Published on December 19, 2013
Medical Professionalism – whose job is it anyway?
Introducing our panel Professor Mike Pringle – President, Royal College of General Practitioners Nigel Acheson – Regional Medical Director (South), NHS England Professor Wendy Reid – Medical Director at Health Education England Maureen Edmondson – Chair of the Patient and Client Council for Northern Ireland Niall Dickson – Chief Executive and Registrar, General Medical Council
Setting the scene: who’s in the room? 1. Student 2. Educator 3. Doctor 4. Patient 5. Employer 6. Professional body 7. Other
Place in order of importance these levers to improve/enable professionalism? Education and training More regulation / legal powers Organisational culture and leadership Greater patient involvement in care and care design More resources
Theme 1 – Accountability or Improvement? Francis • • • • • • Fundamental standards Legal duty of candour Criminal sanctions Regulation Healthcare leadership Authoritative information Berwick • Ethic of learning • Patients and carers involved at all levels • Quality and patient safety sciences • Regulation to be sensitive • Recourse to sanctions rare
Time to vote: Accountability or Improvement? 1. Francis……..accountability 2. Berwick ……improvement
Theme 2 – Raising Concerns
Raising Concerns – a familiar challenge ‘(We)…..should not seem over-anxious to be at work since the spreading abroad of the shortcomings of any erring members of our honourable profession is a proceeding to be carefully restrained within precise limit.’ John Marshall, GMC President, 1887-1891 ‘The system for the investigation … has not proved capable of reconciling the diverse objectives that have to be achieved. X not unreasonably felt that he had to take his complaint outside ‘the system’’. Report of the Committee of Inquiry into Ely Hospital 1969 ‘A combination of inadequate systems and poor culture meant that staff were not encouraged to … speak openly. Those who tried to raise concerns found it hard to have their voices heard.’ Bristol Royal Infirmary Enquiry 2001 ‘Staff witnesses described an atmosphere of fear … and a forceful style of management (perceived by some as bullying). There was also evidence of a worrying acceptance of poor care, of poor behaviour among colleagues being condoned.’ Mid Staffordshire NHS Foundation Trust Inquiry 2010
Raising Concerns – a problem on the wane? Complaints from all sources to GMC are up - 8,109 in 2012 up 24% since 2011 and 104% since 2007 Complaints from doctors to the GMC have risen by 113% over the last five years GMC Confidential Helpline - 881 calls from Doctors (66 investigations) in the last 12 months GMC NTS results: ~16% of doctors in training raised a concern in the last year Evidence in practice: Julie Bailey Helene Donnelly Colchester ‘whistle-blower’ on Cancer Care Pathway
Place these barriers to raising concerns in order of significance Systems/routes to complain are not clear Fear of recrimination from employers, colleagues or doctor about whom complaint is made Feeling nothing will change
Theme 3 – The Good Doctor
Place these characteristics of a doctor in order of importance to you Knowledge/expertise Compassion/empathy Listens and responds in partnership Communicates well Confidence they are up to date Integrity
What patients and the public told us (GMP Consultation 2011)
What doctors told us (Sample of 90 doctors – 2013)
Closing question Will, in the long run, the last year have been good or bad for the future of medical professionalism? 1. Good – from crisis….renewal 2. Bad – its all downhill from here 3. Neither - it won’t make a blind bit of difference
Lunch and exhibition Upper foyer and Exchange hall
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