Category Archives: Consultants

Consultants are at the highest point of their profession – or are they? What ambitions do they have and are they able to do research easily?
How does sub-specialisation fit in with keeping ones skills as a generic doctor? If those generic skills are lost, does it matter?
Should all consultants be in teams run by tertiary centres and with opportunities to go to the centre for updating?
Are the consultants in your local hospital happy they are there? Would they have preferred to be elsewhere? And how do they see management and professional standards changing?

Selecting doctors, and portfolio careers crossing from primary care to Hospital.

In the past NHSreality has opined on the missed opportunity in palliative care. At one point we had 6 qualified diplomas of palliative care, and could have really focussed the oncology and palliative care departments to be more realistic, and to work as teams. There are many other areas of hospital care which GPs could help in. Geriatrics and Rheumatology, Dermatology and even minor surgery and endoscopy.

The rationing of places at medical school has been a disaster. Combined with the advantage women seem to have at 18, being more mature, the workforce is declining rather than rising. Medicine is keen on evidence based research, but one wonders if there is any evidence that 3As does better over 40 years than 3Cs.

A letter in the Telegraph opines on recruiting doctors:

Sir, the difficulties of GP recruitment are complex (Letters May 16th).

I have long held the view that it tarts with the selection process for medical school entry. The requirement of 3 Cs at A level in the sixties and early seventies resulted in a much more diverse student population (although it was predominantly male).

Selection based purely on high academic achievement will perhaps attract undergraduates with different aspirations. Working hours are highly regulated and limited within the “acute sector”. Combine this with the diversity of career options within hospital medicine and you have the perfect storm.

A. portfolio career integrating elements of GP and Hospital work may go some way to address this.

Belfast Telegraph 5th May: Doctors have job offers withdrawn after recruitment error

Western Telegraph 17th May: GP resignation sees Tenby surgery back under control of health board

The Telegraph 22nd May 2018: Most hospitals and GP practices have shortage of doctors, survey …

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Swansea should combine with Hywel Dda, This option is not in the Trusts gift, but is political. And the opportunity afforded by restructuring may be lost if choice and specialist access is not improved…

It is hard to recruit to West Wales. The “little England beyond Wales” is culturally very different from Welsh speaking Carmarthenshire. I used to think Whitland would be near enough, but no longer.

Doctors choose centres of excellence in cities rather than rural areas to work in.

There is an under capacity in diagnostic physicians, and this will remain the case for 10 years.

Reconfiguring West Wales services gives an opportunity to raise standards, reduce infections, accelerate discharge and improve choice.

The medical model is changing, and teams of specialists raise standards fastest.

There has not been the investment in infrastructure that there should have been to speed transport.

Choice for patients needs to be encouraged by the system. A larger Trust ( preferably all of Wales – why not?) will give greater choice.

If a rural area such as Pembrokeshire wishes to recruit consultants and GPs easily, it needs to recognise the drivers for change in the medical profession. New doctors want to have access to new technologies, tests, and treatments. The medical model now involves large teams of specialists raising their standards together. Access to such centres is meant to be “equal” but in effect, especially in Wales, it is dependent on post code. Choice has been restricted to “within your own trust”, and outside referral restricted unless there is no service within your trust. Consultants and their juniors like to have access to specialist investigations, a complete set of treatment options, and research and teaching opportunities.

So why did I move to Pembrokeshire. I enjoy an independent mind-set, and the challenge of working in remote areas. But I saw the possibilities were better where there was a DGH (District General Hospital), a postgraduate centre and teaching opportunities. All these will go if my local hospital closes, or moves outside of the “little England beyond Wales”. I feel cultural affiliation, and when I seek medical care the first language should be one I understand. (English). Consultants arriving in the area were offered subsidised accommodation in a hospital house whilst they looked for a home. New physicians arriving felt they were cared for …

Within GP, the clinical variety and opportunities have reduced, and there is much less room for manoeuvre in todays group practice experience. The shape of the job has changed, and the people in it have changed too. Now it is 80% female reflecting the underperformance of males at age 18 when applying for medical school. It may change even more, because with too few diagnosticians, digital consulting, without an examination may expand, with resultant litigation risk. ( Murray Ellender GPs must embrace digital future – The Times 23rd April 2018 )

