The paper on SASM’s role in clinical governance has now been widely circulated and placed on SASM’s website.
The paper was also discussed at various meetings:
a) with the Chief Medical Officer on the 11th September. He was fully supportive of the document and following a discussion he felt that the preferred option was to return the case to the reporting doctor providing that somewhere within the loop the medical or clinical director would be involved.
b) by the SASM Liaison Group where there was unanimous support for returning the case to the reporting doctor.
c) at the Assessors’ meeting on the 13th September. The vote was as follows:
- 2 for no action
- 3 for a SASM sponsored enquiry
- 23 for Notification to the Medical Director/Clinical Director
- 30 for Returning the case to the reporting doctor.
In addition, 3 voted for either notifying the Medical Director/Clinical Director, or returning the case to the reporting doctor.
d) at the Scottish Association of NHS Medical Directors on the 20th September. There was virtually unanimous support for notification to go directly to the medical director.
e) at regular SASM management meetings. There appeared to be a slight majority in favour of direct notification to the medical director in preference to notification to the reporting doctor.
DISCUSSION: clearly and not unexpectedly there have been different opinions as to how ought to proceed. It can be said that there is virtual unanimity that SASM has a responsibility under GMC guidelines and through advice from the Central Legal Office to report cases of serious concern, whether within the system of care or due to an individual, that could endanger patient safety. SASM now needs to decide what its process of notification should be. It also needs to be pointed out that it would be preferable if there was a standardised process of notification and feedback that applied to all national Scottish audits. This will be raised at a forthcoming meeting of all chairpersons of these audits (March 6th 2007) to discuss this issue and agree on a common framework.
At a Board Meeting on the 26th October 2006 it was decided that it was appropriate for SASM to decide how it will proceed and take this to the above meeting. A compromise between two of the proposed options was thought to be best. Consideration was given to the feelings of the participants who, in general, do not wish management to be involved directly at the start, although they do appreciate that management has a responsibility to ensure these concerns are reviewed. Particular consideration was given to participants identification of the CEO – and even the Medical Director – with the role of ‘employer’, rather than in their having responsibilities for clinical governance.
The chosen option (ratified at the SASM Board meeting on the 11th January 2007) is to firstly notify the individual concerned and ask for confirmation that local peer review has taken place – through a letter or form co-signed by the Medical (Clinical) Director. The letter will also state that the Medical Director concerned will be notified of the case within a defined period of time, 1 month. This will allow confirmation of local peer review and self regulation while at the same time ensuring that ‘management’ responsibility for clinical governance is fulfilled.
It is believed that such an arrangement will be accepted by the participants management, patients and the public. All parties must be comfortable with these new arrangements, especially as this is a departure in terms of SASM’s role when it was set up. It would be a disaster for the audit to lose the goodwill and participation of the consultant surgeons and anaesthetists in Scotland. If this were to happen, there is a very strong possibility that the audit would either fail or the information given would not be as honest and reliable as it currently is. This arrangement, and in particular the compliance rates, will be kept under constant review by the various SASM’s committees.
SASM Clinical Governance Protocol 