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Multiple Jeopardy in Medicine 2018 - Dr Mark Burgin

15/06/18. Dr. Mark Burgin BM BCh (oxon) MRCGP discusses how overlapping regulatory systems are creating a perverse incentive on the quality of medical care.

Medical care is regulated by the CQC, GMC, complaint system, ombudsmen, criminal courts, coroners, internal regulation systems, trusts and clinical negligence lawyers.

The resulting regulatory burden means that doctors must decide who they are going to listen to and who they are going to ignore when making decisions.

The quality of medical care is most strongly influenced when clinical negligence is involved but CN has been demoted to Cinderella status and is generally forgotten in day to day practice.

The focus on high value CN cases so that less than 2% medical accidents being investigated gives most doctors the impression that CN is not a problem in their area of medicine.

Care quality commission (1)

The CQC uses inspections to determine if a service is safe, effective, caring, responsive and well-led but has not incorporated the NHS complaint system which would improve its own responsiveness.

The local managers are often aware of the problems that their service is facing but their opinions on how to solve the problems are not requested.

The CQC has a responsibility to prosecute where there are breaches of the duty of candour but this power is still being developed.

The clinical negligence lawyer may be aware of problems with a service many years before the CQC but there is a reluctance to use this type of data to identify problem areas.

General Medical Council (2)

The GMC considers whether a doctor is impaired due to misconduct, conviction or caution, health or a determination of impaired fitness to practise.

The word impaired suggests that patients’ safety has been put at risk but the finding has a much broader meaning and can include misleading completion of forms.

The GMC asks the doctor to provide a large amount of evidence and writes to all those bodies that the doctor has contact with but does not ask the doctor’s patients for information.

The GMC limits the investigations typically to the last 6 months and a medical report on the doctor’s work by an expert so that clinical negligence concerns can be missed.

Internal systems

A variety of different systems has grown up in each locality from internal reviews to disciplinary panels and management targets and payments by results.

Many processes are not evidence based and a considerable proportion are inconsistent or target savings over quality of care although some represent real innovation.

There is a tendency to measure what can be measured which risks the professionals learning to game the system rather than improve standards.

Trusts know little about what their local population thinks about the various departments they manage resorting to patient satisfaction surveys rather than validated opinion polls. (3)


There should be a discussion between regulators so that one can take complete responsibility for each case so that doctors are not faced with years of investigations from a sequence of regulators.

A register of clinical negligence cases should be held by the Ministry of Justice (like ASKcue) to ensure that other public bodies can perform their duties properly.

The NHS complaint system should be incorporated by the CQC so that the circumstances of a complaint can be investigated for instance systematic problems within a service.

The CQC should require trusts to ask service managers to provide reports on recommendations to solve the issues that are present and commission validated opinion polls. (4)

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website


  2. GMC 2013 Good medical practice

  3. The Kings Fund 2015 Public Satisfaction with the NHS

  4. Independent 2017 Three in four people believe the NHS is in poor condition, poll shows


    Image: public domain