From time to time, and probably more often than any of us would want, it appears that a rogue doctor is providing services often (but not always) within the NHS system. In previous years there were the claims against the employers of Dr Patterson who was criticised for his breast cancer surgery and Mr Jones who worked in Cornwall and was suspended because of the number of complications involved in his surgical procedures. There have been others.
In 2012 the GMC commenced implementation of the first cycle of revalidation. Revalidation is a regulatory process. It is intended to work alongside the process of clinical governance, which is the process of reporting incidents. It is all part of a changing culture in medicine and nursing towards a more open and transparent understanding of problems that arise.
I recently had referred to me a client who has been in essence a victim of a rogue surgeon. That surgeon has had a number of serious complaints as a result potentially of his actions. I am aware of quite a few other cases involving the same surgeon.
Ultimately it appears he was reported by colleagues after the revalidation process had started and he is currently suspended from practice. The GMC will no doubt undertake its process of review and a final decision will be reached in due course.
It is encouraging that this surgeon was reported and that he was reported by his colleagues. It is encouraging that the colleagues felt confident enough and supported enough to take that decision. It is hard however to accept this as indicative of a greatly increased general openness towards complaints and bad practice.
For the uninitiated, revalidation essentially means that a doctor takes part in an annual appraisal process and at least one appraisal will be based on good medical practice. In addition, they will have had to collect and reflect on six types of supporting information which are their continuing professional development, quality improvement activity, significant events, feedback from colleagues, patients, patients and views of complaints and compliments.
As a process it seems fine but it is a little woolly and it is difficult to see how in the midst of that people will be getting proper information about the quality of medical practice.
Appraisals have been a contractual obligation in the NHS since 2003. However, it was only when the revalidation process came in that they had to include quality, improvement and reflection. Uptake of appraisals was not measured particularly well and therefore it was hit and miss as to how and why and when it happened.
As a clinical negligence lawyer I deal with clients who are advised that they can make a complaint about healthcare at any stage. The process is lengthy, often frustrating and for most clients does not provide them with the answers that they require. Although there has been a duty of candour in the NHS for a little while and there is clearly a push to be more open and transparent about things that go wrong, there are still people attending our offices who have been through the complaints process and have in essence been told that there was nothing to complain about. They simply suffered (for example) “post-operative complications”.
In the case which was referred to me my client went through the complaints procedure and I have seen the response from the Trust. It is uninformative and on the whole I would say poor. It is disappointing that such a response came forth particularly they were aware of other complaints from patients and colleagues. Reading the letter responding to the complaint, you would think this man had never done anything wrong at all.
The revalidation process is coming to the end of its first cycle during which time it is hoped that every NHS doctor will have had some form of proper appraisal. Its second cycle commences around March 2016 and it remains to be seen as to whether it will be strengthened or in essence retain the same format. Part of that is that once every five years the Trust is obliged to look at complaints. On a personal level I do not see why this could not be done every year.
Such a review may identify a pattern of behaviour that can be addressed and resolved or a pattern of behaviour and activity which makes that surgeon or doctor is potentially dangerous to patients. Once every five years is not enough.
I am now advising clients to make a complaint to the Trust whenever there is time to do so. It rarely helps the legal claim but it may identify problems which the Trust can review albeit every five years. It isn’t ideal. In fact it is poor. But it may save someone else from the same problem years down the line.