Doctors have to make difficult clinical judgements about their patients on a daily basis and are trained to do so. This decision making develops with experience and the profession balances risk versus benefit on a case by case basis. Decision making, however, has changed rapidly over the last year with the added pressures brought on by the increasing demand on NHS services and the scarcity of resources. Decisions are now being made about whether operations are cancelled because there are no beds, or whether a trainee should be asked to stay when there is a rota gap, or how to deal with exception reporting.
Guidance from the General Medical Council (GMC), the Department of Health, and Health Education England has been confusing for both juniors and seniors over the last year. The medical profession’s ethics and morals have been challenged and a level of distrust has been established. The profession has breathed a huge collective sigh of relief with the publication of a recent letter by Terence Stephenson, chair of the GMC. The GMC has asked doctors to raise concerns about patient safety arising from the current pressures on the NHS. Therefore the GMC must recognise that patient safety may be compromised by the current situation. The GMC has stated it will “engage with employers” who failed to meet standards for doctor training and support. That suggests that there maybe employers who could fail to listen and respond to concerns.
The GMC will be investigating the impact of rota gaps this year suggesting that they believe there are rota gaps and there may be a negative impact. They also report “Health services across the UK are working harder than ever to deal with the fierce pressures of winter and emergency departments and primary care services are struggling to cope with demand.” In addition, the additional challenges of revalidation and the pressures of investigation are recognised with a desire to change.
At last there appears to be a body representing the profession who believes the situations which are witnessed by doctors every day and which cause great anxiety. The request from the GMC to report concerns will be read with great relief by many clinicians.
Stella Vig has been the foundation programme director at Croydon University Hospital for 10 years and holds many roles, including those of core surgery and higher surgery training programme director, JCST chair for core surgery, and general surgery SAC member. She is one of three clinical directors for Croydon and is keen to see efficiency and excellence in patient care within the NHS.
Competing Interests: I am a member of RCS England Council and a trustee for the Society of Chiropody and Podiatry.