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Posts Tagged ‘Out-of-hours’

Out-of-hours firm had systemic failings, CQC says

BBC Health - 15th July 2010 9:33 am

A company providing out-of-hours care in an area where a pensioner died after a painkiller overdose had “systematic” failings, the NHS regulator says.

David Gray, 70, from Manea, Cambridgeshire, was killed by Dr Daniel Ubani, a German medic working his first NHS shift for Take Care Now.

The now-defunct firm was criticised for failing to act on previous cases and warnings on standards.

The Care Quality Commission said the whole NHS should learn lessons too.

The CQC criticised Take Care Now (TCN) for failing to investigate and learn from two previous cases of diamorphine overdoses prior to Mr Gray’s death.

German GP who killed patient in UK struck off

BBC Health - 18th June 2010 9:59 pm

An out-of-hours doctor from Germany who killed a patient with an overdose of a painkiller has been struck off by the GMC.

Dr Daniel Ubani, 67, injected David Gray, of Manea, Cambridgeshire, with 10 times the recommended dosage in 2008.

A GMC panel has ruled that Dr Ubani should be banned from practising in the UK.

Health Secretary Andrew Lansley said he was working to ensure foreign staff have the right language skills.

Dr Ubani was given a suspended sentence in Germany for death by negligence but is still able to practise there. The GMC’s powers do not extend to other countries.

GPs to take back out-of-hours, says government

Healthcare Republic - 18th May 2010 9:08 am

The Conservatives have confirmed they will force GPs to take back responsibilities for out-of-hours by entering into new contract negotiations.

Speaking to the Daily Mail, new health secretary Andrew Lansley said: “GPs should be responsible. There will need to be a new contract to make this point.”

Under Conservative plans, responsibility will be handed back from PCTs to GPs working in local groups, who will commission services or provide them by working in rotas through co-operatives.

GPC chairman Dr Laurence Buckman said he would not oppose responsibility for commissioning out of hours services being included in the contract.

“GPs involvement in out-of-hours commissioning will be a positive thing for GPs and their patients,” said Dr Buckman.

GMC wants new powers to test European docs

By Mike Broad - 19th March 2010 4:49 pm

The GMC has once again called for an urgent change in the law to enable them to test the language skills and competency of European doctors before they start work in the UK.

In presenting evidence to the health select committee, GMC chief executive Niall Dickson said the regulator needed more powers to be able to properly check the competence of European doctors.

Dickson said: “What we can do is check who they are; we can get from the competent European authority a certificate saying they are somebody of good standing, and thirdly we get the qualifications they produce.

“What we cannot do is look behind those things. We cannot say well that qualification doesn’t mean very much. If it is approved, and it is on the European list, then we simply have to accept them and in the case of Dr Ubani that was of course what happened.”

German doctor Dr David Ubani negligently killed a patient during an out-of-ours visit in Cambridgeshire in 2008. David Gray died after being administered 10 times the normal dose of diamorphine. The coroner, and a subsequent inquiry, raised serious concerns about the management of out-of-hours care.

Health minister Mike O’Brien, who also appeared in front of the committee, questioned whether empowering the GMC was the best way to tackle the problem.

He suggested that greater adherence to existing responsibilities, and better management of the ‘performers list’, by trusts and employers could be the solution.

O’Brien said: “I am making absolutely clear that PCTs should have been by law, since 2004, looking at language skills. They had no discretion on this; it was a legal obligation. They should be doing it now.”

He added: “The most important check, and where we have to tighten up a lot, is on the employer because the employer, either a co-operative or a private company, needs to ensure that the competence in terms of the skill and also the language skills are adequate to do GP services.”

Dr Ubani was employed as a locum GP covering an out-of-hours shift by private sector provider Take Care Now, which recruited him at short notice from Germany.

O’Brien felt that that working with PCTs and employers would be more expedient than changing the law. “If we go into a long drawn-out discussion about changing EU Directives, what the GMC want and giving them new powers…I think it will just take longer, but I want to sort this out by the end of this year,” he said.

Tags: Out-of-hours, Overseas doctors
Posted in Hospital Dr News | 2 Comments »

Our GPs must prevent out-of-hours “killings”

By Mike Broad - 4th February 2010 6:20 pm

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
Posted in Dr Blogs | 2 Comments »

Employer of overdose GP loses second NHS contract

The Guardian - 18th December 2009 1:14 pm

A private company running out of hours GP services for the NHS has lost a second contract in the aftermath of the case of a foreign doctor who accidentally killed a patient on his first UK shift as a locum.

Take Care Now was stripped of one contract amid safety concerns and another will not be renewed. It still provides emergency GP services for three other local NHS trusts.

The company is under investigation by NHS watchdog the Care Quality Commission over the death of 70-year-old David Gray. He was given a massive overdose of a painkiller by Daniel Ubani, a German doctor who admitted to being unfamiliar with the drug, tired and lacking concentration.

The commission’s interim report in October raised questions about the company’s ability to fill shifts, manage medicines and take appropriate action for stroke patients. The NHS in Cambridgeshire sacked the company from running weekend and evening GP services in Fenland and east Cambridgeshire this month - four months before its contract was due to end - because of continuing safety concerns.

Now health chiefs in Suffolk have decided to switch out of hours provision to Harmoni HS, a company with six other similar NHS contracts.

Death case locum firm has contract terminated

The Guardian - 9th November 2009 10:04 am

The private company that hired a foreign doctor who accidentally killed a patient on his first UK shift as a locum has had an NHS contract terminated early due to new safety concerns.

Checks on Take Care Now by the national NHS safety watchdog and the NHS in Cambridgeshire have added to their unease about its ability to fill shifts and organise cover for weekend and evening GP services.

Health chiefs in the county have arranged for a local doctors‘ co-operative, Camdoc, to replace TCN in east Cambridgeshire and Fenland from 1 December pending a decision on round-the-clock care in the county. They had already served notice of a shakeup for services by four providers next April.

TCN’s problems over unfilled shifts were revealed last month in an interim report by the Care Quality Commission, which is investigating the case of Daniel Ubani, who killed David Gray, 70, with a painkiller overdose in 2008 in Manea, Cambridgeshire. The Department of Health was so worried by the interim findings that it ordered all 152 NHS organisations responsible for overnight and weekend care to review patient safety.

Further checks conducted after the interim findings were ready for publication have deepened concerns over TCN.

TCN says it uses other staff, including emergency care practitioners or nurses, to cover gaps, and that much of the argument is over the way providers fulfil contracts. Insisting on having health staff in certain local bases is not the best use of resources nor the best indicator of care, it says.

Trusts to review safety of out-of-hours GP services

The Guardian - 2nd October 2009 9:53 am

All 152 NHS organisations responsible for out-of-hours GP services in England have been ordered to review patient safety following the case of a German doctor who accidentally killed a patient on his first shift in Britain.

PCTs, which commission emergency overnight and weekend care for millions of people, will receive letters today from the Department of Health telling them to re-examine induction and training for foreign doctors, call-handling and prioritising of cases, clinical decisions made by GPs and other staff and the management of powerful drugs.

The instruction reinforces a warning from the NHS watchdog the Care Quality Commission that shortcomings so far identified in its investigation of the incident may be repeated elsewhere.

Government officials and Steve Field, chairman of the Royal College of GPs, have been asked by ministers to consider whether further changes are needed nationally to the system under which local trusts check that doctors are fit to practise and speak and understand English.

The government response reflects concern within the NHS over the case in which Daniel Ubani killed David Gray at his home in Cambridgeshire by administering a tenfold overdose of a painkiller. There are fears that Gray’s death highlights systemic failures.