The threat to move our hospital outside of our county, and into another tribal area, will not be taken lying down. So we need a solution that allows consultants all the things they want, and our, mainly female, GPs to get what they want. With a 10 year deficit and shortage of diagnostic doctor skills, we have to centralise in some way or other. ( Patients want all services as close as possible, and many would choose local access instead of lower death rates. They will also demand it is all free, for everyone, everywhere, for ever. )

If we take out the hospital we take away part of the culture. House prices will fall further as professionals leave, and choose to live near tertiary care centres. The already dilapidated and sometimes empty heart of the county town will get even more squalid and forgotten. Yes, we can replace one culture with another, more cynical one. People are already disillusioned in the shires, where the vote went against staying in the EU, even though the people there had more to lose. Taking away their hospital without persuading them that it is for the greater good could lead to civil unrest…. and they will also have a Welsh language school they never asked for.

In the end we have to make the new solution attractive to medical applicants, and that means combining Hywel Dda with Swansea so that hospital jobs are rotated, the educational and research opportunities are there for all, and the important services; stents, stroke and radiotherapy are all provided on site. Without Swansea the new hospital needs more money to have the facilities needed to help recruitment and even then it may not be enough.

Dirty surgery such as gut emergencies should be treated in on of the old DGH theatre suites, and the rest of old DGHs become community care recovery centres. The funding must also be changed, so that all the country, patient and professionals, realises that financially, it is founded on a rock rather than sand. This will win hearts and minds.. but it is tough love.

My personal belief is in means related co-payments, scaled and managed centrally. I have some concern about how to deal with citizens who have cash flow poor, but are asset rich, but this can be debated once we agree to ration and use co-payments.

The three options are all reasonable, given the under capacity and recruitment problems described, and NHSreality goes for a new build in Pembrokeshire, along with new roads. If this were done, and/or the trust combined with Swansea, there would be a great improvement in services for West Wales patients. The finances are a different matter, and I expect continued denial all round.

IT – the solution and a problem… Every patient deserves an examination. GPs must not be robots..

Who wants to be a Hywel Dda board member? “Hywel Dda health board looks at hospital closure options”. The obvious solution is to promise a new build at Whitland, and a dualling of roads west.

Hywel Dda under pressure as doctor says ‘Glangwili will not cope’ once Withybush has been downgraded..

A poisoned chalice. Advertisment for Chairman of Hywel Dda…

Hywel Dda Health Board chief executive Trevor Purt to leave his post

Hywel Ddda on the way to the roasting oven of political dissent and civil unrest?

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A dire shortage of specialist cancer nurses in Oxford reflects a staffing crisis across the NHS that can only be rectified with better long-term planning

NHSreality warned you it was going to get worse, and sure enough it is. It may be that the current crisis is forcing the oncologists to make decisions that they have ducked to now. Patients can often be led into making the right decision, and rarely is it to have toxic therapies that prolong their lives for only a few weeks. The letter from Dr Burt needs to be read and re-read. People are the most valuable resource in the UKs four health services, and we have just not trained enough.

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The Times leader 10th Jan 2018: Care Critical – A dire shortage of specialist cancer nurses in Oxford reflects a staffing crisis across the NHS that can only be rectified with better long-term planning

If anywhere in Britain can offer first-rate cancer treatment, Oxford should be on the list. It has some of the world’s best teaching hospitals, a good record of health service management overall, and every inducement for doctors and nurses considering where to live and work. Yet these inducements seem to be failing. Largely for want of specialist nurses, cancer care in Oxford faces severe rationing that could shorten the life expectancy of terminally ill patients and hurt the chances of recovery for the newly diagnosed.

Emails seen by The Times, written by a senior Oxford oncologist, describe a 40 per cent nursing shortfall that he considers “unsustainable in the short, medium and long term”. They set out a plan to delay the start of chemotherapy for new patients and stretch out fewer cycles over longer periods for those already undergoing treatment.

It is not the drugs that are in short supply, but the staff to administer them. If this were an isolated case the blame could be laid squarely at the door of local NHS managers. In reality the problem is more complex and widespread. Because of falling morale, falling real wages, the scrapping of nurse training bursaries and the impact of Brexit, a general nursing shortage is threatening the quality of care across the NHS. Andrew Weaver, the Oxford oncologist, has issued an appeal for constructive suggestions to fix his staffing crisis. On the national level similar appeals have produced a ten-year NHS “workforce strategy” and an undertaking to train 10,000 more nurses a year, starting in September. This is the right approach, with one glaring shortcoming. It should have been adopted a decade ago.

