elements of the assessment, could not be considered competent and allowed to work as a GP.

We immediately contacted the Post Office demanding an urgent investigation to find the tape. After a few anxious days, we were eventually told that they had no idea what had happened to the tape and, unfortunately, that was all that they could do.

The next step was to tell the registrar. Not an easy task. Needless to say he was very upset. He had already arranged to get married and start work as a GP. Now with the tape lost, through no fault of his, he had no job and no income and faced an uncertain future. We asked if he had a copy of the original tape. Sadly, he did not. We then wondered if he could produce another tape, which we could fast track for marking. Not surprisingly, he declined to even consider such a suggestion. Firstly, he thought that there was no time left for such a time consuming effort, and, secondly, even if there was time, he would not wish to subject himself to a similar ordeal. Who could blame him?

In the midst of this disaster, still grappling with what to do with the registrar, I also received an angry message and letter from his trainer and the training practice. They, with some justification, were astonished at this incompetent trail of events. They were also seriously concerned about what to do about those patients who, in good faith, had given consent for their consultation to be videoed for the purpose of the summative assessment and were now facing the possibility that it might fall into unsavoury hands and be exposed to all and sundry.

My advice, based on no previous experience but common sense, was that all patients should be told immediately and be offered explanation and apologies as appropriate. I sincerely hoped that the patients would be gracious enough to be satisfied with this proposed course of action. But, somehow, I feared (and still fear) that, given the current climate of opinion, there might be some irresistible temptation to seek legal redress. Only time will tell.

Now what about the poor registrar? Well, he is so shattered by this experience that he has decided to go back to his country of origin (in the European Economic Area), find a training post there, and complete his training.

The irony is that if, at some future date, he decides to return to the United Kingdom to work as a GP, he will be entitled to do so under the European Union acquired right arrangements, without having to bother with the summative assessment.

As we can test consultation skills by other methods just as well (if not better), is it not time to consider a different approach without all the inherent dangers and difficulties of videoed consultation?