Friday, 11 February 2011

Rt Hon Stephen Dorrell and GMC Accountability on Revalidation by Dr Helen Bright

Rt Hon Stephen Dorrell MP (Member of Parliament) who chairs Health Select Committee will with other MP members take over the role of General Medical Council (GMC) supervisor from the Privy Council which has been found ineffective before the new government took over. In May 2010, following the elections Rt Hon Nick Clegg, Leader of Liberal Democrats was appointed as Lord President of the Privy Council and he would have noticed many examples of what was done to it by Labour and others to make it completely unmanageable. Read this Oath administered to all Privy councilors by clicking here. (it breaches several articles of Human Rights Act 1998, in my opinion) for a start. So, if they start like that at which destination do they arrive?
One of the brief inquiries Health Select Committee performed recently was to look at the Revalidation of doctors and they have produced a report about it. Click here to read it.
I am pleased to see some awareness of where revalidation of doctors practice (in order to allow doctors to have license to practice) would not work. Most doctors in UK work for state organization NHS (National Health Service). Medical Directors in NHS are designated as responsible officers who would report to GMC for the purpose of Revalidation:

"Responsible Officers

MPs were also concerned that there should be clear guidance about how Responsible Officers (usually local medical directors) should act when a conflict of interest arises between their responsibility to their employer and their responsibility to the GMC for professional regulation (e.g. in cases of "whistle-blowers"). The Committee recommends: "the GMC consider further what safeguards may be desirable to protect the interests of individual doctors in circumstances where they believe a conflict of interest may have influenced the decision of a Responsible Officer".

General Medical Council has a policy already which breaches Articles 6 and 14 of Human Rights Act 1998 by allowing fast tracking of complaints from NHS Medical Directors and other state organization for example, against locum doctors who are self-employed and perhaps, more likely to blow the whistle and be perceived as dangerous (merely because they are not staying in one place all the time where they can be observed and illusion of control attained). They are also more likely to be foreigners.

Doctors who are Whistleblowers have been prosecuted and ridiculed by GMC investigators for many years. It is not known how many people have died as the result of such attitudes. It is certainly easier for an investigator to "investigate" one doctor (scapegoat) than a gang of malicious complainants (also doctors). Article 2 of the Human Rights Act 1998 is breached when the responsible public body whose responsibility it is to investigate unlawful loss of life does not investigate the complaints promptly. In my case it is now about eight years in the case of one death and six years in the case of another death I reported to GMC that they refused to investigate. Other people had similar experiences with GMC refusing to investigate serous acts of incompetence or negligence by doctors.

Independent audit of individual doctor's medical practice is the ideal way forward but impossible if auditors (Responsible Officers, medical directors, doctors themselves) are also accountable to GMC themselves. They would rather run down another doctor than admit their own management of the hospital facilities is at fault and/or services delivered by hospital inadequate.Therefore, there is no other way out of that one than to drop Revalidation of doctors as proposed now.

Auditors must be really independent and able to select material to be audited rather than depending entirely on doctors collecting all the evidence themselves and then presenting it. Some random independent sampling is required e.g. of medical notes by independent auditors if one really wants to have practice audited. The way Revalidation has been proposed to be done is nothing more than pretending that audit would be done.

In organization such as NHS which has huge demands placed on it, and impossible to meet, there is always expectation that both managers and doctors would keep silent when things go wrong, as they do on daily basis. Getting on well with colleagues means managing the silence program very well. Revalidation which attempts to measure what colleagues think of their colleague about to be revalidated is actually measuring conformity and not professional competence when there is no independent judgment.

Similarly, asking patients what they think of their doctor for the purpose of Revalidation is not a simple matter like trying on a pair of shoes and saying if they fit well or not. Psychiatrists who have manic and paranoid patients, admitted to hospitals against their will under Section(s) of Medical Act 1983 do suffer harassment from their patients and many complaints to hospital administrators. It is not a mistake that psychiatrists in NHS were allowed to retire at the age of fifty five, ten years before all other doctors. Yes, ten years earlier.

Additionally, setting boundaries is a problem with many dysfunctional individuals who have never had and never will have any form of mental illness. When doctors set limits these people can get really nasty and complain that doctor has not communicated nicely with them and so on. Another thing they do is project their own aggression and hostility onto the doctor.

