Decision Report 201301493

Summary

Mrs C complained about an out-of-hours hospital consultation with a trainee doctor, which she attended with her four-year-old daughter, Miss A. The appointment was made after Mrs C called NHS 24 to report that Miss A had been unwell for several days and that her condition was worsening. She complained that the doctor did not examine her daughter, and inaccurately concluded that Miss A was suffering from a viral infection. She also complained that he was patronising and condescending. She said she left the examination room and went to the accident and emergency department at another hospital, where Miss A was quickly diagnosed with scarlet fever.

In responding to the complaint, the board explained that the doctor was at the beginning of his second year as a general practice registrar and that a fully qualified GP trainer had been on the premises to supervise him. They said it was unfortunate that Mrs C had chosen to leave the premises before the supervisor could intervene. However, they acknowledged that the incident had thrown up a number of training issues that they needed to address with the doctor before he could complete his training and demonstrate his competence as a qualified GP. In particular, they said this would cover the recognition of scarlet fever.

In bringing her complaint to us, Mrs C acknowledged that the board had identified training gaps and had undertaken to address these. However, she also felt that the incident had highlighted gaps in the supervision of trainee doctors. She noted that she had been in the examination room for up to ten minutes and considered this too long for a trainee to be left unsupervised.

We discussed the case with one of our independent clinical advisers and he had no concerns about the doctor having been left unsupervised for this period of time. He said this was perfectly reasonable for a doctor at this stage of training. We, therefore, did not uphold the complaint. However, we did make recommendations as our adviser had concerns about the adequacy of the proposed action to address the identified training gaps. He noted that the board said the issues needed to be addressed before the doctor could complete his four year training programme, but he considered that they should be addressed much sooner than this. He highlighted that hospital out-of-hours clinics, with the requirement to work with sick children, were one of the more challenging aspects of general practice. Our recommendations on the case, therefore, reflect our adviser's concerns.

Recommendations

We recommended that the board:

• put an action plan in place to ensure that the issues arising from this incident are addressed within three months;
• make arrangements for the doctor's next two sessions to be directly supervised by a GP trainer to ensure that he is competent in this setting; and
• make the doctor's educational supervisors aware of this incident, which should be included in his training record.