Posts tagged ‘GMC’

December 23, 2013

Unwelcome patient attention


Sessional GP and MPS medicolegal consultant Dr Rachel Birch shares a case scenario about a patient who stalked her GP 

Dr L worked as a locum GP in Manchester, doing maternity and other long-term locum jobs within the city practices. Five years ago he saw a female patient, Miss X, with mental health symptoms. He spent time trying to help her to resolve some of her issues. She was referred to counselling and to psychiatry and was found to have a borderline personality disorder.

April 25, 2013

GMC registration and ill health


I have not worked for two years and I am wondering whether to let my GMC registration go as money is tight. I am not working due to ill health brought on by stress at work. …..should I let it go?

October 19, 2012

Revalidation for locums – all in it together


NHS appraisal is a formative process with which many GPs across the UK are already very familiar. In many ways, it’s similar to an annual car service, tuning up our performance to pretty much the best it can be. Servicing a car is generally time-consuming and expensive, and relatively subjective in that the quality of the service can vary between different garages. But there’s probably little variance in what most of us would recognise as a good service for our car. And continuing this analogy, revalidation is very similar to a yearly MOT – albeit every 5 years rather than annually. Just like an MOT, revalidation is a summative assessment – you pass or you fail – and is based on a well defined minimum set of requirements. With an MOT, each constituent criterion is also pass or fail. Broken indicator? Fail. Crack in windscreen 9mm in the A-zone? Pass. 10mm? Fail. It’s all very clear cut, and based on years and years of experience of how legislation has made for safer roads. But in that respect, NHS revalidation is very different. It’s extremely difficult, if not impossible, to quantify most of what GPs do. We are, after all, not machines, and neither are our patients. What we do, what we deal with, every day, is infinitely variable. Unlike the car – a simple machine designed 100 years ago by humans – human illness is the result of 4.5 billion years of evolution. We can’t even agree on the best management of a sore throat! A summative process based on something as subjective as the behaviour of ill people has never been done before (at least, not in any modern, democratic civilised country) and is based on criteria that in many, if not all, cases is incredibly subjective and is likely to change considerably over the course of just one revalidation cycle of 5 years.

June 8, 2012

NASGP and MPU-Unite joint membership


We’re really delighted to introduce a new option for all new and existing members – to add MPU-Unite membership to your NASGP membership, either as an ‘upgrade’ to your existing membership, or when you next renew your NASGP membership. If you’re not already a member, it just takes a few minutes to join.

The MPU – Medical Practitioners Union – has been around since before the BMA, and is now part of the much larger Unite union. Membership of MPU-Unite by no means excludes membership to the BMA, in fact the two work very closely together, with the MPU having two seats on the BMA’s GP Committee, and one of these 2 seats currently being taken up by the NASGP.

So why would you want to join a different union in addition to, or instead of, the one you belong to now?

Because this then gives you the option to be represented by a completely different, independent union if you’re involved in a dispute with an employer who is being supported by a different union.

Why would I want to join MPU-Unite.

They can give you advice and representation in matters concerning contracts and other employment problems. In addition, unlike the BMA, MPU-Unite will also represent you in any GMC ‘Fitness To Practice” hearings.

How much extra will this cost?

All NASGP members who opt in to joint membership will pay an extra £11.48 per month (by direct debit) or £137.76 per year (direct debit and card).

Why would I want to use the joint NASGP/MPU-Unite subscription?

Because it means just one payment (monthly or annually) – making it a bit easier for you – and also because, by joining as part of the NASGP, you can start receiving employment advice immediately, rather than waiting 6 months if you’d joined separately.

To upgrade your existing membership now, sign-in to the members area and follow the instructions.

May 10, 2012

Why are heartsinks so attracted to me?


Dear Career Mentor

I am attracting so many heartsink patients I feel utterly drained. It feels like my only option is to change career, but I don’t know where to start. Please advise me.

June 27, 2011

Isolation remains key issue for Sessional GPs


Paula Wright, Chairman of North-east Employed and Locum GPs, takes us through the findings of the recent report into Sessional GPs from the Royal Medical Benevolent Fund.

Having spent many years supporting our sessional GP group in a variety of roles as treasurer, website manager and chairperson, I was delighted to have the opportunity to be involved in a research project focusing on support structures for sessional GPs. Our sessional GP group was locally recognised as providing important professional support, including job and educational alerts, and members had quadrupled in numbers since we had commissioned its website. So when the Royal Medical Benevolent Fund (RMBF) commissioned us to carry out this research, the first time these groups have been studied formally, this was a subject close to my heart. The research was a mixed methods study involving a literature review, focus groups and telephone interviews with sessional GPs, and online surveys to deanery educators, sessional GP groups and locum chambers.

January 24, 2011

Sleeping with the patient

by Judith Harvey

Improper relationships with patients are in the news.

Mrs M was the patient. She might or might not have been dementing, but she seemed confused and was certainly prone to wandering. She might or might not have been in severe pain from her arthritis , but she certainly had a flail leg after failed surgery. All of which made it difficult for her to live in her isolated cottage with its steep narrow staircase. Somehow her medication had reached alarming levels and might or might not have been making things worse. She was in the cottage hospital for evaluation. Essentially this meant taking her off her psychotropics and titrating her pain relief. After several days no-one was sure what was going on. Does paracetamol take effect within half a minute? Was she skipping down the corridor when she thought no-one was watching? Was she attention-seeking? She was certainly much more peaceful when someone spent time with her.

