Saturday, 24 February 2018

Notes from RCGP Council meeting 23 February 2018

Implications of the conviction of Dr Bawa-Garba

There was extensive discussion about the implications of the conviction of gross negligence manslaughter and subsequent removal from the medical register of paediatrician Dr Bawa-Garba. The mood of Council seemed to be that substantial change was required to ensure this never happened to another doctor again.

I made the following speech:

Many of the players in this case have at best overstated their opinions. The MPS’ statement fails to reassure about the use of written reflections either in this or future cases. It is a matter of record that a form from Dr Bawa-Garba’s ePortfolio was submitted to the court and she faced questioning in relation to it. Furthermore, her reflections were considered by the preceding inquest.
What is concerning is not whether or not evidence of her ePortfolio was used to convict her but that the court did not consider her reflections as mitigation, unlike the Medical Practitioner Tribunal Service, and that honest and meaningful reflections by doctors might in future be demanded by courts and used against them.
In my view, increasing the jeopardy of not being candid was a misstep. What is now urgently needed is to reduce the jeopardy of acknowledging mistakes and missed opportunities so that we can all work together to make our patients safer, just as takes place in the aviation industry.
We must press for legal privilege for reflections by individual doctors on serious untoward incidents. Until then, we should discourage our members and trainees from recording detailed reflections.

In the light of the opinion of the Professional Standards Agency, the GMC have at best been misguided and at worst disingenuous in stating that they had no alternative but to appeal the sensible decision of the MPTS. That they have thus far always won appeals is no justification, as it is now abundantly clear that the courts are unable to distinguish between individual and system failings.
It seems to me that a big failing for courts is the way in which they use expert witnesses, confusing a medical witness who may be expert in a particular medical condition for a peer of the beleaguered doctor on trial.
I have some personal experience of this. A family member found themselves being sued alongside a GP. One of the pieces of evidence used against them was the opinion of an expert witness who admitted that she had not once treated the condition under consideration!
Our work with other organisations should include how we might support courts in receiving the best opinion regarding standards of medical practice. Perhaps College should accredit a cadre of expert generalist witnesses.

College Sponsorship Policy

College will be consulting on a new policy for sponsorship. In June 2018, Council had asked Trustee Board to prepare options for consultation for its approval. I reiterated my suggestion from June that this include principles which potential sponsors must meet, including that if a sponsor seeks to change the clinical practice of College members, that practice must be consistent with College policy. I agreed to submit a set of principles to the Chair of Trustees for consideration of inclusion in the consultation.

College membership recruitment and retention trends

At least partly in response to a previous request from myself, Trustee Board presented membership attrition statistics, some of which I shall shortly add here. These demonstrated that attrition is greatest during the first few years of membership. This stimulated from other speakers suggestions on what more we might do to retain these members. I welcomed these statistics and asked that they be presented to Council regularly. It was agreed that they would be published annually.

E-Consultation and online General Practice

Having been amended in line with feedback from Council, this paper setting out the potential pitfalls of e-consulting was approved. I welcomed the inclusion of the concept of opportunity cost but asked for this, in my view the biggest risk, to be made more prominent. "If GP time is finite, what will we have to stop doing in order to undertake this new work?"

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