Improving patient safety is no doubt at the forefront of everyone’s minds following the Francis Inquiry. Charlotte Hudson reflects on the challenges doctors face in ensuring that good quality of care is delivered.
The GMC’s Good Medical Practice states that patients must be able to trust doctors with their lives and that doctors must make the care of patients their first concern. The Francis Report found serious failings in leadership and culture in the Mid Staffordshire NHS, which Inquiry chairman, Robert Francis QC said went right to the top of the health service.
A doctor’s first priority is to ensure that patients are well cared for and safe from harm. The Royal College of Physicians says: “The provision of good care is a fundamental part of what it means to be a doctor. This includes seeking to address instances of poor practice where patient safety may be compromised, raising these concerns with hospital management and sector and professional regulators where necessary.”
Following the report, a statutory duty of candour on providers will be introduced whereby the NHS will have to be honest about mistakes and report treatment or care that they believe has caused death or serious injury.
Following the governments response to the Francis report, Dr Stephanie Bown, Director of Policy and Communications at MPS, said: “MPS has long held the view that while you can mandate disclosure, legislation cannot deliver the attributes of high quality and open communication such as empathy, sincerity, and comprehensiveness. A culture change is what is needed.”
“We will be further highlighting to government that despite the understandable appeal of a legislated duty, this will not achieve the objective of effective open communication.”
Raising concerns
In December, the GMC introduced a confidential helpline for doctors to raise concerns about patient safety, which allows doctors to blow the whistle on poor care to the GMC for the first time. Since its inception, 12 allegations of a “very serious” nature have been investigated, involving complaints that raise a question about a doctor’s fitness to practise and risks to patient safety.
The helpline was introduced on the back of the GMC publishing new guidance in 2012, Raising and Acting on Concerns about Patient Safety, which sets out doctors’ duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised.
The guidance makes it clear that doctors have a duty to put patients’ interests first and act to protect them at all times – this overrides personal and professional loyalties.
Improving patient safety
The Department of Health’s policy on patient safety says: “Improving patient safety involves assessing how patients could be harmed, preventing or managing risks, reporting and analysing incidents, learning from such incidents and implementing solutions to minimise the likelihood of them reoccurring.”
Working as a doctor is a risky business; it is hectic, sometimes stressful, and often involves working long hours. You may worry about receiving a complaint or claim, and find yourself asking: “How do I prevent making errors and ensure my patients are safe?”
Communication
To prevent errors, it is important to firstly identify the reasons why they occur. A breakdown in communication is quite often responsible. Good communication is fundamental to patient care – between all members of the healthcare team and their patients.
In today’s team approach to delivering healthcare, communication has to extend to more people and there are therefore more opportunities for it to fail. Communication between primary care, secondary care and social and voluntary services should be seen not as a chain, but as a communication net, within which any one member may need to communication with any other.
Patients need and should be given, thorough explanations of symptoms and treatment options, together with any potential risks. Failure to adequately explain this can cause patients to question a doctor’s competence, and could bring your fitness to practise into question.
Handovers
Effective communication with colleagues is also important when handing over care of a patient to another doctor. The next doctor needs to be able to easily take over from where you left off to enable good continuity of care.
Managing risk
The Royal College of Physicians’ (RCP) strategy for quality states that continuous improvement in the quality of care is the responsibility of all physicians. The College says with quality now looking certain to be the principle driver of service improvement over the next few years, the RCP is well-placed to support this agenda.
Conclusion
The GMC’s annual survey of trainees in 2012 found that one in 20 junior doctors had concerns about patient safety, prompting junior doctors’ leaders to insist that patient safety concerns raised by trainees must be fully investigated. If you have any concerns about patient safety it is your professional responsibility to raise them. If you don’t feel comfortable raising concerns with a senior colleague, the GMC’s confidential helpline is there for you to use.
MPS has a wealth of online resources for doctors, from magazines to factsheets, handbooks and booklets. To access the resources visit – http://www.medicalprotection.org/uk/advice-and-publications/. We also hold a number of communication workshops that can be accessed here – http://www.medicalprotection.org/uk/education-and-events/courses-and-workshops.
If you have a topic that you would like discussed contact [email protected].
