Doctors Association UK (DAUK) GP co-leads Dr Sarah Jacques and Dr Steve Taylor highlight the cases of nine-year-old Dylan Cope and eight-year-old Ethan Hanson.

In both cases, the children were appropriately assessed in primary care and urgently referred to hospital by their GP.

However, according to the coroners’ findings, neither child was assessed by a doctor after arriving at hospital.

Patient safety

Dr Jacques and Dr Taylor’s letter states: “These cases raise serious questions about the safety of current assessment systems in emergency departments and the roles of non-doctors.

“When a GP refers a patient to hospital, that referral represents a clinical judgment that is the equivalent of a medical consultant opinion in the community, and thus necessitates a further medical assessment.”

DAUK is urging health secretary James Murray to introduce clear national standards to ensure patients referred by GPs are assessed by a doctor on arrival in hospital.

They are:

• Any patient referred by a community GP to hospital by a GP must be assessed by a doctor in the hospital.
• No patient presenting with undifferentiated (undiagnosed) symptoms should be allowed to be assessed or discharged without the approval of a doctor.
• We ask the Secretary of State to review the current status of assessments in emergency departments to ensure patient safety is the priority and that doctors are involved in all cases of undifferentiated care and GP referrals.

Improvements in clinical practice

In their letter, Dr Jacques and Dr Taylor said: “It’s vital we ensure that the issues identified by the coroners in the cases of Dylan Cope and Ethan Hanson lead to improvements in clinical practice.”

DAUK has invited Mr Murray and Department of Health officials to discuss the proposals.

Read the letter in full.

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DAUK co-chair Matt Kneale said the Government’s plan to regulate PAs and AAs under the General Medical Council (GMC) must be stopped until issues around scope and supervision are sorted.

Dr Kneale said: “The rollout of PAs and AAs must be paused given the amount of uproar there has been and given the amount of patient safety concerns that have been raised across the country.

“Our survey of 650 doctors highlighted alarming instances of patient harm due to the replacement of doctors with PAs and AAs, and seemingly every day we’re hearing more examples of harm and poor practice.

“The safety and protection of the public must be paramount, and so this process needs to be stopped until we’ve sorted the issues around regulation, scope and supervision.”

Dr Kneale was speaking after a crucial piece of legislation around PA and AA regulation was debated in Parliament on Wednesday (17 January).

The legislation was discussed by a small number of MPs in a committee room, away from the main chambers of the House of Commons, and passed by statutory instrument.

It will go before the House of Lords at the next stage.

Dr Kneale said: “Legislation that potentially has huge repercussions for the future health of the country should be debated in the main chambers of Parliament and not hidden away to avoid proper scrutiny.

“Statutory instruments are meant for technical pieces of legislation, and certainly weren’t intended for complex, controversial legislation like the regulation of potentially dangerous medical replacements.

“DAUK is now calling on the House of Lords to really scrutinise this legislation before it’s passed into law, particularly given the serious concern expressed by doctors over the past few months.

“In addition, we’re working with Anaesthetists United and a leading KC to ascertain whether there are causes for any legal challenges.”

In our letter DAUK also:

-expresses concern regarding the news that the GMC has continued to appeal MPTS verdicts following the judgment in Bawa-Garba v GMC

-expresses concern that this week Lord Justice Bean urged that the GMC show ‘restraint’ when exercising this power in the judgment of Raychaudhuri v GMC on the 14th September, and in discussing the case appeal judges expressed ‘regret that it was brought’.

-expresses concern that the GMC is currently appealing the MPTS verdicts of four doctors in the courts in order to impose a higher sanction. DAUK has asked Mr Massey to grateful clarify if this is indeed the case.

-states that we still do not feel that doctors, the patient safety community and the public, have been provided with a clear understanding of how the GMC came to the decision to appeal the MPTS verdict in Dr Bawa-Garba’s case, or indeed the processes which the GMC follows when deciding to appeal the MPTS verdicts of other doctors’ cases.

-confirms that Dr Sarah Wollaston has informed us the Health Select Committee will hold an evidence session on gross negligence manslaughter and patient safety in the Autumn.

-informs Mr Massey that we will be urging the Government to move forward with the legislative changes needed to repeal the relevant amendment to Section 40A that allows the GMC to appeal MPTS verdicts in a timely matter.

-calls upon Massey to cease appealing MPTS verdicts urgently.

-supports the petition started by Dr Jenny Vaughan that calls on the GMC to ensure that the court fees awarded to Dr Bawa-Garba are not paid for from the subscription fees of the doctors who supported her.

