Lord Parekh: Maintaining medical competence.

Lord Parekh lays out his plan to maintain the level of medical competence and skill in the NHS.
The NHS is rightly regarded as one of Britain’s finest achievements. It embodies great moral values and ensures that no pain goes unrelieved for lack of money. Its staff is more or less totally dedicated, has a genuine sense of calling, and is second to that of no other country in its professional competence.

No institution however is perfect and it can always do with improvement. This is just as true of the NHS, which is why several welcome changes have been introduced over the years such as the appraisal and revalidation of the GP and the collection and publication of the casualty figures of surgeons. As I talk to patients and doctors and look at the practices of other advanced countries, I am persuaded that we might like to consider changes along the following lines

1. As the Australian and other experiences show, the audit of the casualty figures of surgeons has helped them improve their practice and over time led to reduction in casualties. Our Royal Colleges introduced this change some years ago, and it would be useful to conduct a survey to see how and to what extent it has improved the prevailing practice.

2. An appropriately redesigned change of this kind needs to be introduced in relation to non-surgical consultants including the physicians. Currently they have no means of knowing how the patients responded to the prescribed medication. If it does not work or has deleterious effects, the GP picks up the pieces and the information does not reach the consultant. If the GP refers the patient to a consultant, the latter might not be the same as the one who saw him initially. A measure of continuity needs to be established between the consultant and his or her patient, and figures need to collected on the adverse effects of the consultant’s advice.

3. Consultants and GPs are subjected to sometimes unreasonable targets, and hence unable to spend as much time with their patients as they would like or is necessary. As a result decisions are made in a hurry or without full knowledge of the case, leading to serious errors of judgement. Steps need to be taken to avoid such situations.

4. GPs are at the centre of the NHS. It is not a secret that patients sometimes avoid certain partners in a practice even when that involves considerable waiting. There are many reasons for this, the suspicion of inadequate clinical competence is one of them. It is in the interest of both the GPs and the patients that the most welcome appraisal system is made more robust. Inadequate GPs should not be covered up by an otherwise excellent practice, The criteria of patient satisfaction should be more carefully defined and include such questions as how many visits she had to make before her complaint was diagnosed and how often her medicine was changed before she felt better. Cases of whistle blowing among the GPs and consultants should be viewed more charitably than at present. They are a public service and sometimes a compulsion of one’s conscience, and hence their occasional excesses or misuse should be condoned or dealt with lightly.

5. GPs need to find more time for further training and experience and to keep abreast of the latest developments in the rapidly changing world of medicine. Although important, revalidation is a little too crude and needs to be more nuanced. As a university professor myself, I welcome steps to ensure that I am up to scratch, but not someone testing my basic knowledge of my subject by crude means.


Epolitix.
Culled from Yahoo News.