It takes three years to train a nurse and at least two more for him or her to specialise in cancer care. The work involves delivering lifesaving but also potentially lethal drugs and cannot safely be delegated to non-specialists. Faced with staff shortages, NHS trusts have historically muddled through or sought emergency funding to hire from agencies, overseas or both.

Muddling through is not an option for patients in urgent need of chemotherapy. Emergency funding is in short supply, and hiring from agencies is rightly frowned upon as an inefficient use of public money. Hiring from overseas has been complicated by Brexit.

In the year after the EU referendum the number of nurses from the European Economic Area (EEA) registering to work in Britain fell by 32 per cent. Some of the decrease was accounted for by nurses failing new and necessary language tests, but the fall was still significant. It has been compounded by a sharp increase in the number of EEA nurses opting to leave in the same period.

In absolute terms an exodus of British nurses from the profession is even more troubling. In 2015, for the first time, more left the national register of the Nursing and Midwifery Council than joined it. Last year the net loss was nearly 5,000. The Royal College of Nursing has spoken of a “perfect storm” of factors leading to a record 40,000 nursing vacancies nationwide. Prominent among these is a vicious circle of increasing workloads deterring new recruits.

Macmillan Cancer Support recently listed the consequences of a “historic lack of long-term planning”. One is that a majority of doctors and nurses are no longer confident that the NHS gives cancer patients even adequate care. Where this care is prompt, personalised and comprehensive it can still be second to none. Where it is not, outcomes and survival rates lag behind those of other advanced countries. Having fought to stay on at the Department of Health, Jeremy Hunt will want to do better. A good first step would be a more ambitious expansion of nurse training and a reinstatement of bursaries for specialist training where it is most needed. Starting with cancer.

Top hospital cuts cancer care due to lack of staff

Patients dying in corridors and on makeshift wards, A&E chiefs warn – Chris Smyth 12th Jan

A seminal letter on this subject 9th Jan 2018:

Sir, Oncologists need to take a long hard look at what they are trying to achieve. Response rates in second and third-line chemotherapy are very poor and inevitably interfere with quality of life. There is an obsession with including patients in clinical trials, which are costly and are often used for career progression rather than cancer progression. The hardest thing for an oncologist to learn is not how to treat patients but when to treat them. Many need to learn that no treatment is often the best treatment. It takes guts to tell a cancer patient that no further active anti-cancer treatment is now right for them. The best oncologists do that.

Oncology can surely not moan about staff shortages when literally dozens of consultants and senior nurses sit down for hours on end to discuss routine cancer cases, the management usually being obvious. Multidisciplinary team-working (or medicine by committee) is the biggest waste of NHS resources bar none.
Dr Paul Burt

Retired clinical oncologist, Stockport

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Just like Brexit, health is a complex and long term problem. Decisions on both should be taken only by experts..

Brexiy buyers remorse may be increasing, as the message in health is clear. There is going to be less rather than more. The Guardian on 13th October published “Labour flags up Brexit poll suggesting public regrets decision”, and no wonder when rather than saving £350m we are losing more than twice than much, annually in the devaluation of the £ and the cost of imports.

Just like Brexit, health is a complex and long term problem. Decisions on both should be taken only by experts.. As the health services collapse, mainly due to lack of long term planning, and a political and media collusion of denial, some of the predictions in NHSreality are becoming true. The only thing that is National is the opportunity to buy better, faster private care…. We need more youngsters to man our service industry country, and if we don’t stay in the EU we may need to take the example of a town in Japan. (The Economist Jan 9th: A small town in Japan doubles its fertility rate).

The first part of the safety net is the GPs, and the second is the Hospitals and all their staff. 80% of health contacts are seen by GPs, but lives are saved mainly in the second net.. Rationing needs to happen at all levels and the letter from Dr Burt (below) should be read with care. NHSreality has asked for GPs to work alongside Oncologists and this alone would save millions.

Subsidising parenthood appears to work wonders

An unofficial two tier National system. (Where moneyed people go privately)

Covert and post code rationing.

A disengaged medical workforce.

A management wriggling on the inability hook: to make the books balance.

An English language which obfuscates the truth.

A collusion of denial between politicians and the media.

