The government has released new guidelines on the use of information to ensure NHS organisations have systems and processes in place to protect patient safety.
The guidelines form part of the Safeguarding Patients report, released yesterday in response to the fifth Shipman inquiry report, initially released in December 2004.
This week’s report also takes into account a further three lesser known inquiries: the Neale inquiry into an obstetrician who was struck off the register in Canada for incompetent performance of surgical procedures but nevertheless managed to maintain his registration and obtain employment in the UK for several years afterwards; the Ayling inquiry into a Sussex GP who sexually assaulted patients and the Kerr and Haslam inquiry into consultant psychiatrists in York who were responsible over many years for the sexual abuse of female patients.
As EHI reported three years ago, the Shipman Enquiry decided that it was crucial for patients to be able to obtain information about their doctor from the General Medical Council.
The enquiry called for: “In all cases where a GP’s registration is subject to conditions, or where s/he has resumed practice after a period of suspension or erasure, patients of any practice in which the GP works should be told. A letter of explanation, which has been approved by the PCT, should be sent to all patients. Patients should have the opportunity to refuse to be treated by a doctor who is subject to conditions or who has previously been subject to an order for suspension or erasure.”
However, the Department of Health (DH) has been cautious in addressing this recommendation in its response.
The report says: “The department is sympathetic to the intention behind this recommendation. At the same time, a balance needs to be struck between the public interest in helping to rehabilitate a health professional who is subject to restrictions or who is returning from suspension or erasure from the professional register, and the legitimate right of patients to know the position.
“Trust, assurance and safety emphasises at the importance of ensuring that rehabilitation is available to health professionals who have made honest mistakes, or who have been suffering from stress or other health problems, but who could still have a valuable contribution to make if their return to work, can be sensitively handled. The issues are not straightforward and we will discuss further with NHS, professional and patient groups the best way of taking these proposals forward.”
Commenting on calls for doctors details to be included in the spine’s central database, the report says: “The Government agrees that for doctors the GMC’s Medical Register should be the key national list of doctors entitled to practise in the United Kingdom and should contain tiers of information about each doctor and their standard of practice. The department will discuss with the GMC and other stakeholders how the register could be developed for this purpose; and will invite the regulators for the other professions to consider whether similar arrangements would be appropriate.”
It also commented on ensuring that information on staff backgrounds are securely stored and transported between practices when necessary.
“The department agrees in principle that all healthcare organisations should maintain files for each of their professional employees or (for PCTs) for health professionals performing services to patients for whom they are responsible.
“We agree that this “file” – which might be a set of paper files or of interconnected electronic files – should hold all material relating to the quality of the services provided by the individual professional.”
The DH added that it would be looking into ensuring that PCTs and employers are aware of concurrent employment of health professionals and have made arrangements to share information on concerns, especially where patient safety is at issue.
They promise: “We will discuss with stakeholders the possibility of extending these principles to the sharing of other information relating to potential threats to patient safety.”
The “file” must be sent to any practice the individual moves to, unless they also work in a secondary care trust, in which case a copy of relevant information in the file should be made available to the other PCT/trust, with arrangements for regular updating.
The DH added: “We agree that the department, or another central organisation such as NHS Employers, should issue guidance on the content of files to be kept by PCTs and employers, and also on the principles for creating and giving access to records.”
The government pledged that it would continue to work with the Royal College of General Practitioners to examine the wider role of practice profiling and the use of other routinely available data in the assurance and improvement of the quality of services delivered in primary care
The RCGP will also work with the Prescribing Support Unit (now part of the NHS Information Centre) on the way in which prescribing data can be used to assure the quality of GP services and help determine which individual doctor is responsible for the prescribing decision.
The report said: “The intention should be to make the maximum use of existing information streams and to feed back results in a way that is most useful to practices and to commissioners, rather than to impose a new burden of information collection.”
After setting up the Primary Care Mortality Database, the DH pledged to explore the potential use of practice-level mortality data as a clinical governance tool.
“We agree in principle that it would be helpful for all practices to keep a register of the deaths of their registered patients, including those who die in secondary care, for use in local clinical audit,” the report says.
The report also re-iterated the DH’s policy on letting patients see correspondence relating to their healthcare http://www.ehiprimarycare.com/news/item.cfm?ID=2474.
Health secretary, Patricia Hewitt, said: "As the Shipman Inquiry acknowledged, the NHS has made much progress since these inquiries were established. In particular, new structures and processes to ensure the quality of care, known as “clinical governance”, have put in place systems which will help prevent such abuses continuing undetected again.
“Nonetheless, the government accepts that further safeguards are needed. The proposals I am publishing today build on and strengthen existing clinical governance processes.”
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