Locum Staffing and Medical Staffing

Chris Lancelot: Has the NHS had its day?
Chris Lancelot, GP newspaper, 04 September 2009, 12:09pm
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Is the NHS outdated? MEP Daniel Hannan thinks so, and incurred instant opprobrium from the government, the Conservative hierarchy and the BMA. To many, the NHS is clearly sacred and inviolable.
Which is a pity. What other mid-20th century institution has stayed still? Roads, shopping, communications and transport have all moved on since the 1940s: now we have motorways, superstores, mobile phones and the internet. Is the NHS really so perfect as to be unchallengeable and unalterable?
Let's put aside political doctrine and look at the facts. The overall concept of a health service free at the point of need and paid for out of general taxation has a lot going for it, and is one to which generally I subscribe. Nevertheless, the structure of the NHS itself contains inherent weaknesses.
The biggest problem is that people don't value what they don't pay for. This is why there is such a demand over self-limiting illnesses, so many DNAs and such emphasis on 'my rights'. There is no psychological incentive for individuals to manage carefully their use of NHS resources: no wonder demand seems to expand exponentially.
Partially because of the absence of such self-correcting controls the NHS requires a large bureaucracy to manage it - and the bigger the bureaucracy the greater the potential for inefficiency. The NHS may be good for patients, but it is truly awful for those working in it - bullied by politicians and often constrained by clueless managers.
But what are the alternatives?
Would you really work for an organisation where financial managers control clinical activity? Where patients are barred from a variety of treatments unless they can pay? That delivers services which vary according to where the patient lives? No, I'm not talking about the USA - this is the NHS, here and now.
So my advice is: let us all take off our blinkers and be rational and objective. The NHS is not the only way to provide universal healthcare: other countries have better outcomes (France) or more efficient financial arrangements (Singapore). The NHS may be fine in theory, but if the outcomes don't match the rhetoric then a careful, impartial reappraisal is needed, whatever the political pundits may say.

GP newspaper, 03 September 2009, 12:09pm
What should GPs do if they receive a claim for clinical negligence? The MDDUS's Simon Dinnick offers advice.
While the Medical and Dental Defence Union of Scotland's (MDDUS) experience is that the number of claims for clinical negligence has stopped rising, they are often for higher amounts of compensation, and are usually better prepared, than before.
Under English procedures, solicitors will usually have gone to some trouble to investigate the complaint and take expert advice, so a letter notifying you of a claim must be taken seriously.
AcknowledgementBut whether you practice in Perth or Penzance, the basic principles for how it is advisable to react remain the same.
If you are notified of a claim, simply acknowledge it and let the author know that you are taking advice from your defence organisation (or professional indemnity insurer).
Contact your organisation as soon as possible to tell it about the claim. Its advisers will explain to you what to do next.
Prepare a written report as soon as you can, while the memory of events is as fresh as it can be. Detail what you know about the patient and each aspect of the consultation(s) in question. Answer the allegations and give your general impressions.
This report is confidential to your defence organisation, so share your thoughts and concerns honestly.
If you cannot recall a specific event - it may have been some time ago - then say so.
If you have moved on in the meantime, contact the GP practice concerned.
Collect and take copies of the relevant medical records, in case the patient moves to another practice or - perish the thought - dies. In either case, the records may be removed from the surgery before you have had a chance to write your report.
If your notes are difficult to interpret, make a verbatim transcript.
It is usually a good idea to tell your partners or an immediate colleague about the claim. This should provide you with a point of reference and support if you need it within your working environment. It is also important that your colleagues are not upset by finding out about something potentially significant by accident.
Do not be tempted to write letters to or sound off to the claimant's lawyers. You may compromise your defence organisation and yourself, and risk forfeiting your cover.
Once you have given your organisation your report, try to regard the problem as no longer yours. It is your organisation's job to deal with it.
Do not dwell on the claim or try to deal with it yourself. If it is causing you stress, defence organisations generally have staff who are skilled at listening and offering practical advice.
What to do
- Simply acknowledge the claim, stating that you are taking advice.
- Contact your defence organisation as quickly as possible.
- Prepare a written report as soon as you can.
- Collect and take copies of the relevant medical records.
- Tell your partners or an immediate colleague.
- Don't write letters or sound off to the claimant's lawyers.
PatienceAny negligence claim may take up to three years to run its course. Try to be patient.
Answer questions as they arise and attend any necessary meetings with barristers or relevant experts. Such meetings will be held only when essential.
Of course, a negligence claim must be taken seriously. But in terms of process, it is similar to a claim following a road accident - with emotion thrown in.
Trust your advisers and do nothing to distress your patient further. They will need and expect sympathy and tact as the situation is likely to be difficult and stressful for them too.
Be reassured that few cases go to court. Claimants often withdraw or are persuaded to abandon their cases. Sometimes detailed analysis leads defence advisers to conclude that it is better settled out of court.
If you are asked to go to court, this is more likely to be because your defence organisation believes you have not been negligent than the opposite.
Finally, bear in mind that, sadly, claims for clinical negligence are a fact of modern life.
- Mr Dinnick is head of legal services, Medical and Dental Defence Union of Scotland, www.mddus.com