Collaborating upstream - beyond fitness to practise “An ounce of prevention is worth a pound of cure”

Tista Chakravarty-Gannon Principal Regional Liaison Adviser, GMC

Session snapshot

GMC and Education – the direction of travel

What drives the issues we see? What can we do about it?

“An ounce of prevention is worth a pound of cure”

Which 3 specialties proportionately receive the most complaints?

A. Paediatrics B. GP C. Anaesthetics &

intensive care D. Surgery E. Obs and Gynae F. Radiology G. Psychiatry Paediatri

cs GP

Anaesthetic

s & in

tensive...

Surgery

Obs and Gynae

Radiology

Psychiatry

0% 0% 0% 0%0%0%0%

Proportion complained about by specialty

1. Psychiatry 2. Obstetrics and gynaecology 3. Surgery 4. General Practice 5. Ophthalmology 6. Medicine 7. Emergency medicine 8. Paediatrics 9. Radiology 10. Anaesthetics and intensive care

medicine 11. Pathology

Common complaints

What is the most common complaint from colleagues (including employers)?

A. Clinical care B. Working with

colleagues C. Probity D. Health (incl.

substance misuse)

Clinica

l care

Working w

ith co

lleagues

Probity

Health (in

cl. su

bstance

m...

25% 25%25%25%

Probity

www.adamzyglis.com

Is fear a driver? You make a mistake at work…

‘I was told that “The GMC won’t like it if you wear sleeveless tops”. You are always used as a threat.’

‘We’re taught to fear you, which really builds

barriers in our understanding of your role’ ‘We are put off from self-reporting even minor

things…because we think you’ll end our career’

< 0.05%

Upstream regulation?

Getting upstream

19

Welcome to UK Practice

‘’’’A nerve-calming exposure to all it entails to be a good doctor in the UK’

96% of participants said they will reflect on their practice as a result of taking part

99% of participants said they will

change their practice as a result of taking part

Engaging Interactive Impactful

20

Proactive regulation in action – Duties of a doctor

‘As an education [the Duties of a Doctor Programme] was very strategic’ (Dr Ian Grant, Responsible Officer , BHRUHT)

6 month tailored support programme Developed and delivered in partnership with NHS

providers 100% of participants rated the programme as

“good” or “very good” 92% of participants said they will change their

practice as a result of taking part

Engaging Interactive Impactful

Working with doctors to deliver GMP

Is it all just common sense?

•The Abortion Regulations 1991 5 •The Access to Health Records Act 1990 5 •The Access to Medical Reports Act 1988 7 •Blood Safety and Quality Legislation 8 •The Census (Confidentiality) Act 1991 10 •The Children Act 2004 10 •The Civil Contingencies Act 2004 11 •The Civil Evidence Act 1995 12 •Commission Directive 2003/63/EC (brought into UK law by inclusion in the Medicines for Human Use (Fees and Miscellaneous Amendments) Regulations 2003) 12 •The Computer Misuse Act 1990 13 •The Congenital Disabilities (Civil Liability) Act 1976 14 •The Consumer Protection Act (CPA) 1987 15 •The Control of Substances Hazardous to Health (COSHH) Regulations 2002 16 •The Copyright, Designs and Patents Act 1990 16 •The Crime and Disorder Act 1998 17 •The Criminal Appeal Act 1995 18 •The Data Protection Act (DPA) 1998 18 •The Data Protection (Processing of Sensitive Personal Data) Order 2000 25 •The Disclosure of Adoption Information (Post-Commencement Adoptions) Regs 2005 26 •The Electronic Commerce (EC Directive) Regulations 2002 26 •

