Surgeons in difficulty
25th November 2016
Leeds
John MacFie
Ignorance or ineptitude
A common mistake people
make when trying to design
something completely
foolproof…………..
is to underestimate the ingenuity
of complete fools
Referrals to GMC:
Who gets complained about?
Who gets complained about?
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Male doctors get more complaints.
Age also affects risk.
National Health Service Litigation Authority
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Governmemt body: deals with a complaints
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About 38% of claims are abandoned by the claimant, and about 43%
are settled out of court.
•
In 2004-5 £502.9 million was paid out in respect of clinical negligence
claims, and £25.1 million in respect of non-clinical negligence.
•
By 2015/6 payments (which include defence and claimants' legal costs)
had risen to more than £1.4 billion
•
47.59% related to maternity, 21.45% to surgery, 15.65% to medicine,
7.83% to A&E and 7.48% to all other specialities.
2004-5 : 5,609 claims of clinical negligence and 3,766 of non-clinical
negligence.
Surgeons in difficulty
so, we live in a litiginous society……..
so, what happens………
Maintaining Higher Professional Standards in Modern NHS
(MHPS)
•
Maintaining High Professional Standards in the Modern NHS (MHPS)
describes the procedures which Trusts in England have to follow for
handling concerns about conduct, performance and health
•
Detailed process is described with clear separation of roles and
responsibilities
•
•
•
Gives a process
Understood by both sides
Other countries follow different frameworks
MHPS
•
Part I:
Action when a concern arises.
•
Part II:
Restriction of practice and exclusion.
•
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Part III:
Conduct hearings and disciplinary matters.
Part IV:
Procedures for dealing with issues of capability.
•
Part V:
Handling concerns about a doctor’s health.
What are the issues?
Conduct and capability are in all areas
The performance triangle
Work
Context
Clinical
Knowledge
& Skills
Health
Behaviour
Three main concern areas
Behaviour / misconduct – 58%
Clinical concerns
including governance/
safety 58%
30%
19%
29%
4%
5%
7%
5%
Health concerns 21%
Base - 5634 cases referred to NCAS Dec 2007 – Sept 2013
Mismatch between performance triangle and “concerns”
Why are so many surgeons in difficulty ??
Morale, manpower and the NHS
Morale, manpower and the NHS
Is this dispute about money ?
Is it about 7 day working ?
Is it standardisation state
employees ?
Is it about the NHS ?
Morale, manpower and the NHS
Morale, manpower and the NHS
Why is morale so low..........
• accountability : breakdown of the implicit contract
•
the implicit contract
Morale, manpower and the NHS
•
the “concordat” created between the state and the medical profession at
the inception of the NHS in 1948 has become unstable
•
•
the clinical and political autonomy of doctors is now challenged
the twin bases of medical power (doctors having unique access to
medical knowledge and the public regarding them as the primary
authority on medical care) has come under threat.
Why is morale so low..........
Does stress lead to personality change.....
Tourette’s
Dr Jeyll and Mr Hyde
How behavioural strengths can become weaknesses
STRENGTH
DYSFUNCTIONAL BEHAVIOUR
Enthusiastic
Volatile
Shrewd
Mistrustful
Careful
Moving away
from others
Cautious
Independent
Detached
Focused
Passive-Aggressive
Confident
Arrogant
Charming
Vivacious
Moving against
others
Imaginative
Diligent
Dutiful
Manipulative
Dramatic
Eccentric
Moving towards
others
Source: Hogan and Hogan (1997, 2001); King (2008)
Perfectionist
Dependent
Why is morale so low..........
• accountability: breakdown of the implicit contract
• loss clinical independence
•
The evolution of the NHS manager
1946: hospital secretary
1968: the diplomat
1983: general manager
1992
CEO
Why is morale so low..........
• accountability: breakdown of the implicit contract
• loss clinical independence
• job satisfaction
Consultants are not what they used to be ......
in my day (as a trainee):
• trainees did almost all operations
• consultants popped in when there was
something interesting happening
• consultants were happy to start the last
case and leave the trainee to finish off
now, (as a consultant):
• consultants are present for most major operative
procedures
• trainees pop in when there is something
interesting happening
• trainees are happy to start the last case
and leave the consultant to finish off
Why is morale so low..........
• accountability: breakdown of the implicit contract
• loss clinical independence
• job satisfaction
• pay
But consultants are well paid........
• £75,000 – £120,000 pa fulltime basic
• gold plated generous pension
• £3000 - £86,000 for ACCEA
• £143, 717 average income London consultant
(includes London weighting and on call supplement)
( for 30 hours clinical work / week)
• more than an Old Bailey judge
• more than a British Army General
• more than Prime Minister
Morale and the NHS - consider
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Specialists very poorly paid in UK
UK losing much home grown talent
28% appointments last year qualified overseas
Juniors pay also low compared to US and Europe particularly when cost of
living considered
Morale, manpower and the NHS
How not to become a doctor in
difficulty…………..
5 tips…..
1
Do nothing
!!!
Do nothing !!!
Consider:
• unnecessary surgery e.g. cholecystectomies / hernias
• inappropriate surgery e.g. Tongue tie
• waiting list initiatives (avarice)
• “vomit”...........The incidentaloma
• “ I can so I will “
2
Check equipment before
proceeding
No 4
Go see the patient
Tip 5
Communicate !
Number 5
Communicate !
• encourage mentoring
• don’t hesitate to seek assistance
• talk, chat, discuss, compliment, comment
• double check (airline pilots)
• be human
If you don’t communicate you
are not part of the team