Press releases Monday 28 June to Friday 2 July 2010
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(1) UK’s reliance on locums putting patient safety at risk, warns doctor (2) Venetian blinds can cause accidental strangulation (3) BMJ study on ovarian cancer wins prestigious award
(1) UK’s reliance on locums putting patient safety at risk, warns doctor
(Feature: How I tried to hire a locum)
http://www.bmj.com/cgi/content/extract/340/jun29_1/c1412
(Commentary: Responsibilities of individual doctors)
http://www.bmj.com/cgi/content/extract/340/jun29_1/c3385
The UK’s heavy reliance on locum doctors to work in the NHS is leading to a dangerous state of affairs where patient safety is at risk, warns a senior doctor in this week’s BMJ.
Professor Chris Isles from the Dumfries and Galloway Royal Infirmary in Scotland recounts his frustrating hunt to fill his medical staff rota using locums, leading him to some critical conclusions about the poorly regulated locum sector in the UK.
He was dismayed to be offered locum doctors who were inappropriate in terms of experience, qualifications, and fatigue, and his account raises some serious questions for the NHS.
“A huge amount of time has been wasted attempting to book doctors with little experience of working in the UK, whose competencies I have been unable to assess, who did not always have the right paperwork, and who could break an agreement at will and without repercussion,” he writes.
Demand for agency locum doctors has increased in recent years, fuelled by the full implementation of the European Working Time Directive for doctors, as well as increasingly hard to fill vacancies.
According to a recent report by the public sector watchdog Audit Scotland, the NHS in Scotland spent £47m (€57m; $70m) on locum doctors in 2008-9, 43% of overall medical staffing expenditure. About £27m of this was on agency locums. In England, the Department of Health does not centrally collect figures to show how much NHS trusts spend on locum doctors.
Audit Scotland also found that procedures for induction and supervision of locum staff were vague and therefore more likely to be overlooked.
Professor Isles believes the responsibility for this “must lie with the European Working Time Directive and Modernising Medical Careers, which have created a health service in which we are forced to rely so heavily on locums.”
He concludes: “But most of all I rage at the locum agencies whose abject failure to regulate themselves should surely have led to intervention by the GMC by now. We pay lip service to patient safety by allowing this scandalous state of affairs to continue.”
In an accompanying commentary, Niall Dickson, Chief Executive at the General Medical Council, says: “This disturbing account highlights both the continuing shortage of doctors in some parts of the country and the apparent failure of some agencies and doctors to provide reliable information about their skills and competence.”
The GMC has robust systems to ensure that the information about doctors on the medical register is up to date, correct, and available to those who need it, when they need it, he adds.
But he points out that the information is necessarily limited, and that the register “provides less assurance in relation to doctors from the European Union as we are not currently allowed to assess them for their competence or their linguistic ability.” The GMC is currently working with the Department of Health and the European Commission to change this.
Dickson concludes: “Locums provide a valuable service but they need to be supported with good induction - all doctors are vulnerable in unfamiliar settings … These case studies highlight the difficult position faced by hospitals trying to ensure adequate cover, but it also shows precious time is being wasted when they are not provided with accurate information on which to base a decision.”
Contacts:
Feature: Professor Chris Isles, Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland, UK
Email: chris.isles@nhs.net
Commentary: Niall Dickson, Chief Executive and Registrar, General Medical Council, London, UK
Email: ndickson@gmc-uk.org
(2) Venetian blinds can cause accidental strangulation
(Personal View: Accidental strangulation with a Venetian blind cord – a near miss)
http://www.bmj.com/cgi/content/extract/340/jun29_1/c3458
In this week’s BMJ, a paediatrician is calling for Venetian blinds to be redesigned to safeguard babies and toddlers from accidentally being strangled to death by the looped cords.
Dr Mahesh Masand, consultant paediatrician at Dr Grays Hospital in Elgin, Scotland, recounts the day when a 22-month-old girl was rushed to A&E after her mother found the toddler hanging from the looped cord of a Venetian blind in her bedroom. The little girl was kept on a ventilator for three days and discharged with no complications after seven days.
It is extremely fortunate, says Masand that the girl’s mother walked into the bedroom when she did, perhaps seconds away from the toddler suffocating to death. Dr Masand has subsequently found out about other cases that have tragically resulted in the death of children in the UK. He says at least 11 Australian children have been accidentally strangled by blind or curtain cords since 2000 and he refers to a claim by an advisor from the Royal Society for the Prevention of Accidents who said “one or two children die each year in the UK in this way.”
The author maintains “one cannot stop all accidents happening but at least can limit the chance of their happening” and he is now calling for the industry to redesign their products as a matter of urgency. He argues “there should be a safer way of raising a blind than using a looped cord.”
Masand concludes that “survival after hanging injury in childhood is uncommon due to lack of adult presence at the time of hanging … the focus hence needs to be placed on attempting to prevent the hanging from occurring in the first place.”
However, he adds that parents can look into various other safety measures, such as shortening or removing loops, installing tie-down devices that keep loops taut against walls, keeping cords out of reach of children, using a cord tensioning device or cord pulley on walls, and eliminating climbing hazards by moving furniture, including cots, beds, and high chairs, away from windows with looped curtain or blind cords.
Contact:
Mahesh Masand, Department of Paediatrics, Dr Grays Hospital, Elgin, Scotland
Email: mmasand@nhs.net
(3) BMJ study on ovarian cancer wins prestigious award
(Research: Risk of ovarian cancer in women with symptoms in primary care: population based case-control study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b2998
A study on ovarian cancer published by the BMJ has won the 2009 Royal College of General Practitioners (RCGP) Research Paper of the Year Award. It is the eighth BMJ study to win this prestigious award since 2000.
The Research Paper of the Year Award is now in its thirteenth year. Its main aim is to raise the profile of research in general practice and primary care.
The winning paper, by William Hamilton and colleagues from the School for Primary Care Research at the University of Bristol, showed that many women with ovarian cancer can go undiagnosed for months because their symptoms are not always being investigated promptly.
They also showed that the symptom which carries the highest risk (abdominal distension) was not included in current guidance for urgent investigation. If it were, the researchers argued that some women could have their diagnosis speeded up by many months.
Dr Hamilton has also recently been involved in writing a BMJ Learning online module this year, on early symptoms of ovarian cancer, which is available free of charge to health professionals at http://learning.bmj.com
Dr Fiona Godlee, Editor in Chief of the BMJ said: “We are delighted that another BMJ paper has won this award. This study is important for both clinicians and for developers of guidelines in this field, and it is inspiring to see such high quality research being undertaken in primary care. At the BMJ we believe strongly in the value of identifying best practice in health care and communicating this effectively for the benefit of patients. We are proud to have published this important piece of work.”
Notes to Editors: Risk of ovarian cancer in women with symptoms in primary care: population based case-control study BMJ 2009; 339: b2998, doi:10.1136/bmj.b2998 (Published 25 August 2009)
Contact:
Emma Dickinson
Email: edickinson@bmjgroup.com
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For more information please contact:
Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk
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BMA House, Tavistock Square, London WC1H 9JP
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