A system where even those fearful conditions, such as cancer, are not properly and fairly covered by the state safety net.  (Bring back fear instead of “In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear“)

Carolyn Wickware in Pulse reports 30th October 2017: GP leaders prepare for explosive vote on practices leaving the NHS

Sarah Marsh in the Guardian 11th Jan 2018: NHS winter crisis: hospital ‘felt like something out of a war zone’ – Husband of a patient and locum doctor share moving experiences of severe pressures on national health service

Kat Lay has reported on Cancer services, especially in Oxford, in the Times recently. Jan 11th: Hospice loses beds in NHS staff crisis and in the letters 12th Jan:

Cuts to cancer care owing to staff shortages

Sir, For the past three years we have been urging the government to tackle cancer workforce shortages in the NHS. It is totally unacceptable that these shortages could now lead to delays in patients getting treatment. This latest episode at the Churchill Hospital in Oxford (report, Jan 10), where chemotherapy may be delayed owing to a lack of specialist nursing staff, adds to a growing list, which includes cases where lung cancers were left undiagnosed because of a lack of radiologists. Immediate action needs to be taken by the government to deal with this, otherwise problems like the one at Oxford will become more widespread and more severe.

An additional 150,000 people are expected to have cancer diagnosed annually by 2035. We need more staff, with the right training and support, in the NHS to deal with the increasing number of cancer patients who need to be diagnosed and treated. We estimate that the projected 2022 consultant oncology workforce could be roughly half the size that it may need to be to deliver the best care, with a shortage of between 1,281 and 2,067 staff. Health Education England recently published its first-ever plan to deal with the staff shortages in cancer care, but this relies heavily on stretched local areas taking action and making difficult spending decisions, and will not change the situation overnight.

We have a national ambition to achieve world-class cancer outcomes for all patients. We will not get close to achieving this — and to offering patients the best chance of long-term survival — without tackling crippling workforce shortages.
Sir Harpal Kumar

CEO, Cancer Research UK

Sir, Oncologists need to take a long hard look at what they are trying to achieve. Response rates in second and third-line chemotherapy are very poor and inevitably interfere with quality of life. There is an obsession with including patients in clinical trials, which are costly and are often used for career progression rather than cancer progression. The hardest thing for an oncologist to learn is not how to treat patients but when to treat them. Many need to learn that no treatment is often the best treatment. It takes guts to tell a cancer patient that no further active anti-cancer treatment is now right for them. The best oncologists do that.

Oncology can surely not moan about staff shortages when literally dozens of consultants and senior nurses sit down for hours on end to discuss routine cancer cases, the management usually being obvious. Multidisciplinary team-working (or medicine by committee) is the biggest waste of NHS resources bar none.
Dr Paul Burt

Retired clinical oncologist, Stockport

Sir, Cancer care at the Churchill Hospital is likely to be compromised as a result of the shortage of trained oncology nurses. The reasons are multifactorial; one that is quoted by the management of the hospital is the high cost of housing in Oxford. Training more specialist nurses takes five years, whereas the introduction of an Oxford weighting to nurses’ salaries on a par with the existing London weighting could be introduced immediately. London is not the only city with housing costs well above the national average. No doubt new money would have to be found to do this but it would go some way to help nurse recruitment in high-cost areas.
Griffith Fellows

Retired urologist, Churchill Hospital, Oxford

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Bringing back fear, and suffering. A return to 19th century inequalities.. How quickly politicians destroyed what was the best safety net in the world?

 

 

 

 

Post code lottery on Prostate Cancer diagnosis and treatment. Fragmentation ensures private options flourish…..

Dead patients don’t vote, and uninformed families don’t complain. The result of early diagnosis and treatment is very good, but the result of a later diagnosis of cancer of the prostate, especially in younger men is poor. 25% of needle biopsies on cancer prostate patients are negative, so a more accurate diagnostic algorhythms is to be welcomed. Unfortunately, due to fragmentation and lack of choice, informed citizens may need to go privately. If you are unfortunate enough to be in a “worst” area you may have five times the risk of death from this disease. although hopefully some 9 years later things are better.   There are no approved screening tests for Ca Prostate, but serial PSA tests are reasonable.

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Obviously in Private Medical Care there is an incentive to screen (perverse?), and the Mayo Clinic gives good advice. Prostate cancer screening: Should you get a PSA test? The AUA (American Urological Association) recommends that beginning at age 55, men engage in shared decision-making with their doctors about whether to undergo PSA screening. The AUA doesn’t recommend routine PSA screening for men over age 70, or for any man with less than a 10- to 15-year life expectancy.

