Examination of Witnesses (Questions 120-127)
NATIONAL HEALTH
SERVICE AND
DEPARTMENT OF
HEALTH
5 FEBRUARY 2007
Q120 Mr Mitchell: Oh well, they are
always whinging about that. Everybody is.
Professor Marshall: General practices
are held much more to account now than they were five or 10 years
ago.
Q121 Mr Mitchell: But not enough.
Professor Marshall: It is a process—a
journey. It is a question of getting the right balance between
holding people to account and line-managing them, and getting
the best out of them. That is difficult balance.
Q122 Mr Mitchell: Why can they not
be encouraged to snitch more on each other? In my experience,
they never do. Patients go from one doctor to another feeling
that they have been badly treated, but the second never complains
about the behaviour of the first; nothing is said about it. Only
expert evidence would make the patient effective. I notice that
paragraph 2.16 reports that 94%. of GP respondents had "a
patient safety incident reporting system in place ... two thirds
of GPs and nurses ... had reported an incident and one third of
GPs had reported an incident to their PCT." I bet those are
mainly incidents of patients being aggressive towards them rather
than of them failing their patients. Can you tell us whether they
are?
Professor Marshall: I do not have
specific data on the nature of the incidents.
Q123 Mr Mitchell: It is a self-protection
mechanism, in other words.
Professor Marshall: I agree that
in the past doctors have not been very good at what you call snitching
on each other, but that is changing. Clinical governance is part
of that process; it is about taking responsibility for your colleague's
practice, as well as your own.
Q124 Mr Mitchell: But I notice that
the Professional Executive Committees are much less satisfied
than anybody else with the progress that has been made, and paragraph
2.9 says that committee members give it lower scores than anybody
else. There is a fashion for denigrating these professional executive
bodies. "Making a Difference", from the NHS Alliance,
disparaged them, and the Department clearly thinks that they are
less effective than they should be. However, they could be right,
could they not? They are the people at the patient face. They
know what is going on and whether the controls are effective.
The Report says that "GPs (making up 29% of PEC respondents)
consistently gave lower scores". PECs could be Reporting
accurately, whereas the PCTs could be puffing up their own performance.
Duncan Selbie: The NHS Alliance
says that we need PECs, and that that is why they are being reviewed,
strengthened and made fit for purpose. We will have something
to share with you in the next few weeks. The consultation ends
on Wednesday.
We should remember that the National Audit Office
Report is about looking back, and there is nothing the matter
with that, because it is about capturing the lessons. However,
the new organisations are stronger and more able. I spoke to two
PCT Chief Executives last week about underperforming doctors.
One case was very clear; it was a problem about sexual behaviour,
and the doctor was suspended. The other was about attitude and
communication difficulties, and the doctor was suspended. These
people—PCT Chief Executives and boards—are not in
doubt. Every board has a sub-committee looking at this issue all
the time, and it is simply not the case—
Q125 Mr Mitchell: Is the assessment
from the PECs at the patient face more accurate than the self-assessment
of the PCTs?
Duncan Selbie: I prefer what front-line
people have to say.
Mr Mitchell: I will stop you there.
Duncan Selbie: May I continue?
Mr Mitchell: Time is pressing, but yes.
Duncan Selbie: Mr Khan said that
people do not always recognise that they are doing what we ask,
because of the language that we use, and a number of people have
remarked on that. When we say clinical governance, they say, "What
is that?" However, when we say, "Listening to patients,
responding to complaints and looking at incidents and learning
from them," they say, "Oh yes, we do that."
Q126 Mr Mitchell: Okay. That leads
to my next question, which is whether we can develop an adequate
machinery of control and checking to assess performance as well
as to assess whether they are listening to patients and are doing
the job properly, unless we involve patients more in the structures.
Frankly, we seem to have been pathetic in that direction. The
PCTs do not seem to involve them effectively. Although the Government
are talking about democratisation and making the NHS accountable,
it is not really accountable by any means. Can we do the job without
involving patients more?
David Nicholson: No, we cannot.
PCTs are increasingly realising that that is the case. It is not
just at PCT level; it is at the practice level. About 30% of our
practices currently have patient participation groups within them.
We are working with the National Association for Patient Participation
to make that 100% over the next few years. At the practice level,
we will have the input, knowledge and understanding to make such
things happen. You are absolutely right. There is no doubt that
we will never be able to assure ourselves that things are okay
unless the patients say that they are and are engaged in such
matters.
Q127 Mr Mitchell: I am glad to hear
that. Given that we are paying GPs so much more, now is a good
time to discipline them more. In conclusion, I am not suggesting
a structure of "turn in your GP for fun and profit",
but the channels now available for patient complaints about ill
treatment by GPs are totally inadequate.
David Nicholson: I hope that you
will be reassured by what the Government announce in the next
week or so.
Chairman: That concludes our hearing.
It has been a difficult hearing for us. I am sure that the processes
are in place but, as Mr Mitchell has made clear, it is not entirely
apparent how responsive GPs are. Equally, one wants to avoid the
effects of heavy-handed regulation. We have to trust professionals
to a certain extent. It is therefore a difficult area, but thank
you very much for assisting us.
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