Locum GPs are in a challenging yet rewarding position, in that they frequently review patients that have been seen by other GPs. However, many locum GPs may be concerned, if they were to come across a clinical error, what would be the most appropriate way to provide feedback to those GPs?
Dr Rachel Birch, Medicolegal Consultant at Medical Protection, addresses this issue in more detail, presenting two different case scenarios where locum GPs felt it was important to provide feedback to practices.
Locum GPs are often best placed to pick up on potential clinical errors in general practice. There are many reasons for this, and they could be regarded as a valuable safety net in patient care. They may be reviewing patients whose investigation or treatment has been started by another GP. As such, they may be a “fresh pair of eyes” and may pick up on a subtle difference that the treating GP may have overlooked. Not knowing the patient can sometimes be helpful, as locum GPs may have to go back to the beginning to reassess the patient.
Locum GPs have lots to offer practices in terms of learning; working in different practices with different patient populations and ways of working can bring experience that it can often be helpful to share.
The General Medical Council expects all doctors to “encourage a culture that allows all staff to raise concerns openly and safely” and “contribute to and comply with systems to protect patients”, including reflecting on care provided, taking part in audits of your work, and contributing to adverse event recognition. It is important, therefore, that locum GPs feedback to practices where they feel there could have been improvements in patient care.
Case study - Grumpy GP
Dr A is a regular locum at a practice and consulted with Mrs T, not having previously met her. Mrs T is 58 years old and attended her regular GP, Dr G, four weeks ago with two episodes of vaginal bleeding in the last month. She told Dr A that she had declined a pelvic examination, as Dr G is male, and that he had referred her for a pelvic ultrasound. The patient was happy for Dr A to undertake a pelvic examination. Following a discussion about the possible causes for her symptoms, she was referred to gynaecology as a 2 week wait referral. Dr A felt it was important to discuss the patient with Dr G, as she felt that he should have referred the patient as a 2 week wait referral four weeks previously. However, Dr G is known to be grumpy and often loses his temper with colleagues and she was concerned as to the best way to raise the issue with Dr G.
This situation is not uncommon and it is important to recognise that, in a clinical environment such as medicine, not all professional colleagues will share the same views or personality traits.
Dr A is right to want to provide feedback to Dr G and this usually best done directly, person to person, without involving a third party. Therefore in this situation, face to face or over the telephone might be most appropriate, although sending an email through the secure NHS email system would be an alternative, if, for example, Dr A were about to go on a holiday or be absent for a period of time.
It is helpful to put yourself in the other person’s shoes - how would you want to be informed if you were Dr G?
Dr A should approach Dr G sensitively and with respect and should avoid using words such as “mistake” or “error”. Instead she should try to focus the conversation on learning and reflection, where possible. She may not know whether Dr G will accept the feedback in good humour, but nevertheless, it is important to try and to offer any support that Dr G requests.
Case study - Prescription errors
Dr P was working in a three-partner practice for the first time. He consulted with Mr D, who had been seeing Dr S for the last few months about his blood pressure. Mr D told him that there had been two recent prescription errors - one for the wrong dose and the other for a medication with a similar name to his blood pressure tablet. Mr D didn’t want to make a fuss, but he told Dr P that he was worried about Dr S, who he had known for twenty years. He felt she was not herself recently, appearing distracted and forgetful.
Later that afternoon Dr P decided that she couldn’t ignore the patient’s comments and should tell someone about them.
In this situation, Dr P is right to want to tell someone about the patient’s comments about Dr S. Mr D has known her for many years and has expressed concern, potentially about her health.
“If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or us. If you are still concerned you must report this, in line with our guidance and your workplace policy, and make a record of the steps you have taken.”
Dr P doesn’t know Dr S and doesn’t know how she may react to the concerns that the patient has raised. Dr S has a potential health issue and the risks of telling Dr S include that she may seek to reassure Dr P, she may lack insight into her health and may deny or ignore the patient’s concerns. In addition it could have a detrimental effect on her health, once which Dr P may not be able to quantify.
Therefore it would be more appropriate for Dr P to raise the concern with one of the other GP partners or with the practice manager.
If locum GPs come across concerns about a GP colleague’s clinical care, decision making or health, it is important to consider how best to raise these concerns and the most appropriate person to approach, keeping in mind that the most important principle is that these concerns are shared, in the interests of patient safety.
Rachel Birch firstname.lastname@example.org
Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.