Services
Keeping you safe
How do we keep you safe?
- Click on a link to find out about all the different safeguards that are in place to ensure you receive an excellent and safe service when you are a patient at the MSG.
Don’t forget, we’re always keen to hear your feedback on the care you’ve received and you are always welcome to ask for a second opinion.
How can I give feedback? - MSG
What safeguards are in place when a doctor is appointed at the MSG?
Firstly, we only appoint consultants - senior doctors who have completed full medical training in a specialised area of medicine. Most doctors we appoint have already worked as a consultant in the NHS for a few years.
Secondly, all our consultants must be registered with the UK’s General Medical Council which gives them a licence to practice. The GMC sets the standards of patient care and professional behaviour that doctors need to meet.
And then of course we do all the normal checks, such as references and DBS (disclosure and barring service).
All the checks above also apply when we appoint a short-term locum doctor.
Who checks on whether a doctor is doing a good job?
All our consultants must be registered with the General Medical Council which brings with it all kinds of safeguards for patient care.
They all must have an annual appraisal to review their practice, compare what they do with other doctors, learn from feedback from patients and colleagues and identify areas where they can develop.
Every five years the local Responsible officer recommends to the GMC whether a doctor should be revalidated (licenced to practice), based on evidence from their last five appraisals.
The GMC’s appraisal and revalidation process for doctors is probably the most thorough of its kind in the world and is based on Good medical practice, the GMC’s core ethical guidance for doctors.
The Good medical practice framework for appraisal and revalidation (gmc-uk.org)
What to expect from your doctor: a guide for patients (gmc-uk.org)
Who is the Responsible officer and what do they do?
Dr Peter Rabey, HSC’s medical director, is appointed by the States of Guernsey as the Responsible officer.
By law, the Responsible officer protects patients by ensuring appropriate annual appraisals take place, making recommendations to the GMC, and investigating and referring concerns.
You can read the latest report from the Responsible officer here CHttpHandler.ashx (gov.gg)
What does the annual appraisal cover?
Every year our consultants must put together a portfolio which they present to a trained appraiser. The portfolio covers:
- Continuing professional development – what have they done to keep their skills and knowledge up to date?
- Quality improvement activity – how have they compared their performance against local, regional or national benchmarking data, what kind of clinical audits have they taken part in?
- Significant events – have they been involved in any events which could or did lead to harm for patients, what did they learn and what actions did they take as a result?
- Patient feedback and colleague feedback
- Complaints and compliments
Who are the appraisers?
Appraisers are senior doctors, working at the MSG or at HSC (Health & Social Care) or at larger hospitals such as Southampton, who are appointed by the Responsible officer.
What happens after the appraisal?
Based on the portfolio of evidence, the appraiser agrees with the doctor a personal development plan (PDP) so that they can continue to improve the quality of the care they give to patients.
After five annual appraisals, the Responsible officer reviews the output from those appraisals and, if the doctor is keeping up to date and giving good care, he recommends to the GMC that the doctor is revalidated.
How do doctors get feedback from their patients and colleagues?
Patients are given a questionnaire which asks how satisfied they were with the quality of the care they received and the way the doctor behaved towards them. The responses are analysed and fed back by an independent company.
For colleague feedback, a structured questionnaire is sent to a wide range of clinical and non-clinical work colleagues who have knowledge of the doctor’s practice.
Doctors review all the feedback with their appraiser.
Who checks whether the doctor follows their personal development plan?
Continuing professional development (CPD) – keeping your skills and knowledge up to date and taking part in quality improvement – is a key requirement for doctors. At every annual appraisal, the appraiser will look closely at progress against the previous year’s PDP.
The GMC’s Good medical practice sets out in detail the standards of care and behaviour expected of all medical professionals.
What does this look like in practice for consultants working in the MSG or at the PEH?
As well as all the formal CPD (continuing professional development) and quality improvement activities that are covered in the annual appraisal – see How doctors’ performance is reviewed (above) – for doctors it’s about constant questioning of yourself and of others about whether you are taking the right actions for a patient.
It happens through regular multi-disciplinary meetings. For example every Friday there is an Xray meeting where radiologists meet with senior physicians. They compare notes on patients they have cared for over the past week and ask for feedback on decisions they’ve taken and the next steps in managing a patient’s care.
It happens through links with doctors in specialist units in the UK who are regularly contacted to discuss cases and through ‘off-island attachments’ – where MSG doctors spend time in a UK hospital to gain additional experience and enhance the standard of hospital care for islanders.
And it happens informally, and constantly, through regular conversations as clinicians meet each other, always taking the chance to ask a colleague for their opinion on how you are caring for a patient.
What counts as an incident?
Anything that has caused or has the potential to cause risk or harm to a patient, staff member or incident.
An example of a clinical incident would be if someone was prescribed the wrong drug. An example of a data protection incident would be if a letter was sent to the wrong patient. Health and safety incidents, eg trip hazards, are also recorded and acted on.
Most clinical incidents do not cause harm to patients. For example, the wrong drug might have been prescribed for the patient, but the mistake was corrected before the drug was administered. This still counts as a clinical incident.
All clinical incidents are logged jointly with HSC on an online system known as Ulysses. Most are reported by the clinician who was directly responsible.
How are incidents investigated?
Incidents are investigated by the manager of the department concerned and their report is shared so that any lessons are learned.
What about serious incidents?
When an incident is reported, the manager will assess whether it meets the criteria for a serious or ‘never event’ incident. If it does, a ‘swarm’ meeting will be called immediately.
The swarm meeting will identify what has gone wrong and what actions need to be taken immediately to prevent the incident from happening again.
The focus is on identifying the system and policy failings which allowed the incident to happen, rather than looking to blame an individual.
What makes something a ‘never’ event?
Never events are serious incidents that are entirely preventable. They should never have happened - because guidance or safety recommendations providing strong systemic protective barriers are available and should have been implemented by all healthcare providers.
The Lead governance partner is one of our senior consultants, who combines the role with their clinical duties. Our current governance partner is consultant anaesthetist Dr Graham Beck and he is supported by two colleagues from the admin team.
Dr Beck reviews all formal complaints and incidents to ensure they are fully investigated.
He also looks at whether there are any immediate patient safety issues or any concerns about performance and if so ensures immediate actions are taken to reduce the risk of it happening again.
If a patient’s complaint or an incident reveals serious concerns about a doctor’s capability or conduct, or if a pattern of complaints or incidents is a cause for concern, the Lead governance partner will inform the Responsible officer and instigate a process known as ‘Maintaining high professional standards’.
The concerns are investigated jointly with HSC and if substantiated, could lead to disciplinary action for the doctor.
However the key focus of all the governance processes is to identify areas for improvement and work with colleagues to improve performance and services to patients.
If you have serious concerns about a doctor’s behaviour, health or performance, we encourage you to let us know as soon as you can. But you can also raise your concerns with the General Medical Council (the GMC) and they can investigate whether patient safety, or the public’s confidence in doctors, is at risk.
For each specialty at the MSG, HSC brings in an expert, independent organisation (such as the appropriate specialist Royal College) every five years to carry out a thorough review.
The reviewers look at the extent to which care and treatment meets recognised standards and best practice and is in line with national guidance and local policies. Plus they look at the resources available for assessing and treating patients locally, the way the specialty is run and they review complaint rates and a sample of complaints.
We value partnership – it’s another of our core values. We are committed to working closely with patient groups such as CareWatch and with other healthcare providers to understand their views and to learn from them what more we need to do to keep patients safe and improve quality of care.