GPs (General Practitioners) become subjects of complaints by patients when they do not prescribe something even when they should not (e.g. antibiotic for viral infection without secondary bacterial infection complications). In every medical specialty there is something that causes problems in doctor-patient relationship and not just unrealistic patient expectations.

While communications between doctors and patients are very important, dysfunctional individuals lack capacity for intimacy. In a relationship it is not just one person who bears the responsibility for communications. It works both ways. Meanwhile, it is a fact that most organizations have problems with communications in many forms. Withholding of communications for example, as in a power game.

Therefore, Revalidation could measure just conformity with the ethos of "Anything for a quiet life" and not communications skills or good patient doctor-relationship when all the factors are not taken into account and patient files examined.

One cannot examine any files or validity of anonymous 360 degrees appraisals by patients or by staff when facts of their assessments are unknown.

Continuous Professional Development of doctors is a different matter and this can be certified separately by some educational institution. The Royal Colleges do have their own conflicts of interests too. One of these is that they also act as providers of continuous professional development and limit what they would recognize as provided by other educational institutions irrespective of the quality of education provided by other educational organizations. The Royal College of Psychiatrists demands so called Internal units of education which is unreasonable in the case of those doctors who are in private practice and get all their units outside the practice or on the Internet. The Royal College of Psychiatrists accepts only ten units of CPD done on Internet at the time when distance learning has been accepted as a valid method of study in medicine for the purpose of CPD. If ten is OK why not hundred units? Well, the Royal College of Psychiatrists, for example, prefer doctors paying hundreds of pounds for the course provided by the college. That is all.

When GMC destroys doctors careers as in the case of Whistleblowers, Revalidation becomes impossible.

Local management of doctors in state hospitals or private hospitals should address the problem doctors with no need for them to be involved in Revalidation process as currently proposed.

Those who are in private practice are revalidated every time when they look at their bank account as private patients do walk out if not happy with the received treatment. If something goes wrong they certainly know how to sue and where to complain.

In summary: doctors have to keep up to date and it is fair that regulator checks on that. Every year this can be submitted or every five years for revalidation. That is all that is required plus independent audit of practice. Managers are responsible for the management of doctors in organizations that need it. Doctors in private practice are in a way regulated by their own patients who have the power NHS patients do not.

Independent audit of medical practice by professional(s) is the only proper way to do it. Any doctor working in NHS or private practice is entitled to a fair process. If doctors want fairness they must insist on the process that would guarantee it.

GMC is not capable of revalidating doctors and should not be forced to do it or to rubber stamp assessments of doctors which actually measure something else and not professional performance/competence. GMC have already eliminated dissidents en masse and with pleasure during the last government and against the public interest. The only safe safeguard against GMC abusing their power again is not to let them have that power.

So, if anyone is really interested in proper audit of medical practice why not ask for it? Doctors are paid enough to be able to afford the payment for it and should never risk their reputation or registration at the hands of those who have conflicts of interests always and not just with whistleblowers. One cannot rely on medical directors awareness of their conflict of interest as it is not in the human nature to admit it to oneself when there are strong needs and emotions. A medical director would rather pay his mortgage and keep his wife and children happy than take risks of declaring any conflict of interests to the NHS managing board or GMC or even to himself/herself. It is far easier to justify own silence or to blame others especially if they are vulnerable (different status is enough). It is a mistake to assume that those in responsible positions would act responsibly if asked to do so or if they are provided with guidance. There is a Code of Conduct for NHS Managers but GMC does not hold those doctors responsible for their conduct when they do breach it and attack other doctors thus breaching their own Code of Conduct for Doctors as well (treating others unfairly). NHS Trusts do not hold responsible medical directors when they breach their NHS Code for Managers in cases where there is NHS trust liability for negligence and Medical Directors engage in suppression of the facts that would expose NHS Trust to negligence claim.

Speaking from experience, of course.

1 comment:

harold nock said...

Last year i sent files concerning the death of my disabled daughter Wendy Jean Nock to The Health Select Committee, and the GMC clearing of all medical staff involved.The SHC did not have the decency to reply to me.I will not give up my fight to get justice for my daughter. TheGMC failed to take into account the discrepancies in the doctors statements and on many occassions failed to respond to my letters and requests for information as to how they arrived at their decisions