Apologies over the unnecessary death of David Gray have filled the front pages and airwaves this week.
He was given a fatal overdose by Dr Daniel Ubani, a German doctor flown in to provide out-of-hours GP cover in Cambridgeshire, and a coroner ruled this week that his death amounted to gross negligence and manslaughter.
The coroner William Morris issued 11 recommendations to the Department of Health to improve out-of-hours GP services.
The main one, and most people’s biggest bone of contention, is the need for a review of how EU agreements work in the UK. Morris said the government must issue guidance to all NHS trusts over checking doctors’ English, their experience of the NHS and how they acquired their GP status.
However, as the GMC is at pains to point out, they’re not allowed to test doctors from the EU. The combination of EU law and domestic legislation (the Medical Act 1983) excludes the testing of a European applicant’s language proficiency or their competence.
This is a bit of a problem when you consider that Ubani was flown in at the eleventh hour, started work immediately with no induction and was utterly incompetent. (Makes you also wonder why we booted out loads of good doctors with excellent English from the sub-continent a couple of years ago).
Without wanting to come over all UKIP, our health secretary needs to grow a spine and put our relationship with Europe on a proper footing on this issue.
Morris also demanded “robust” clinical and management measures, including training and induction for non-UK doctors, and said only the company actually running the out-of-hours GP services should recruit doctors in future. It follows the Care Quality Commission making similar demands of trusts last year.
And this is where we get to the crux of it. Of course all overseas doctors coming into the UK should be tested and we should have a clear idea of the equivalence of their training. But, the real problem is how we’ve organised our out-of-hours GP services. Crap European doctors shouldn’t be required.
This week’s apology by NHS Cambridgeshire, which employed Take Care Now to provide the services in question, is revealing.
Dr Paul Zollinger-Read, chief executive of NHS Cambridgeshire, said: “We as an organisation still have much to learn from this case. Our monitoring of contracts has already improved significantly, but we must not become complacent.
“Systems around the registering of GPs by the GMC and on Performers’ Lists need to reviewed, and the recruitment, checking and vetting of GPs by our providers is vital if we are all to prevent this happening again.”
He’s got responsibility but seemingly limited power to control events. It doesn’t take much to go wrong, in a safety critical environment, where organisations are contracting and sub-contracting to the private sector, to lose sight of the process.
The reasons why Ubani was used remain. He was cheap and available (he even paid for his own flight and accommodation). It had nothing to do with quality. More checks will help but, in our new age of austerity, PCTs are still going to be looking for cheap deals.
I think it speaks volumes that Take Care Now is still in business, regardless of whether it has improved. It lost its Cambridgeshire contract, but still provides services for two other trusts: NHS Worcestershire and NHS Great Yarmouth and Waveney.
The GP contract has been an unmitigated disaster for out-of-hours care in the community. It’s time to bring local GP practices back into the equation and if that means the GP contract has to be re-negotiated, then so be it.
Tags: Out-of-hours, Overseas doctors
Why is the furore about GP out of hours ?
This role passed from GP’s to the PCT’s as a result of the governments introduction of the GP opt out and the impossibility of meeting daytime work and full 24/7 cover in the present litiginous environent.
The problem lies in a failure to resource the OOH service adequately and with the appropriate skills Ie a large enough number of full time employed staff who are trained and resourced to fulfill the tasks they need to deliver.
Foorcing it back onto GP land as will no doubt be done by the politicians will require a major expansion in GP numbers to ensure there are enought to provide OOH cover and to meet all the QOF and patient acess targets in the day.
Another example of how successful “Market reforms ” are in providing safe medical care.
The reason ubani killed was because he is a bogus doctor. The university has no record of him ever passing his medical degree, his references were bogus and there is no eveidence of him ever having trained or experience of general practice ever.