How big a risk is there that more patients who need a GP to see them out-of-hours may suffer death through drug administration errors?
Following the death of a patient in Cambridgeshire from an opiates overdose at the hands of a doctor from Germany doing an out-of-hours session, this is a question GP consortia cannot answer conclusively.
However, they will certainly consider it when awarding contracts to service providers. And if consortia ensure the providers they contract with undertake all the checks listed here, as well as having robust induction and audit processes, hopefully there will be no more preventable deaths.
|PROVIDERS' INDUCTION POLICIES|
After the Cambridgeshire death, the process by which out-of-hours providers check doctors working for them was reviewed, although the basic requirements remain essentially the same (see box, below).
|CONDITIONS FOR OUT-OF-HOURS DOCTORS|
Additional conditions added by some SHAs
Extra conditions some SHAs now insist on were added as there was variation in the level of evidence required by individual PCTs. Previously, when a doctor was on one PCT performers list, this was used as permission to work anywhere in the UK.
Some EU doctors 'shopped around' to find PCTs less stringent in applying the requirements of entry to their list.
It seems too that some locum agencies pointed doctors to these PCTs.
While a doctor may have a certificate of equivalent experience in another EU country, this experience may vary markedly from that in the UK. For example, a GP in Italy will not routinely see children as all children are registered at birth with paediatricians who provide treatment until their 16th birthday.
In the UK, greater emphasis is now on assessing the doctor's clinical experience. The areas focused on particularly are:
- Palliative care and use of drugs in terminal care with particular emphasis on administrating and recording use of controlled drugs.
- Understanding and reporting significant untoward incidents.
- Child protection and vulnerable adult policies.
- Demonstration of clinical knowledge expected from a GP in the UK.
These areas are explored at interview but the clinician must undertake a session supervised by a suitably experienced clinician employed by the provider.
Only if the supervisor is satisfied will they be allowed to undertake further sessions (which are audited using the MRCGP audit toolkit).
Providers now have greater responsibility for ensuring that all doctors they hire are suitably qualified and experienced. They can no longer rely on sub-contractors or agencies to provide this evidence. If they do and problems arise, they will be held accountable.
- Dr Law is medical adviser on out-of-hours services for the East of England Ambulance NHS Trust in Essex