It is for primary care trusts (PCTs) to ensure that those providing NHS primary medical services meet the terms of their contract. There are requirements for those contracts set out in the National Health Service (General Medical Services Contracts) Regulations 2004, the National Health Service (Personal Medical Services Agreements) Regulations 2004 and the National Health Service Act 2006: Alternative Provider Medical Services Directions 2008. Where a contractor fails to comply with the terms of their contract, the PCT may issue a remedial notice giving the contractor a specified time within which the concerns should be remedied. Where the contractor takes no steps to remedy the matter, the PCT may terminate the contract. In certain circumstances, the PCT may impose sanctions on the contractor.
There are no contractual requirements for general practitioners (GPs) or GP practices to provide explanation for instances where misdiagnosis and other forms of mistreatment have occurred.
Under the terms of their contract, GPs are obliged to operate a complaints procedure which allows patients to raise concerns about any matter connected to the provision of services under the contract. Under this procedure, all complaints must be properly investigated and the complainant given a written summary of the investigation and its conclusions. There are also requirements set out in the regulations and directions referred to regarding the qualification of persons who perform services, conditions for employment and engagement of those persons, training, level of skill, appraisal and assessment.
Professional guidance published by the General Medical Council (GMC) includes an obligation for doctors to share with patients, in a way they can understand, the information they want or need to know about their condition, its likely progression, and the treatment options available to them, including associated risks and uncertainties and to respond to patients’ questions and keep them informed about the progress of their care.
The Quality and Outcomes Framework (QOF), which rewards GP practices for achieving quality indicators, includes an indicator (Education 4) to reward practices for undertaking a minimum of 12 significant event reviews in the last three years. A significant event occurs when a patient may have been subjected to harm, had the circumstances/outcome been different (near miss). Each review case must consist of a short commentary setting out the relevant history, the circumstances of the episode and an analysis of the conclusions to be drawn. The practice is required to report to the PCT on its analysis and the PCT is expected to discuss the reviews as part of its QOF assessment visit.
The National Patient Safety Agency (NPSA) has developed a form to help health care staff report patient safety incidents. These are any unintended or unexpected incidents which could have or did lead to harm for one or more patients receiving NHS-funded health care. NPSA recommend that it should be used as soon as possible after the incident has happened.
Subject to the outcome of consultation, it is planned that the Care Quality Commission will register all GP practices to a consistent set of essential quality and safety criteria. Registration of primary care practices would help both to drive up the quality of practice-level clinical governance and to enable PCTs to concentrate on overseeing a small number of poor-quality practices.