Written evidence from Lifeblood: The Thrombosis
Charity (REV 28)
SUMMARY
- Lifeblood recognises and fully supports the General
Medical Council's (GMC) prioritisation of revalidation.
- Doctors should be able to demonstrate at revalidation
adherence to best practice standards of safe and effective care
and that their patients are receiving a positive patient experience.
- Lifeblood recommends that any core revalidation
criteria match national priorities for the NHS as well as knowledge
on conditions which are recognised as having a significant health
and economic impact on the NHS.
- VTE Prevention, as a national priority has the
capacity to save thousands of lives and hundreds of millions of
pounds of NHS spending each year, but has low awareness among
health professionals.
- As such, knowledge of and adherence to nationally
accepted minimum standards of VTE prevention should form a core
criteria of professional revalidation.
- Lifeblood supports the recommendation of the
Academy of Medical Royal Colleges in calling for this inclusion.
SUBMISSION
1. Lifeblood: The Thrombosis Charity (Lifeblood)
is delighted to submit evidence for the Health Select Committee's
Inquiry into the revalidation of doctors.
2. Lifeblood will respond to the most relevant
issues. This submission will focus on the Statement of Intent
published in October 2010, as agreed by the General Medical Council,
the Chief Medical Officers for England, Northern Ireland and Wales,
the Deputy Chief Medical Officer for Scotland and the Medical
Director of the NHS in England. This submission will also draw
on the GMC response to the revalidation consultation, also published
in October 2010.
3. Lifeblood recognises and fully supports the
GMC's prioritisation of revalidation. We fully agree that the
revalidation system must support high quality and safe care in
the organisations and practice settings where care is delivered.
4. In confirming the timetables and milestones
for NHS employers and other healthcare providers to have the local
systems in place to support the revalidation of their doctors,
Lifeblood recognises that there is core information that will
be required by doctors who will be leading the appraisal. Lifeblood
recommends that there are clear criteria to determining this core
information.
5. Lifeblood recommends that any core criteria
match national priorities for the NHS as well as knowledge on
conditions which are recognised as having a significant health
and economic impact on the NHS. An effective appraisal process
must include awareness and up-to-date understanding of the medical
protocols around such health and prevention priorities.
6. In developing a streamlined process which
reflects these national priorities, Lifeblood supports the role
of the Academy of Medical Royal Colleges' Faculties and Members
to review their speciality and general practice frameworks. Any
separation of information which is "expected" and which
is "optional" must mirror national healthcare priorities
if it is to be significant, relevant and useful.
7. It is essential that in developing what "expected"
standards look like, the Faculties draw on the expertise of organisations
dedicated to the relevant area.
8. The prevention of venous thromboembolism (VTE)
- manifested as deep vein thrombosis (DVT) or pulmonary embolism
(PE) - is a condition which the Health Select Committee in 2005
recognised as the greatest avoidable cause of hospital mortality.
Although PE are known to be under-diagnosed and often missed,
in 2008-09 alone, there were 62,066 recorded cases of DVT and
56,029 recorded PEs (Hansard, 1 November 2010: Column 658W)
and in 2008 over 19,000 recorded deaths in England due to PE.
9. It is recognised by leading clinicians, the
Department of Health, and the Academy of Medical Royal Colleges,
that significant progress can be made in reducing avoidable deaths
and long term morbidity from VTE, through simple and effective
risk assessment and prophylaxis in hospital, as two thirds of
all cases of VTE occur following hospital admission ("hospital
acquired VTE"). The rate of death due to hospital acquired
VTE result in it being the number one patient safety issue in
hospital care. It is therefore essential that the principles underlying
the revalidation of doctors recognise the importance of bestowing
professional responsibility on clinicians to ensure their clinical
knowledge is intrinsically linked to delivering patient safety,
by demonstrating the understanding of these core components to
a competent authority.
10. VTE has historically been classified by the
Chief Medical Officer as a Cinderella issue, due in part to low
levels of professional awareness about the causes and preventative
steps that should be taken to prevent avoidable incidence of VTE
in hospital patients.
11. Lifeblood supports the Academy of Medical
Royal Colleges' five point plan to cutting the numbers of deaths
from VTE, specifically the commitment by Colleges and Faculties
to ensure Fellows and Members participate in regular audit of
the percentage of patients risk-assessed for VTE, which in some
specialties, "is suitable for becoming a mandatory standard
for revalidation".
12. VTE prevention needs to become an embedded
standard of care in the NHS, so that the scale of this preventable
condition can be tackled, and clinicians can be adequately protected
from the risks of medico legal challenge, which are now prevalent
in confirmed diagnoses of hospital acquired VTE, due to the requirement
for root cause analysis, to identify where national guidance was
not followed.
13. Education has a part to play by ensuring
the next generation of doctors are properly educated at the undergraduate
level, by ensuring a consistent level of inclusion in medical
school curricula. However, part of the solution for protecting
the patients of today rest with qualified doctors.
14. VTE prevention knowledge is therefore central
to enabling doctors to undertake their daily duties in a safe
and effective manner. Therefore, adherence to nationally agreed
prevention protocols should be demonstrated during professional
revalidation.
November 2010
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