A GP’s view
Dr Raj Thakkar, a GP in Wooburn Green, Buckinghamshire
Patient safety has to be the overriding principle with which you handle these comments.
Patient feedback is a reflection on the level of healthcare your practice is providing. Satisfied patients tend to have had their health concerns dealt with appropriately.
It is worth considering whether the reports are genuine. Why did the receptionist choose to tell you rather than someone else? Find out in more detail which patients made comments and what exactly was said.
If several patients are involved, the concern is all the more worrying. The most recent patient questionnaire may support the recent comments.
It is imperative that the subject is broached with sensitivity. You may want to discuss what to do with other colleagues to help formulate a universally accepted plan or you may rather have a one-to-one conversation with the colleague in question. A one-to-one, however, may be considered secretive and this may not be in the best interests of your patients.
Checking if the doctor in question is okay may provide insight into why the situation arose. If no clues are offered, it is appropriate to be open about the comments made and allow her to respond.
Hopefully, the response will provide you with a reason — stress at home for example.
Anger might of course show itself. In this situation, it may be worth explaining you had no choice but to discuss the comments made by patients and you would like to talk about it when she has had a chance to consider the situation.
Difficulties can arise if she denies there is an issue. In this case, if there are concerns about patient safety, a partners’ meeting may have to be held and the issue handled more formally.
Perhaps a consultation skills update is required. An update for all doctors may be perceived as less punitive to the individual. Another patient feedback questionnaire for all doctors in the practice may demonstrate improvement once she has addressed her problems.
A patient’s view
Ian Semmons, Patient Partnership Group
If a formal complaint has been made by a patient, you have a clear duty to follow the complaints procedure that should be in place within the practice.
Each practice team member has both an individual and collective responsibility to ensure that the team delivers the highest standards of patient care at all times, along with an overall responsibility to raise any concerns when these objectives appear to be compromised.
The first step is to interview the receptionist in order to establish a clearer picture. Examples of the concerns need to be aired with any evidence to support them provided, which may involve talking to the patients who have raised these concerns.
It may well be that a pattern starts to emerge that will shape the future direction of the enquiry. Once things become clearer you will be able to decide what you are going to do.
If there is sufficient evidence, then the next step will be to discuss the complaints with the doctor concerned. Depending on the structure of the practice this may involve a meeting including the senior partner, with any future action linked to the outcome.
It may be that there are personal issues affecting the doctor’s performance that any discussion could start to resolve.
A medico-legal opinion
Janet Page, medico-legal adviser, Medical Protection Society
This situation needs to be handled sensitively.
The GMC imposes a professional obligation on doctors to ensure that the safety of patients comes first at all times. This may involve supporting colleagues who have problems with performance, conduct or health.
Before approaching your colleague you need to establish whether the receptionist’s impression reflects a genuine problem. Have any of the other receptionists commented? How many times has it happened and over what time period?
Having established that there is an issue, you should talk through your concerns in private with the colleague in question.
There are a number of possible explanations. Are the doctor’s surgeries under particular pressure? Does she tend to over-run or have more than her fair share of high-demand patients or those with complex medical problems? If so, adjusting the bookings to ease the pressure may resolve the problem.
Other possibilities are that she lacks confidence because of knowledge gaps in particular aspects of clinical practice, or that she needs to improve her interpersonal and communication skills. These performance issues can be addressed at a local level, either within the practice or with the assistance of the primary care organisation or LMC.
You should also consider whether this issue is a reflection of an underlying health problem, and if so you should encourage your colleague to seek appropriate professional help and support her in doing this.
Finally, if the problem cannot be resolved locally or the doctor refuses to acknowledge it, all other avenues have been exhausted and you believe patients may be at risk, then ultimately you may have no option but to report your concerns to the GMC.