•The Freedom of Information (FOI) Act 2000 29 •The Gender Recognition Act 2004 32 • The Gender Recognition (Disclosure of Information) (England, Wales and Northern Ireland) (No. 2) Order 2005 33 •The Health and Safety at Work etc Act 1974 33 •The Human Fertilisation and Embryology Act 1990,as amended by the Human Fertilisation and Embryology (Disclosure of Information) Act 1992 34 •The Human Rights Act 1998 35 •The Limitation Act 1980 38 •The Medicines for Human Use (Clinical Trials) Amendment Regulations 2006 39 •The National Health Service Act 2006 39 •The NHS Trusts and Primary Care Trusts (Sexually Transmitted Diseases) Directions 2000 40 •The Police and Criminal Evidence (PACE) Act 1984 41 •The Privacy and Electronic Communications (EC Directive) Regulations 2003 42 •The Public Health (Control of Diseases) Act 1984 and the Public Health (Infectious Diseases) Regulations 1988 42 •The Public Interest Disclosure Act 1998 43 •The Public Records Act 1958 45 •The Radioactive Substances Act 1993 45 •The Regulation of Investigatory Powers Act 2000 46 •The Re-use of Public Sector Information Regulations 2005 47 •The Road Traffic Acts 49 •The Sexual Offences (Amendment) Act 1976, sub-section 4(1), as amended by the Criminal Justice Act 1988 49

•The Electronic Communications Act 2000 27 •The Environmental Information Regulations (EIR) 2004 28

Supports safe decision making Promotes values, behaviours and relationships

Capacity

There is presumption of capacity under the MCA 2005 Does the person have an impairment of, or a disturbance in the functioning of, their mind or brain? Does the impairment or disturbance mean that the person is unable to make a specific decision when they need to?

Understand > Weigh > Retain > Communicate

Presumption of incapacity

37%

Best interest decisions

62%

Talia is 32 yrs old. She was diagnosed with HIV 2 years ago but lost to follow up. She has just re-engaged with GUM services

Partner of 4 years is unaware of diagnosis

History of violence from partner- evidence of healed rib fractures on C Xray

Does not want to go to the police regarding abuse

Does not want to reveal her status to partner

Does not want to tell her GP

You are the GUM clinician. Do you explain to Talia that you must disclose to her GP?

A. Yes B. No

Yes No

64%

36%

Talia is a competent adult. Would you disclose information about domestic violence?

A. Yes – to police B. Yes – to social

services C. No

Yes – to

police

Yes – to

socia

l service

s No

17%

59%

24%

You have counselled Talia re telling her partner about her HIV status. She won’t. Do you arrange partner notification?

A. Yes B. No

Yes No

43%

57%

Public Interest test?

Benefits to an individual

Public interest in + confidential

medical service

Possible harm to the

patient or society

93%

What would be most useful to help colleagues keep up to date with GMP? Multiple responses

A. More monitoring B. Local GMC

teaching support C. Guidance for NHSE D. Explicitly built into

curricula and CPD E. More time!

More m

onitorin

g

Loca

l GMC te

aching s

upport

Guidance fo

r Tru

st Board

s

Explic

itly built

into cu

rricu

la

More tim

e!

20% 20% 20%20%20%

Medicine is a tough career; we need doctors trained to be resilient and better capable to deal with adversity. Do you…?

1. Agree – current selection and undergraduate programmes do not produce students who are adequately prepared for a challenging career

2. Agree – but most of the problems lie in the organisations in which or with which doctors have to work

3. Disagree – doctors are already resilient – the focus should instead be on providing proper levels of support for hard pressed practitioners

4. Disagree – resilience comes largely from experience

5. Not sure

Agree – curre

nt selecti

on...

Agree – but most

of the ...

Disagree – docto

rs are al...

Disagree – re

silience

com..

Not sure

0% 0% 0%0%0%

20%

49%

9%

14%

9%

If I were struggling to cope as a result of pressures on the service, I am confident that I could ask for and receive help without being penalised.

1. Strongly agree

2. Agree

3. Neither agree nor disagree

4. Disagree

5. Strongly disagree

Can you find the

the mistake? 1 2 3 4 5 6 7 8 9

The space to think…

Know and use GMC guidance

The GMC and quality

“Professional regulation should be as much about sustaining, improving and assuring the professional standards of the overwhelming majority of health professionals as it is about identifying and addressing poor practice or bad behaviour”

The Rt Hon. Patricia Hewitt, MP Secretary of State for Health, Trust Assurance and Safety, 2007

Thank you

0161 250 6822

07919 256 476

tcgannon@gmc-uk.org

@tcgannon

Tista Chakravarty-Gannon