Recently some question has been raised on the use of hormonal therapies and a link with dementia, which emphasises the need for early curative treatment options.

In New Zealand the Health Navigator as a decision making aid: 

The pros and cons of screening for prostate cancer should be discussed with your doctor to help guide you in deciding if it is the right course of action. Routine screening for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Experts have been unable to agree that prostate cancer screening helps patients. Use this decision aid to help you and your decide whether or not you will have a prostate specific antigen (PSA) test.

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The Times on 1st January 2018 reported (not on line) “Prostate scan lottery”: (Previously Chris Smyth had reported that One in ten men is refused prostate cancer test – June 13th 2017)

“Seven out of 1o men are missing out on the latest technology that detects prostate cancer. Prostate Cancer UK says that the availability of enhanced MRI scanning is patchy, with only 30% of men having access to the tests. More than 150,000 men a year have needle biopsies triggered by a high PSA  blood test. A third have the disease diagnosed and 11,000 men die each year.

Prostate Cancer UK: mpMRI: The new test with the potential to save thousands of men’s lives

Adrian Monti for the Mailonline 27th June 2017: The scientist who helped create a new prostate cancer scan (that’s now saved his life, too)

Nursing in Practice 17th June 2009: Postcode Lottery on Prostate Cancer – Campaigners have revealed official figures which indicate that men in some parts of England are almost five times as likely to die from prostate cancer as those in other areas.

Olivia Lurche in the Express reports: Prostate cancer treatment: New hope for patients suffering symptoms of DEADLY disease – PATIENTS with suspected prostate cancer should have an initial MRI scan to improve detection of aggressive forms of the disease in a bid to save lives.

Experts said the the scans could reduce the number of men undergoing unnecessary biopsies for prostate cancer.

A report, published in British medical journal The Lancet, estimates an MRI could help 27 per cent of men avoid an unwarranted biopsy, during which a small sample of tissue is removed from the body for examination.

Adding an early MRI scan could also reduce the number of men who are diagnosed with a cancer that later proves harmless by 5 per cent, researchers found.

Angela Culhane, chief executive for Prostate Cancer UK, praised the findings as a ‘huge leap forward’ for the ‘notoriously imperfect’ diagnostic processes currently used.

“The results from the (trial) make it clear that giving men with raised PSA an mpMRI scan before a biopsy can help increase the number of aggressive cancers detected whilst reducing the number of unnecessary biopsies for men.”

“This is the biggest leap forward in prostate cancer diagnosis in decades with the potential to save many lives.”

They found a specific form of scanning MRI scan can provide detailed information about the cancer, such as how well-connected to the bloodstream it is. Experts said this could in turn help distinguish between aggressive and harmless types of cancer.

As part of the study more than 570 men with suspected prostate cancer – those found to have elevated levels of the prostate-specific antigen (PSA) protein in their blood or other symptoms – were given an MRI scan followed by two types of biopsy.

Researchers found the MRI scan correctly identified 93 per cent of aggressive cancers, while most commonly used biopsy type only diagnosed about half.

Dr Hashim Ahmed, of the University College London Hospitals NHS Foundation Trust (UCLH), said the current biopsy test could be inaccurate because tissue samples were selected at random.

“This means it cannot confirm whether a cancer is aggressive or not and can miss aggressive cancers that are actually there,” he said.

”Because of this, some men with no cancer or harmless cancers are sometimes given the wrong diagnosis and are then treated even though this offers no survival benefit and can often cause side effects.”

“On top of these errors in diagnosis, the current biopsy test can cause side effects such as bleeding, pain and serious infections.”

The organisation was already working with clinical experts and professional bodies to investigate how a rollout of the MRI scan method may unfold, she said.

The Medical Research Council said an approximate 100,000 men every year in the UK undergo a type of biopsy – with about 66 per cent found to have no cancer or no life-threatening cancer.

The study was conducted by researchers from a range of institutions, including University College London, and funded by bodies including the UK Department of Health.

One PSA is not a screening test. Serial PSAs are a good indicator but they have not been sanctioned..

