From the received GMC guidance, verbal discussions with senior colleagues/line managers and raising the issues at Consultant meeting discussions do not seem to satisfy the GMC request of formally raising (and documenting) concerns.
I am sure I am not the only consultant who has had numerous junior doctors approach them (or discussed with them at their educational supervision meetings), their concerns about staffing levels.
I am certain that colleagues in various organisations have raised this at their consultants meetings, and I am aware most organisations are aware of the clinical demand/request for additional consultant and junior doctor colleagues (and nursing staff –even more of a priority perhaps). But, do we now have to formally notify our line managers of the concerns raised by junior doctor colleagues and consultant colleagues?
We are all also conscious of locum payments costs which many organisations deem too high to justify (in view of consequential longer term harm due to resource constraints). However, it is imperative that when things go wrong, that senior management at the very top of the organisations are aware of the seriousness, risks and concerns having been raised and also take proportionate responsibility for events that arise. They are appropriately reimbursed to make the difficult decisions in resource allocation and should take the responsibility of events which flows from this.
Juniors doctors already struggle on their nights on-call to comprehensively assess each patient they’re requested to assess, and it is inevitable that an occasion will arise when prioritisation in retrospect is deemed incorrect (although this is quite difficult to prove as it is never clear what other unwell patients were simultaneously competing for the doctor’s time).
Consultant colleagues also can no longer provide the safe comprehensive service we have been doing because of spending less time each with many more patients. Professionally, it is not appropriate for us of spend the limited clinical time we have focused on fewer patients at the expense of not seeing all patients on ward rounds. I feel it is still appropriate to make prioritisation decisions (sometimes on limited information) to ensure those patients deemed at most risk and at need of consultant input receive it. Clearly, there is risk in such decision making and some apparently straight forward clinical cases which are delegated to junior doctor colleagues may turn out more serious with potential adverse outcomes.
I note ironically however, that consultants and junior doctors are at a higher legal risk if they briefly assess a patient and not identify the problem than if they did not have the time to asses the patient at all (and can justify this due to competing demands on their time).
I would value the thoughts of fellow consultant colleagues and senior managers as to the approach we should be taking both on a local and more national scale especially as it seems the GMC is well aware of the main underlying problems facing all of our organisations to varying degrees at different times.
Rapid Response:
Re: David Oliver: Should NHS doctors work in unsafe conditions? : Medico-legal Risk vs Patient Care
https://www.gmc-uk.org/interactiveflowchart/documents/Raising_concerns_f...
From the received GMC guidance, verbal discussions with senior colleagues/line managers and raising the issues at Consultant meeting discussions do not seem to satisfy the GMC request of formally raising (and documenting) concerns.
I am sure I am not the only consultant who has had numerous junior doctors approach them (or discussed with them at their educational supervision meetings), their concerns about staffing levels.
I am certain that colleagues in various organisations have raised this at their consultants meetings, and I am aware most organisations are aware of the clinical demand/request for additional consultant and junior doctor colleagues (and nursing staff –even more of a priority perhaps). But, do we now have to formally notify our line managers of the concerns raised by junior doctor colleagues and consultant colleagues?
We are all also conscious of locum payments costs which many organisations deem too high to justify (in view of consequential longer term harm due to resource constraints). However, it is imperative that when things go wrong, that senior management at the very top of the organisations are aware of the seriousness, risks and concerns having been raised and also take proportionate responsibility for events that arise. They are appropriately reimbursed to make the difficult decisions in resource allocation and should take the responsibility of events which flows from this.
Juniors doctors already struggle on their nights on-call to comprehensively assess each patient they’re requested to assess, and it is inevitable that an occasion will arise when prioritisation in retrospect is deemed incorrect (although this is quite difficult to prove as it is never clear what other unwell patients were simultaneously competing for the doctor’s time).
Consultant colleagues also can no longer provide the safe comprehensive service we have been doing because of spending less time each with many more patients. Professionally, it is not appropriate for us of spend the limited clinical time we have focused on fewer patients at the expense of not seeing all patients on ward rounds. I feel it is still appropriate to make prioritisation decisions (sometimes on limited information) to ensure those patients deemed at most risk and at need of consultant input receive it. Clearly, there is risk in such decision making and some apparently straight forward clinical cases which are delegated to junior doctor colleagues may turn out more serious with potential adverse outcomes.
I note ironically however, that consultants and junior doctors are at a higher legal risk if they briefly assess a patient and not identify the problem than if they did not have the time to asses the patient at all (and can justify this due to competing demands on their time).
I would value the thoughts of fellow consultant colleagues and senior managers as to the approach we should be taking both on a local and more national scale especially as it seems the GMC is well aware of the main underlying problems facing all of our organisations to varying degrees at different times.
Competing interests: No competing interests