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The Government recently announced a new system of
annual appraisals for GPs in which they will have their
skills and competence tested. The new initiative was
triggered by the investigation into
Harold Shipman and
eventually it will lead to all 150,000 practicing
doctors needing to have their licences renewed by the
General Medical Council
(GMC) every five years. Incompetent or
Medically negligent doctors face hearings or even losing their licence.
The Care Quality Commission
(CQC) said in its report
published last year that Primary Care Trusts (PCTs) must look at the quality
of clinical decisions, the efficiency of call handling
and the adequacy of staffing and doctors training in an
effort to properly check the performance.
One crucial problem regarding overseas doctors is
that current European legislation means that there is no
obligation for an overseas regulator to inform their
counterparts in another country of any disciplinary
action that has had to be taken against a doctor or
other health professional. So a GP who has been struck
off in say Italy is able to work in the UK or any other EU
country undetected despite the fact the may have been
medically negligent or found to be incompetent.
Indeed, this occurred in the case of Dr Ubani. A BBC
Newsnight investigation found documents in Germany
relating to the doctor, showing that he was guilty of
malpractice and evidence of complaints about him dating
back many years but all of this was not known by the
English medical authorities prior to appointing him for
what turned out to be his first and last locum shift in
this country.
In fact Ubani failed in his first attempt to work in
this country because of his poor command of English. He
was later admitted to the performer’s list of Cornwall
and Isles of Scilly NHS, which apparently had less
rigorous checks but did not get the opportunity to work
there and took the fateful shift in Cambridgeshire a
month later.
The General Medical Council, no doubt with the Daniel
Ubani case in mind, has called on the
European
Parliament to change the current situation and create a
statutory duty to share information.
The British Medical
Association (BMA) has joined in these calls, saying: “While
the BMA agrees with the principle of cross-border
patient mobility it is essential that there is a legal
requirement for regulatory bodies in member states to
exchange information about doctors’ disciplinary
records. In this way doctors who have been struck off or
suspended will be prevented from travelling to other
countries and treating patients.”
The Government has stressed that care has improved
since 2004, despite GPs having stopped providing
out-of-hours cover
(OOH). In terms of the situation following
the Ubani case, it has said that GPs providing such care
will be subjected to tighter controls, greater skills
and knowledge testing. A new report, ‘General Practice
Out of Hours Services,’ follows the review by Dr David
Colin-Thome and Professor Steve Field and recommends
improved induction and training and a national database
of doctors covering OOH services.
This report provides a number of measures which it
hopes the PCTs will follow. Among them is the
recommendation that PCTs should review the performance
management arrangements in place for their out-of-hours
services and ensure they are robust and fit for purpose.
It also recommends that the
Department of Health should
issue guidance to PCTs to assist them in making
decisions about whether or not a doctor has the
necessary command of English.
Primary Care Trusts have already been issued with
interim guidance to assist them in complying with their
obligation that all approved OOH GPs have a satisfactory
knowledge of English. The Department of Health now hopes
that by the end of this year there will be a model
contract for PCTs to refer to when looking for OOH
services. It also intends to ask GPs themselves for
input into how their local OOH services meet the needs
of their local communities.
The Conservatives, in the run up to the election,
have said that they will challenge existing GP contracts
in a bid to provide an improved service on evenings and
weekends. Shadow Health Secretary Andrew Lansley said
that a future Conservative Government would make GPs
‘collectively responsible’ for out-of-hours services,
saying that they are best placed to ensure that patients
are treated properly.
The Liberal Democrats, for their part, say that there
should be a language and competence test for every
overseas doctor wishing to work in the UK. Their Health
spokesman Norman Lamb accuses the Government of knowing
that the safeguards already in place were inadequate but
not taking any action to improve them.
http://news.bbc.co.uk/1/hi/health/8493537.stm
The health service is never out of the headlines for
long. The issue over out of hours care was soon replaced
by the report into the
appalling care given to patients
at Stafford Hospital. With the election looming the
three main parties will be putting forward their own
future plans for the NHS and as out of hours care is
still fresh in the minds of the electorate, it is highly
likely to be raised at some point in the coming weeks.
All politicians must strive to show that lessons have
been learnt since the tragic death of David Gray.
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