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Proposals of Donaldson report are “not evidence based,” says Scottish health department

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39052.531111.DB (Published 07 December 2006) Cite this as: BMJ 2006;333:1190
  1. Bryan Christie
  1. 1Edinburgh

    The health department in Scotland has strongly rejected many of the proposals put forward in July by England's chief medical officer to reform the way UK doctors are regulated. The key complaint of the Scottish Executive Health Department is that many of the recommendations are not evidence based and are “unlikely to result in improvements in patient safety.”

    In a response to Liam Donaldson's report Good Doctors, Safer Patients (BMJ 2006;333:163), Harry Burns, Scotland's chief medical officer, and Paul Martin, the chief nursing officer, argue that much greater attention should be paid to harmonising the regulatory framework across all professions.

    “The fact that the majority of ‘mistakes' made in clinical practice are multifactorial in nature and often team based is not acknowledged anywhere in the Donaldson report,” they say.

    The official response from the Scottish health department was drawn up after discussions were held with interested groups in Scotland. The department:

    • Rejects the proposal to create licensed General Medical Council affiliates to investigate concerns or complaints at a local level as “unworkable” in Scotland

    • Opposes the removal from the GMC of responsibility for setting fitness to practise standards—it says it is not clear how this proposal would enhance protection of the public

    • Rejects the notion of using financial incentives to promote safe practice as “unacceptable” and one that “flies in the face of a positive culture of professional accountability and conduct”

    • Criticises the report as “Anglocentric” and says that it fails to take account of the different way systems have developed across the UK, and

    • Accepts the principle that the standard of proof needed to remove a doctor from the register should be lowered but wants this to be explored further to determine whether it will improve the safety of patients.

    “Many of the recommendations have no clear evidence base but nonetheless have far reaching implications which would result in significant future work and resource commitment,” Dr Burns and Mr Martin say. “We cannot support recommendations which are not evidence based and which, in our view, are unlikely to result in improvements in patient safety [and] care.”

    The BMA has also criticised many of the recommendations (BMJ 2006;333:987, 11 Nov). Its chairman in Scotland, Peter Terry, said: “The Scottish Executive has given a robust point by point critical analysis which largely and very clearly explains why many of the ideas proposed by Donaldson are both inappropriate and impractical, particularly for the devolved Scottish health service.”

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