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After promising to clone GPs, and failing, Mr Hunt promises to “make” more radiologists… Importing them will block our own for years. Exporting films abroad is an option…

The strict and high standard training of radiologists has been threatened by cutbacks, just like GPs. Numbers have been insufficient for years, and although “Intelligent computerised reading” may reduce the numbers needed in the longer term, but short term there is a terrible risk. Will patients be asking for their X rays to be read by a consultant, and if this is not possible in their DGH then they should ask for the films to be read privately… The result of long term under capacity rationing is here and now: a two tier health service. Trusts who insist patients who go privately are put at the bottom of NHS waiting lists might have a problem with patients already admitted to hospital. Will they send them home again? Instead of recruiting from abroad, and blocking our own youngsters from Radiology careers, the films should be sent abroad pro tem. (Commissioning export?)

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The Times December 5th reports: Hunt promises 300 more radiologists for NHS England

The NHS will take on 300 more radiologists in England, Jeremy Hunt, the health secretary, has said. The pledge is part of the Cancer Workforce Plan, intended to tackle what one charity called a “crisis in the diagnostic workforce”. Another 200 clinical endoscopists, who use tiny cameras on flexible tubes to investigate suspected cancers inside the body, will also be appointed. It is hoped that the new staff will be trained by 2020, according to Health Education England.

Mr Hunt said: “We want to save more lives and to do that we need more specialists who can investigate and diagnose cancer quickly. These extra specialists will go a long way to help the NHS save an extra 30,000 lives by 2020.” However, the all-party parliamentary group on Cancer said that NHS England would “struggle” to achieve ambitious plans to improve cancer care. John Baron, the chairman, said that the cancer strategy was in danger of being derailed and added: “Corrective action now needs to be taken.”

They dont really care – they have known about the shortage of Radiologists coming for decades..

The GP recruitment farce – Mr Hunt never said the 5000 would come from the UK!

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A sinister development in the role of the GMC the position of a trainee, and the risk of a worsening, defensive culture of fear

Honesty and Candour are at risk. In a post truth world we need to control the damage being done to the medical profession. Without a no-fault compensation scheme this situation will get worse. Already precedent has been set by demanding access to Trainee doctors “educational portfolio”, and these two cases together are worrying. A sinister development in the role of the GMC the position of a trainee, and the risk of a worsening, defensive culture of fear. Gagging with such behaviour is really another form of bullying.

In Letters in the Times 5th December a team of 760 professionals at the top of their game question the GMC and it’s approach to candour. Medicine on trial:

MEDICINE ON TRIAL
Sir, We are concerned that the General Medical Council (GMC) is putting the culture of candour in medicine at risk and perpetuating an injustice by seeking the permanent erasure from the medical register of Dr Hadiza Bawa-Garba. Dr Bawa-Garba, a trainee paediatrician, was convicted in 2015 of negligent manslaughter after the tragic death of Jack Adcock in 2011.

The Medical Practitioners Tribunal Service (MPTS) then had to decide if she was fit to continue to practise. It heard that her clinical practice was generally regarded as excellent, with no other concerns flagged against her. It recommended she could apply to return to service as a doctor after 12 months’ suspension. The MPTS identified “multiple systemic failures” within the service. The evidence for these failures was not fully examined at the criminal trial; had they been, this would almost certainly have reduced her purported culpability.

The GMC is now appealing, via the High Court, seeking to have her struck off. We know of no evidence that terminating Dr Bawa-Garba’s medical career will make any patient safer. On the contrary it promotes a climate of defensiveness. In 2001, the joint declaration by the government and the GMC recognised that “honest failure should not be responded to primarily by blame and retribution, but by learning and by a drive to reduce risk”.

We urge the GMC to recognise that many within and outside medicine are already losing confidence in it and that this case could define its future.

Dr David Nicholl, consultant neurologist, Birmingham; Sir Peter Bottomley, MP; Nick Ross, journalist; Captain Niall Downey, doctor, pilot & patient safety trainer; David Field, professor of neonatal medicine, University of Leicester; Professor Sir Iain Chalmers, James Lind Initiative, Oxford. Plus a further 769 names at manslaughterandhealthcare.org.uk/letter

Trainee’s portfolio ‘used as evidence against them’ in legal case

The real man smiles in trouble, gathers strength from distress, and grows brave by reflection. Thomas Paine Article from Pulse magazine once again the opportunity to learn from mistakes will be lost in order to satisfy the thirst for cash for claims bonanza that is going on in the UK. Good luck retaining doctors with […]