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HealthChat - CNO Jane Cummings in conversation with Roy Lilley - 10th November 5.30pm King's Fund London Book Here.  Come and chat, network and enjoy a glass of wine. Some tickets left at 39.95

Good, bad and ugly    
News and Comment from Roy Lilley
At the back of the town square the small boy stood, jaw-dropped, in amazement. A crowd gathered. Dragged into a circle of sawdust a man; bound, tearful and exhausted. He was tied to a lamppost.


The crowd hurled abuse and gasped as a sinister figure in a hood and leather apron, stepped forward. The man was flogged. The crowd cheered.


'What's happening...' said the boy.


Came the hushed reply; 'He is a GP who made a mistake... he is being thrashed by the GMC's chief flogger, Naill Dickson.'


The boy gulped and made a mental note not to become a doctor.


Last Friday the BBC reported; "Doctors who make mistakes in the care of their patients could face tougher sanctions, under plans being considered by the General Medical Council".


Naill Dickson, once a fine journalist, now a bureaucrat, (the irony not lost) said; "...in the small number of serious cases where doctors fail to listen to concerns they should be held to account for their actions...." he believed "...doctors and patients wanted to see 'stronger action' in serious cases..."


Keeping accused doctors dangling for months whilst complaints are investigated by the glacial GMC is not torture enough? Some accused doctors have committed suicide during the interregnum. Putting them through hearings and legal processes and stripping them of their right to practice as a doctor is often appropriate but is it tough enough? Humiliation not enough? Disgrace, dishonour, shame... no there has to be more.


What else is there? Prison?  Cut off a surgeon's right hand? A spell in the stocks? Sweeping streets, on hands and knees, with a tooth-brush?


Dickson wants more apologies; at a time when institutional apologists trot them out, two a penny... as genuine as a fairground tiara.


The GMC say (I think) they get about 10,000 complaints in a year. By the time they've sieved a couple of hundred make it to a hearing and a handful of Docs are struck off.


One mistake is a mistake too many so how do we stop mistakes.


First we have to find out just how many mistakes are actually made. No one knows. For instance; what goes on in the GP surgery is about as transparent as the Pope at confession... and rightly so. We have to trust GPs otherwise there is no point to family practice.


Report a colleague's bad practice or be strapped into the ducking stool - that ought to do it?


Question: Do we want to create an environment where a Doc, who makes a mistake, can ring a mentor, buddy, supporter or organisation and say; 'I'm sorry, I've made an error, can I talk it through with you and see what we can do to sort it, please.... '


Or:  Do we want to create an environment where a Doc who makes a mistake thinks; I'll keep quiet, cross my fingers and hope it goes away. Anything to avoid Dickson's Hang&Flog improvement techniques. Forget retraining, continual professional development and inheriting experience.


Once again I shout at the computer screen; inspection doesn't work! Turn-up and it's OK, you've wasted the visit. Turn up and it's wrong... you're too late.


It's the same for regulation; base it on terror and tears and terrified people will hide their mistakes and shed their tears in private. Dickson & Co have been 'regulating' since 1858 ... give up boys, it ain't working.


There is more to this than meets the eye.


The GMC is a voice struggling to be heard.  Despite excellent publications like this (must read), they are a depository for errors, mistakes, blunders, boob-boos and things that go bump in the night.  I'm hearing the GMC, disappointed that enhancements to their powers were left out of the last Queen's Speech, fears it is losing influence; seen as ineffective, processes too slow and mired in lawyers. Time to call time? The CQC with its flat-earth inspection regime is glossy, new, quicker, more transparent and unlike the GMC, the marionette of ministers. The CQC will unseat the GMC as Whitehall's go-to organisation.


The GMC knows it's fighting a losing battle. Their best response; more regulation and tougher regulation - it will fail. Just as more inspection and tougher inspection will fail.


Time for the GMC -unplugged; back to its statutory duty as the keeper of the register; working on a computer, in rooms over a chip-shop, in Milton Keynes.  


The rest of the job done by the CCGs and Trusts who know much better where the good, the bad and the ugly doctors really are.

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CNO England 
Jane Cummings
in conversation with
Roy Lilley
10th November
King's Fund
Staff nurse South Lanarkshire 
Registered MH Nurse Immigration removal centre South Lanarkshire
(Two posts) 
Advisers and assistant programme supoert manager London 
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This is what I'm hearing;
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>> Inspector Field has let the cat out of the bag.  In an interview with the HSJ (This week, page 11, but not yet on line) he admits the CQC 'are not an improvement body'.  I wonder how that squares with the Perfumed Jennifer Dixon, NED at the CQC who is on record saying she thinks it should be.I wonder if she will step down?
>>  I'm hearing - NHS111 is struggling to hit 'answer in 60 seconds' target and in some parts of the country they are swamped with calls.
>>  I'm hearing - since 2007 food prices have gone up 12% and wages gone down by 7.6%.
>>  I'm hearing LaLite's plan to appoint associate doctors with 2 years training and half the pay of Doctors isn't going down too well at the BMA.  More here.
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