-extends an invitation to both Mr Massey and Professor Terence Stephenson to the formal launch of our Learn Not Blame campagin in Westminster hosted by Dr Philippa Whitford MP in November.

read the full letter here

‘For those of us observing it’s still hard to believe that we have got to the stage where an otherwise dedicated and hard working doctor has been criminally prosecuted and taken to court by the GMC for what were essentially honest mistakes [made when] working under pressure,’ she said.

Dr Bawa-Garba is appealing a decision made in January by two High Court judges that she should be erased from the medical register rather than receive the year’s suspension that had previously been imposed by the Medical Practitioners Tribunal Service (MPTS).

‘Systemic failings’

Their ruling followed a successful appeal by the GMC, which argued that suspension was ‘not sufficient’ to protect the public or maintain public confidence in the medical profession.

On Wednesday, the opening day of the appeal, Dr Bawa-Garba’s counsel James Laddie QC said there was particular concern in the medical profession over the court’s decision to disregard ‘systemic failings’ which contributed to the environment in which Dr Bawa-Garba came to make the mistakes leading to the death of six-year-old Jack Adcock in 2011.

Dr Batt-Rawden, who sat in court during the appeal’s opening yesterday, said: ‘Particularly concerning to all of us has been the GMC’s line of argument. To an observer, it seems the crux of their argument is that system failures were not relevant in Hadiza’s case, and should not have been taken into account by the MPTS when determining her level of culpability and her sanction.

‘This has huge ramifications for the medical profession and for patient safety. We are all working in an immensely pressured system, with widespread staffing issues and rota gaps. Hadiza’s story of doing the jobs of several doctors at once, across multiple wards and multiple floors, with a failing IT system, in the absence of senior colleagues or indeed a consultant is sadly increasingly common.

‘Before this case I don’t think any doctors thought that mistakes made whilst simply trying their best under such pressured circumstances would ever lead to a criminal conviction, or erasure from the register. Now, all of us are feeling vulnerable.’

In written argument before the court, Ivan Hare QC for the GMC said the appeal should be dismissed because the High Court was correct to decide that the MPTS failed to apply the relevant rule of the GMC (Fitness to Practise) Rules Order of Council 2004 and undermined the rationale for making criminal convictions conclusive evidence of the offence committed in disciplinary cases.

In response to Dr Bawa-Garba’s case, The Doctors’ Association UK has launched a new campaign ‘Learn not Blame’.

‘We must move away from a culture of blame and fear, to one of learning,’ Dr Batt-Rawden said. ‘We repeatedly fail to learn from scandals such as Mid-Staffs and Gosport and the NHS urgently needs a safe space to enable staff to speak up about patient safety issues.’

She added that there are ‘no winners’ in a culture which seeks to blame one individual for medical error whilst failing to address wider system failures.

‘Our ongoing campaign seeks to empower doctors to be part of a transformational change process working towards a shift from a culture of blame, to one of learning.’

She concluded: ‘An unsuccessful appeal today would do further damage to a profession whose morale is already at rock bottom, and signals a further move away from the open, transparent NHS that we all want to see.’

We need a culture of learning, not of blame and persecution. We need a culture of compassion and care for all who are served by it and all who work in it. A culture where mistakes and harm are prevented by openness, listening and learning. And where mistakes and harm do happen, change, not blame, is the outcome. A just culture. This is the only way we will see a real improvement in patient safety.

This campaign has been born out of a growing awareness amongst clinicians of how a toxic mix of defensiveness and concern for reputation management above all else can lead to blame-seeking culture. This is bad for doctors and worse still for patient safety.

Most patients and families, when things go wrong in healthcare, just want to know honestly what happened and make sure that the same thing never happens to anyone else. But many people face a brick wall when seeking answers from NHS organisations, and get pushed into an adversarial complaints procedure, or even litigation.

Equally, staff who raise concerns often find themselves the subject of counter-accusations, victimisation and blame, instead of having their concerns acted upon. Staff are forced into a formal whistleblowing procedure, where the ensuing legal action may bankrupt them and ruin their careers.

This campaign aims to bring doctors together to say – enough. This has to stop.

The campaign will encourage individuals to commit to action within their own sphere of influence, and join together as a movement to put pressure on NHS leadership to mirror that change and commit at a Trust or Health Board level to an open, learning and just culture.

Look out for more details coming soon, and how YOU can be the change.

#LearnNotBlame