3. Cases

Question 1

Harold Shipman & Revalidation (2012)

(1) Reforms
(2) Revalidation
(3) Pros and cons

Answer 1

Reforms

• Move way from single handed GPs
• Controlled drugs
• Death certificate

Revalidation

(1) Doctors report to Responsible Officer, who make a GMC recommendation on fitness to practice every 5 years
(2) Portfolio
- Continuous professional development record –> conferences, courses, retraining
- Review of own practice/quality improvement activities –> clinical audits
- Feedback on own practice –> colleague/patient, review of complaints

Pros and cons
+Formalises revalidation
+Substantiated by comprehensive evidence
+Requires doctors to review GMP values and evidence this
-Runs risk of identifying underperformance once a year
-May be mismanagement of individuals at previous times of the year
-Process may require information that trusts don’t hold

Question 2

MMR Vaccination scandal

Answer 2

(1) Wakefield published a study alleging a link between MMR and autism
- Not confirmed by any other researcher
- Research based on 12 cases
- Applied for a patent on single jab measles vaccine before scandal
- Planned to launch a venture on the back of a vaccination scare where he could profit off (1) new medical tests (2) litigation driven testing
- Lacked paeds qualifications, not sanctioned by ethics boards
- Instructing solicitors representing parents who believed their children were harmed by the vaccine

(2) Stats
- Immunisation rates dropped in Britain 92-73% as low as 50% in some parts of London
- In Wales in May-March 2013, over 1200 people were infected with measles as a result of lack of vaccination, leading to an urgent MMR campaign

Question 3

Mid-Staffordshire NHS Foundation Trust Scandal (2009-2013)

(1) Health Commission Report (2009)
(2) First Francis Report (2010)
(3) Second Francis Report (2013)
(4) Reforms
PATIENT SAFETY
DUTY TO SPEAK UP
COMPASSION AND EMPATHY

Answer 3

Enquiries conducted revealed an astonishing degree of poor care and negligence

(1) Health Commission Report (2009)
- Lack of effective management systems for emergencies
- Failure of Board to develop an open culture and challenge practice despite information pointing to obvious problems
- Between 400-1200 more people died than would have bene expected in a 3 year period from 2005-2008

(2) First Francis Enquiry (2010)
- Staff issues: lack of leadership, lack of integration, lack of attention to patient dignity, slow diagnosis and management –> slow/premature discharge of patients, poor record keeping
- Culture: patients scared to raise concerns, staff distracted
- Board issues: poor governance –> clinical audit practice underdeveloped, critical incidents not reported, poor investigations

(3) Second Francis Enquiry (2013)
- Culture: defensiveness and secrecy, complacency towards poor standards
- Institutional: RCN not supportive of members raising concerns, Department of Health too remove

(4) Reforms
- 290 reforms
- PATIENT SAFETY = no 1 priority in medical and nursing training
- DUTY TO SPEAK UP on individuals and organisations
- COMPASSION AND EMPATHY emphasised in nursing recruitment and training

Question 4

NHS Values

Answer 4

1. Comprehensive service, available to all
2. Based on clinical need, not ability to pay
3. Provide the best possible value for taxpayers’ money
4. Accountable to public, communities and patients that it serves
5. Aspires to the highest standards of excellence and professionalism

Question 5

GMC Good Medical Practice

Answer 5

1. Knowledge, skills, performance
2. Safety and quality
3. Communication, partnership and teamwork
4. Maintaining trust

Question 6

Principles of good clinical governance

Answer 6

1. Practice compliant with latest evidence
2. Provide safe care to patients
3. Recognize limitations
4. Develop skills, train and educate others
5. Attentive to patient needs and take into account feedback