Trims wrote:
> I was shocked to read in this week's Private Eye *three* articles from
> 1992 blowing the whistle and naming names three years before the
> operations stopped. I hadn't realised that the problem in Bristol had
> been such *public* knowledge.
Not that long ago, I was involved in setting up one of the first clinical
audits in surgery. To make it meaningful, I insisted that it involved
looking at all operations performed by the surgical department, with
statistics for average wait before operation, average inpatient duration,
average complication rates, etc, with all figures further subdivided
according to clinician and procedure. The first quarterly report was
shocking - the variation in all statistics between clinicians was
astonishing, with some eminent colleagues performing consistently worse
than others. Not surprisingly, the project was promptly shuffled off into
storage while those same eminent colleagues discussed how audit should
continue.
At the time, I suggested that the Royal College of Surgeons should require
all consultants to submit such figures by way of an annual return, not
dissimilar to the practice of obstetricians. The RCS would then have had
responsibility for looking into cases of clinicians whose results were
consistently worse than average - and, I suggest, the RCS would be the best
qualified body to consider mitigating factors, etc.
Today, we have plans for the publishing of league tables with some woolly
concept of 'weighting' to offset higher mortality in some units. We are
told by our beloved leader (am I the only one to think he looks worryingly
like Selwyn Froggit?) that such league tables will allow GPs to choose
clinicians/hospitals with good performance figures, even though the
politics of PCGs may tie those same GPs to a particular hospital,
regardless of our apparent freedom to refer wherever wee wish.
I suggest that this is the moment for the RCS (and perhaps other royal
colleges) to start doing rather more than they have in the past, by way of
compulsory audit.
Andrew wondered whether there may be a more meaningful role for the RCGP.
General practice is not as amenable to audit as surgery, but perhaps there
is a role here.
Prit (still feeling good about leaving general practice)
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|