Who carries the can when things go wrong?

A few years ago, a fellow GP in Exeter had to face an NHS disciplinary committee over an alleged case of negligence.

His problem was that at the time he was on vacation in France.

Even though he was out of the country, the practice was still his responsibility.

Under the contract with the NHS, GPs were responsible for the practice 24 hours a day, 365 days a year.

The behavior of staff or substitutes must be determined by the partners.

If he could prove that the locum was on the local list of approved GPs and that he had done everything possible to ensure that the locum was competent, he could be clear, but say “no idea, I was not there” was no excuse.

When I worked as a hospital doctor in the suburbs of Plymouth, there were two local practices.

The doctors at both practices were popular, but one had charming and helpful receptionists, the other had difficult “dragons”.

My non-physician friends would say that a practice was unlucky with its staff. I bit my tongue.

There’s no luck in that. The attitude of the receptionists is fixed by the partners.

When we had a vacancy, we appointed a new receptionist who had glowing credentials. She had worked in a practice in the South East and they were sad to see her go when she moved to Torquay.

Pretty soon we started getting negative feedback. She was difficult with patients, asking too many questions and being generally obstructive. Away from reception, she was friendly and fit in well with our team.

When we discussed the situation with her, it became clear that she had been trained to limit the number of patients seeing the doctor.

This approach involved too many questions and was generally obstructive.

We discussed our different philosophy, but she felt we were wrong. Allowing patients easy access would lead to abuse of the system.

She believed that patients should be treated like children who should be “educated” according to strict rules.

She meant well and that was how she had been trained. It may have worked in her previous practice where she was obviously very popular with GPs.

Our problem is that this did not fit our approach. She left on good terms, still believing we were wrong.

How far down an organization’s chain of command should accountability end?

If the quality of substitutes and receptionists is the responsibility of general practitioners, should this idea apply to other professions?

If a ship hits the rocks, is the captain to blame, even if he was not on the bridge?

Should Cressida Dick, the Metropolitan Police Commissioner, have resigned because some junior officers were grossly misogynistic?

The idea of ​​taking responsibility across an organization is not universal.

Was ‘Yes Prime Minister’ an exact satire of the civil service when Sir Humphry suggested that civil servants should not quit? “That’s what ministers are for.”

When things go wrong, it’s easy to blame a junior member of staff, but there must be other issues.

A newly qualified doctor who makes a mistake should not carry the canister alone.

The organization should ask why they were placed in this position. Where was the support?

Was there anyone the doctor could have contacted for advice?

It is unusual for errors to be the sole responsibility of an individual. It is often the system that breaks down.

And sometimes the problem is even further up the chain.

Is the organization so underfunded that there was no one else to offer support?

Was the equipment poorly maintained? Was all staff supportive and was morale too low?

When something goes wrong, the whole organization has to look at itself. There’s no point in saying “the sous chefs will roll”.

About Elizabeth Smith

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