Appraisal and doctors in court
A conference report from the BGS Belfast Spring Meeting, by Liz Gill.
The afternoon then turned from patient care strategies to professional conduct with a session on governance and risk management. In her talk entitled, “High Court Avoidance”, Dr Angelique Mastihi from the Medical Protection Society listed reasons doctors might find themselves in court: for clinical negligence, to appeal against a medical practitioners tribunal decision such as a GMC suspension or sanctions or for a judicial review. This was where an individual or a group could ask the court to review the decisions and actions of a public body if they felt, for example, that there had been an unfair decision in tendering or, if they felt a certain type of treatment should be available on the NHS, or where a trust or a patient asked if a proposed treatment would be lawful if given or withheld.
Doctors could find themselves in the High Court in compensation cases either as a defendants or witnesses, but only two per cent of claims actually reached that stage as judges generally wanted them dropped or settled. In reality doctors tended to be more involved in cases lower down the legal system such as coroners’ courts and hospital inquiries.
“Medicine is risky and complex both for the patient and the clinician and you need to be pro-active in reducing risk,” she added. It was important to identify potential risk – “If I hear a doctor say they’ve never made a mistake, that makes me anxious” – and its likelihood and then take steps to prevent it. It was important though, to review the situation as sometimes those steps actually increased risk.”
“For example, there was a GP surgery which had its bright yellow sharps bin on the floor near the toys box. That obviously wasn’t a good idea so they moved it but they put it up as high as possible which meant staff couldn’t see inside and there was then a needlestick incident.”
“As resources become more limited, we will need to prioritise which risks we deal with. It’s also important to communicate risk to both the patient and the family. Keep up to date with good medical practice and keep a record of the good stuff you do. If something does go wrong, listen to the patient and their family, give clear explanations, investigate what’s happened, seek advice from colleagues and a defence organisation.”
Dr Peter Flanagan, medical director at the Northern Health and Social Care Trust, then offered some practical advice for creating the perfect appraisal folder. Such folders which will play an essential part of the new revalidation process, should include a summary of current medical activities, knowledge, skills and performance, safety, communications, team work and the maintenance of trust. It should include all areas of practice including charitable work as well as mentioning significant events including near misses, complaints and compliments and details of the doctor’s own health. There should be feedback from colleagues, patients and trainees.
“For the older generation, appraisal is relatively new but it should be embraced as a positive opportunity. It should be a constructive dialogue giving the doctors a formal opportunity to reflect on their work and how it can be improved. One of the reasons doctors get into difficulties is because they don’t reflect. It’s also an opportunity for them to flag up their concerns.”
Jon Billings, assistant director of registration and revalidation with the General Medical Council, concluded the afternoon with an outline of how the new system will operate over five year cycles using the annual appraisals. Designated ‘responsible officers’ will make recommendations to the Council who will rule on whether a doctor’s licence to practise should continue. “It means doctors will have a career-long relationship with the regulator. It also provides a tremendous opportunity to find ways of driving improvements.”