Annex 3: Examples of information to be shared with CQC

During a teaching session with trainees, the GMC adviser is told of a live internal investigation where staff at the hospital failed to record fluid intake/output in a patient with recurrent vomiting. The evidence of dehydration was concealed from the medical records. Two trainees state that they have heard of previous instances where medical records have been amended to conceal errors on the same ward, but staff have been too fearful to report this.

Rationale

This represents a risk to patient safety as it shows potentially life-threatening failures in monitoring a patient and cultural issues about raising concerns. This could also cause future harm to patients.

What will information be used for?

To trigger a responsive inspection.

A medical unit was run by bank and agency staff on one weekend. These staff did not have access to patient records and care ceased at the weekend as a result.

Rationale

Without access to patient records there is a potential risk of future harm to patients.

What will information be used for?

To trigger responsive inspection.

The issue was raised to the GMC by a locum GP who has covered at the surgery on several occasions. They raised the issue locally 3 months ago, but after returning the previous week, there has been no change.

Rationale

Inadequate staffing levels, poor record keeping and inadequate ways of communicating abnormal results all indicate systems concerns and potential risk to patient safety. 

What will information be used for?

To inform the CQC inspection programme.

On a GMC visit, the team identify the following: The closure of the gynaecology ward at weekends means that patients are dispersed to a number of different outlying wards. The process by which patients are assigned to different wards is unclear, including the sign off process. Their care may be provided by the doctors in these departments who do not have any training or experience in obstetrics or gynaecology although they have been provided an induction to the specialty and treatment of its most common conditions.

Rationale

This raises concerns as to whether the quality of care is: safe, effective, caring, responsive to people’s needs or well-led.

What will information be used for?

To inform intelligence monitoring and the CQC inspection programme.

A letter of complaint has been sent to the GMC from Core Medical Trainees at a hospital stating that: Doctors are moved around from ward to ward on a daily basis in order to cover gaps in the rota. This has led to poor continuity of care and absolutely no teaching or training value. When raised with medical staffing, these concerns have been ignored because service provision seems to remain a priority.

Rationale

This raises concerns as to whether the quality of care is: safe, effective, caring, responsive to people’s needs or well-led.

What will information be used for?

To inform intelligence monitoring and the CQC inspection programme.

During a GMC training session, doctors raise the following concerns: there is a high volume of patients coming into the emergency department, the four hour target is being breached daily and trainees are unable to move patients into the appropriate specialty wards because there are no available beds. The staff in the emergency department report undermining behaviours in several receiving specialties and patient flow is not working as it should. There are reports of ambulances parked outside the emergency department because paramedics are not able to hand over patients to the emergency department and provide them with a safe environment to await treatment. The issues have been raised locally, but there has been no change.

Rationale

This raises concerns as to whether the quality of care is: safe, effective, caring, responsive to people’s needs or well-led.

What will information be used for?

To inform intelligence monitoring and the CQC inspection programme.

This is due to long term boarding of medical patients who no longer need hospital care but cannot be discharged into the community because they do not have carers or community-based healthcare professionals to provide after care.

Rationale

This raises concerns as to whether the quality of care is: safe, effective, caring, responsive to people’s needs or well-led.

What will information be used for?

To inform intelligence monitoring and the CQC inspection programme.

During a session on adult safeguarding with a group of out of hours and locum GPs the RLA is told by a group of doctors about poor standards of care at a named care home and that they have raised their concerns with the management of the home about breaches of DOLS legislation, but they are continuing.

Rationale

This raises concerns as to whether the quality of care is: safe, effective, caring, responsive to people’s needs or well-led.

What will information be used for?

To inform intelligence monitoring and the CQC inspection programme.