Medical Professionalism – whose job is it anyway?

Introducing our panel

Professor Mike Pringle – President, Royal College of General Practitioners

Nigel Acheson – Regional Medical Director (South), NHS England

Professor Wendy Reid – Medical Director at Health Education England

Maureen Edmondson – Chair of the Patient and Client Council for Northern Ireland

Niall Dickson – Chief Executive and Registrar, General Medical Council

Setting the scene: who’s in the room?

1. Student

2. Educator

3. Doctor

4. Patient

5. Employer

6. Professional body

7. Other

Place in order of importance these levers to improve/enable professionalism?

Education and training

More regulation / legal powers

Organisational culture and leadership

Greater patient involvement in care and care

design

More resources

Theme 1 – Accountability or Improvement?

Francis

• Fundamental standards

• Legal duty of candour• Criminal sanctions• Regulation• Healthcare

leadership• Authoritative

information

Berwick

• Ethic of learning• Patients and carers

involved at all levels• Quality and patient

safety sciences• Regulation to be

sensitive• Recourse to sanctions

rare

Time to vote: Accountability or Improvement?

1. Francis……..accountability

2. Berwick ……improvement

Theme 2 – Raising Concerns

‘(We)…..should not seem over-anxious to be at work since the spreading abroad of the shortcomings of any erring members of our honourable profession is a proceeding to be carefully restrained within precise limit.’

‘The system for the investigation … has not proved capable of reconciling the diverse objectives that have to be achieved. X not unreasonably felt that he had to take his complaint outside ‘the system’’.

‘A combination of inadequate systems and poor culture meant that staff were not encouraged to … speak openly. Those who tried to raise concerns found it hard to have their voices heard.’

‘Staff witnesses described an atmosphere of fear … and a forceful style of management (perceived by some as bullying). There was also evidence of a worrying acceptance of poor care, of poor behaviour among colleagues being condoned.’

Raising Concerns – a familiar challenge

Report of the Committee of Inquiry into Ely Hospital 1969

Bristol Royal Infirmary Enquiry 2001

Mid Staffordshire NHS Foundation Trust Inquiry 2010

John Marshall, GMC President, 1887-1891

Raising Concerns – a problem on the wane?

Complaints from all sources to GMC are up - 8,109 in 2012 up 24% since 2011 and 104% since 2007

Complaints from doctors to the GMC have risen by 113% over the last five years

GMC Confidential Helpline - 881 calls from Doctors (66 investigations) in the last 12 months

GMC NTS results: ~16% of doctors in training raised a concern in the last year

Evidence in practice: Julie Bailey Helene Donnelly Colchester ‘whistle-blower’ on Cancer Care Pathway

Place these barriers to raising concerns in order of significance

Systems/routes to complain are not clear

Fear of recrimination from employers,

colleagues or doctor about whom

complaint is made

Feeling nothing will change

Theme 3 – The Good Doctor

Place these characteristics of a doctor in order of importance to you

Knowledge/expertise

Compassion/empathy

Listens and responds in partnership

Communicates well

Confidence they are up to date

Integrity

What patients and the public told us(GMP Consultation 2011)

What doctors told us(Sample of 90 doctors – 2013)

Closing question

Will, in the long run, the last year have been

good or bad for the future of medical

professionalism?

1. Good – from crisis….renewal

2. Bad – its all downhill from here

3. Neither - it won’t make a blind bit of difference

Lunch and exhibitionUpper foyer and Exchange hall