October 11, 2010

MPS urges GP practices to set up confidential computer logins for locum GPs


All GP practices should provide unique and confidential computer logins for locum doctors to ensure that they can be identified at a later date, urges the Medical Protection Society (MPS). MPS is aware of cases where an adverse event has occurred, yet there was no way of identifying who was involved, because different locums were sharing the same login. Speaking today at a conference for locum GPs, Dr Stephanie Bown, MPS Director of Policy and Communications said:

Medical records should be attributable, the author of any entry should be clear. When making electronic records locums should not share usernames and passwords as it is important for practices to be able to identify the author of an entry and who saw the patient. When several different doctors and nurses are involved in a patient’s care, it’s important for any one of them to know who the patient has seen previously. By knowing who saw a patient, it is possible to share feedback on their performance, which leads to better care and less complaints. Whilst all practising doctors should have their own professional indemnity in place, practices could be held liable for the errors of a locum if that individual cannot be identified or traced when a claim is subsequently brought. If different people are sharing the same login, it can be impossible to trace the individual responsible.”

GMC guidance states that doctors must keep clear, accurate, legible and contemporaneous patient records, and part of this is attributing entries to an author. And see detailed information from Pallant Medical Chambers on how to advise practices.

August 7, 2008

Is there such a thing as Informed Consent?

by Judith Harvey

A patient and a doctor lying hand in hand on the operating table. That was what came to my mind as I browsed ‘Consent: patients and doctors making decisions together’, the GMC’s new guidance. Consent, it rightly says, is a process, and obtaining it is a partnership. But ultimately the dialogue has to come to an end, and then the patient is on his own.

A doctor who has obtained ‘informed consent’ has done her duty. The patient has understood the risks and benefits and thought about what they mean for him, and has made his decision. On paper, it all sounds so very rational. But real life is rarely rational. Can there be such a thing as truly informed consent?

In the bad old days, obtaining consent meant shoving a form under a patient’s nose, months after their outpatient appointment and an hour before surgery. I wonder if what is now shoved is a handful of leaflets, and if so, whether they are provided in a way and at a time that actually helps the patient. Couldn’t an outpatient appointment be offered after the procedure has been agreed but before surgery? That way, once the realities have sunk in patients could talk to the surgeon about their worries: the rare side effect mentioned in the leaflet; waking up vomiting after the operation; who will look after Rover while they are in hospital. Surgeons are not like timeshare salesman; well, not usually, but a cooling off period would probably reduce the number of operations and improve the outcome of those that are performed.

Consent needs to be given with the heart as well as the brain. People smashed up in an RTA or rigid with pain from an acute abdomen just want someone to get on with the job. Where there is time for reflection, it helps if someone in the family, or a friend, or a character in a soap opera, has been through the procedure.  This provides an emotional context for consent.

Consent to screening is perhaps even more fraught with pitfalls . Patients ask for a test because “it’s good to know” and “for reassurance”. But that’s not what screening is about. It is about identifying people with pathology. The trouble is the false positives. Investigations undertaken to establish that someone does not have a problem can create long-lasting damage to the body or psyche. A colleague of mine was so strongly opposed to the promotion of PSA tests that he vowed he would sue anyone who measured his PSA without his consent – at that time most private health screenings would automatically include PSA. That might not happen now, but the implications of screening tests are hard to comprehend, and the screening industry performs its PR well. In the US every man is urged to know his PSA: a mildly abnormal screening test is a useful sub-total wallet-ectomy. Doubtless so is a total body scan, in some quarters a popular birthday gift I am told. Don’t give me one. As a GP interested in screening and its benefits and costs, I should be better placed that most to know what I might be in for. But I waved a cheery “it’s nothing” to my husband when he dropped me off at the breast screening unit, and I was shaken when I was recalled. It was all right in the end, but the days before the appointment, the sitting in the waiting room, the further tests, waiting for the results, were a glimpse into hell.

Of course, it is possible to overdo the consent process. But between the choice of spending hours on pre-HIV test counselling and the “ Roll up your sleeve” school of consent, there is a middle way. The challenge is to make a hypothetical situation feel real enough for the implications to sink in, and risk tables just don’t do that.

When I worked for VSO, volunteers’ overseas accommodation was all too often a problem. Volunteers would complain that they hadn’t been warned. I would remind them of the lengthy pre-departure briefing course discussion on ‘what may go wrong’. “Yes,” they would say, “but you didn’t tell us loud enough.”

The Irish gave the Lisbon Treaty the thumbs down. It seems that the majority of the Irish support the EU, but the documents are too long, too complicated, too technical, for anyone to understand, including most of our representatives. So Eurosceptics were able to derail the approval by drawing people’s attention to the bit of small print – sometimes very small – that might permit something they didn’t like, be it abortion or conscription into a European army. Those emotional negatives killed off the concept of a European Union.

Marriage involves giving consent. But does being reminded barely a minute before the contract is made that the proposed union is ‘for richer for poorer, in sickness and in health’ count as informing of risks and giving the couple the time to reflect on their decision ? Has anyone ever stopped the ceremony to ask exactly how big a credit card debt constitutes ‘poorer’?

Context is all. Telling the world about one’s health on Facebook is one thing, letting information about one’s tonsillitis go on the Spine is for many people quite another.

It seems to me that useful consent is emotional consent. Sure, we need someone to run the risks past us. But we also need to feel what our decision might mean for us. That’s not got much to do with ‘numbers needed to treat’. It is about feelings and emotions. Perhaps a roleplay should be part of the consent process?

First published in NASGP Newsletter ‘The Sessional GP’  August/September 2008


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