NEWS
Healthcare leaders call for GMC to be stripped of power to appeal ‘fitness to practise’ decisions
A coalition of 13 leading healthcare organisations have urged the Government to deliver on its 2018 commitment to strip the General Medical Council (GMC) of its power to appeal decisions made by the Medical Practitioners Tribunal Service (MPTS). In 2018, the Government accepted in full the recommendations of the Williams review into gross negligence manslaughter in healthcare, following the case of Dr. Hadiza Bawa-Garba. This included the central recommendation that the GMC should have its right to appeal fitness to practise decisions removed. The relevant legislative changes have not been made to the Medical Act, however, so the GMC continue to appeal decisions. According to data obtained through an FOI request, since the start of 2018 it has challenged at least 14 MPTS decisions. The Williams review concluded that removing the GMC’s right of appeal against MPTS decisions would help to address the mistrust of the GMC among doctors and contribute to cultivating a culture of openness that is central to delivering improved patient safety. It also said that public protection would still be maintained, with the Professional Standards Authority (PSA) retaining its near identical right of appeal to MPTS decisions.
The letter to the Health Secretary calling for section 40A of the Medical Act 1983 to be finally removed as part of the forthcoming Health and Social Care Bill, was signed by Medical Protection Society, The Doctors’ Association UK, Hospital Consultants and Specialists Association, British Medical Association, Royal College of General Practitioners, Royal College of Surgeons of England, Royal College of Physicians, Royal College of Paediatrics and Child Health, Royal College of Surgeons of Edinburgh, Medical Women’s Federation, Association of Anaesthetists, British Association of
Physicians of Indian Origin, and Medical Defence Shield. Professor Dame Jane Dacre, president at the Medical Protection Society who coordinated the letter, commented: “The GMC’s power to appeal decisions made by the MPTS has led to fear across the medical profession and a lack of confidence in the GMC. It is also unnecessary as the PSA has the authority to appeal decisions. The GMC is the only UK health regulator that has such a right of appeal. “The Government agreed that the GMC should be stripped of the power in June 2018, following the Professor Sir Norman Williams review into Gross Negligence Manslaughter in healthcare. However, until the relevant legislative changes are made to the Medical Act, the GMC can and do continue to challenge decisions.” Prof. Dacre emphasised that there has never been a more important time to address this issue:
“COVID-19 has sparked discussion about the extent to which individuals should be held to account when working in pressurised and extreme circumstances, and now more than ever, the regulator needs to be able to operate in a way that instils confidence among patients and doctors,” she commented.
New findings on use of ECMO for COVID patients
For critically ill COVID-19 patients treated with extracorporeal membrane oxygenation (ECMO), the risk of death remains high, but is much lower than suggested by initial studies. The findings support the use of ECMO as ‘salvage therapy’ for COVID-19 patients with acute respiratory distress syndrome (ARDS) or respiratory failure who do not improve with conventional mechanical ventilatory support, according to the new research by Dr. Ninh T. Nguyen, chair of the Department of Surgery, University of California, Irvine Medical Centre (UCIMC) and colleagues. “Our findings refute previous reports of futility for ECMO therapy in the setting of COVID-19,” commented Dr. Fabio Sagebin of the UCIMC Division of Cardiothoracic Surgery.
Extracorporeal membrane oxygenation is a life-sustaining therapy for carefully selected patients with respiratory or circulatory failure. Requiring specialised equipment and highly trained professionals, ECMO is mainly provided at large medical centres. While some hospitals have been using ECMO therapy for COVID-19 patients with severe ARDS, there is a “paucity of data” on
outcomes, according to the authors. Initial case series reported “exceedingly high” mortality rates: over 90%. Dr. Nguyen and colleagues used the nationwide Vizient hospital database to analyse outcomes of 11,182 patients with COVID-19 and ARDS who received ECMO between April and September 2020. The patients were treated at 155 US medical centres; numbers of patients treated with ECMO ranged from 1 to 38 per hospital. The majority of patients were under the age of 50 years (57.9%) with about 37% aged 51 to 64 years. Only about 5% were aged 65 years or older. For these ECMO-treated COVID-19 patients with ARDS, the overall rate of in-hospital death was 45.9%. Although high, that is roughly half the mortality rate reported in smaller ECMO studies from early in the pandemic. It’s also comparable to the 39% death rate in a recent analysis of about 1,000 patients from the Extracorporeal Life Support Organisation registry (largely treated at higher-volume ECMO centres). For patients in the new study, average
12 l
WWW.CLINICALSERVICESJOURNAL.COM
length of hospital stay was lengthy: 37 days, including 29 days in the intensive care unit. The in-hospital mortality rate increased with age: from about 25% for patients aged up to 30 years, to 42% for those aged 31 to 50 years, 53% for those aged 51 to 64, and 74% for those aged 65 or older. The researchers performed a subset analysis comparing patients aged 18 to 64 who were treated with (1,113 patients) or without ECMO (16,343 patients). In-hospital mortality was 44.6% for the ECMO-treated patients compared to 37.9% for those treated without ECMO. “Our data showed that patients with COVID-19 and ARDS treated with conventional ventilatory support had a high risk of death and patients selected for ECMO, which is a higher risk group, had a similarly high rate of death,” according to Dr. Sagebin. “The data suggests that in appropriately selected patients, we can save lives with this therapy.”
The report featured in Annals of Surgery, which is published in the Lippincott portfolio by Wolters Kluwer.
MAY 2021
©wutzkoh -
stock.adobe.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80
