13 Figure 2
Were you given support to deal with the consequences following the error?
No Yes, I received
limited support Yes, I received
comprehensive support CASE STUDY: Left out in the cold 0% 10% 20% 30%
and name badges. As all work is booked through the chambers, we have a strict policy that if any practice manager ever says ‘please can we have a locum, but not Dr Smith again’, we will only continue to book locum work if the surgery agrees to talk to Dr Smith about why they don’t want him anymore.”
Responding to a complaint Locums and sessionals might not have the opportunity to contact the patient to give an open and honest explanation of what went wrong and why, or to demonstrate to the patient that lessons have been learnt to try and prevent the incident recurring. Poorly handled explanations serve only to compound the harm, distress and loss of trust that has already been experienced, increasing the likelihood of litigation. Information cannot be provided as openly and empathically if it is second-hand. If you are asked to reattend the practice to try and resolve a complaint at the local stage, this will probably be in the form of a fact-finding interview or writing a witness statement. You should familiarise yourself with the patient’s records and make sure that any statement is factually correct, conciliatory, empathic and (where relevant) includes an expression of regret. You should ask to see a copy of the reply the practice intends to send, to check it is
■■ MPS, A Culture of Openness – An MPS Perspective (2011) – www.medicalprotection.org/uk/booklets/a-culture-of-openness
■■ MPS, Complaints factsheets (June 2011) – www.medicalprotection.org/uk/uk-factsheets/complaints
1. MPS/ComRes Survey, An online poll of 541 MPS members in March 2011, which involved GPs, consultants and non-consultant hospital doctors (2011)
2. Sir Liam Donaldson, World Health Organisation’s “World alliance for patient safety” conference (2004) 3. Department of Health, Listening, Responding, Improving: A Guide to Better Customer Care (2009) 4. Ibid 1
factually accurate, and should not hesitate to contact MPS for advice.
Barriers to openness There are other barriers to openness as well as not being automatically involved in the complaint process. MPS members highlight time constraints as a key factor in restricting their ability to communicate as effectively as they would wish. Two thirds of MPS members believe that there is a pervasive blame and shame culture within the NHS – and believe this is difficult to overcome. When a mistake occurs, 70% of doctors said they received limited, or no support, from their organisation, making it difficult to resolve the complaint promptly and accurately.4 MPS believes that a cultural change is what is needed to improve openness. Meaningful, open and honest communication with patients and working in a culture that expects it is more likely to be delivered by doctors committed to transparent working at all levels, rather than doctors forced to report adverse incidents through legislation and a “top down” managerial approach. By improving communication between GP practices and locums and sessionals, complaints resolution can focus on openness and honesty between the doctor in question and the patient, allowing complaints to be resolved locally and quickly.
practice for one day to cover unexpected staff absences over a busy holiday period. He saw Miss C, a 35-year-old patient,
who presented with severe abdominal pain. He prescribed some paracetamol and told her to come back in a few days if the pain had not subsided. The next day, Miss C was rushed to hospital with acute pain. On arrival at the emergency department (ED), she was diagnosed with appendicitis. She was rushed to theatre and luckily the procedure was performed before the appendix ruptured. She complained to the practice about Dr A’s failure to diagnose. The following week, Mrs W, the practice manager, received Miss C’s complaint, logged it and sent it to the GP partners for discussion at their next meeting. They drafted what they believed to be a sufficient response using the patient’s notes. Dr A was not consulted throughout the process and no attempt was made to contact him. Miss C was invited into the surgery to discuss the response. She was thoroughly dissatisfied. She felt that the details of the consultation were sketchy and the response was very cold and impersonal. No-one was open and honest with her. No-one apologised. Miss C felt that the practice was hiding something and she decided to take the complaint against Dr A further.
LEARNING POINTS: ■ ■ Practices should make sure the doctor
who is the subject of the complaint is involved in responding to the patient’s concerns and drawing up steps to avoid errors in the future.
■ ■ Practices should have a complaints manager (again, usually the practice manager) who can deal with all complaints in the first instance and a responsible person (usually a GP partner) whose role (in part) it is to ensure that the correct procedure is being followed.
■■ The complaints manager should make every effort to contact the locum through the relevant agency, giving them adequate notification of the complaint and the right to respond to the complaint.
■■ It is a good idea for the practice manager to keep a log of all the locums used at the practice, along with their contact details.
r A was a member of GoodDoc, a locum GP agency. He was contracted to work at an inner city medical
SESSIONAL GP | VOLUME 3 | ISSUE 2 | 2011 | UNITED KINGDOM www.mps.org.uk
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