Revalidation

The new system of revalidation due to start in December is about addressing "deficiencies" according the the health secretary, Jeremy Hunt.

There are currently no mandatory checks on the performance of individual doctors, however there is the system of registration which is over seen by the General Medical Council (GMC).

If serious complaints are raised about medical practice the GMC begin disciplinary procedures. This system only identifies problems after they occur whereas by contrast revalidation has been designed to try and prevent the problems occurring by regularly monitoring medical practice.

Each NHS organisation will appoint a "responsible officer", such as a medical director, in charge of overseeing the revalidation process.

The revalidation process will be carried out every five years by the GMC using evidence based on annual appraisals and feedback from both patients and colleagues on the medic in question. The "responsible officer" will make a recommendation to the GMC to aid their decision and in the vast majority of cases revalidation will occur. However, minor issues may lead to revalidation being delayed and major issues could lead to revalidation being rejected. In this case the medic would then not be allowed to practice.

In December of this year senior medical leaders will undergo revalidation checks and by April 2016 the "vast majority" of medics should have been checked.

"During piloting and testing of the new system, concerns were raised over the performance of 4.1% of doctors.

In 2.4% of cases the issues were judged to be lower level, such as lateness, in 1% they were medium level, which included problems with behaviour including rudeness to patients, while in 0.7% the problems were serious and would have had an impact on safety" (Source: BBC News)

The change is certainly a significant one, in fact "the biggest change in medical regulation for 150 years since the creation of the GMC." However we will have to wait and see if the new system is an effective one, will it lead to improvements in provision or could it affect patient care? For example the administration and assessments will be very time consuming, time which could be spent on patient care.. But regular checks will help to ensure doctors are providing the service expected of them..

"Smart-e-pants"

Recent preliminary research described in the Telegraph has shown that “smart-e-pants”, specially designed underwear, may be able to stop patients developing pressure sores.

Pressure sores form when patients remain stuck in one position for too long. As a consequence the surrounding skin is compressed and blood supply is cut off. If the blood supply remains cut off and therefore a lack of oxygen and nutrient delivery to the tissue occurs for a prolonged period the tissue will die. This can then lead to open sores developing which can cause further problems and are at risk to infection. Click here for more information. Particular sore prone areas include the hips and the coccyx, both of which would be covered by the underwear.

The underwear is designed to prevent these series of events occurring. Lined with electrical wiring and with electrodes placed on each cheek tiny electric currents are released every 10 minutes to stimulate the surrounding muscles, mimicking fidgeting in an able patient, which prevents sores developing.

The month long trial involving 33 patients by researchers from the University Of Calgary, Canada found that none of the patients developed pressure sores despite all being considered high-risk patients.

The most important factor in preventing pressure sores is ensuring regular movement throughout the day. Current treatment involves turning patients over to relieve pressure and the protective padding of prominent bony areas.

Pressure sores cost the NHS up to £2 billion each year and affect 500,000 patients in the UK each year. Larger studies are needed to determine whether or not the underwear could be used as an effective tool in the prevention of pressure sores. The article suggests that the underwear could be available to market in three years and could potentially save the NHS time and money through prevention. 

"Right-to-life" case

This week I am writing about another ethical court case I read about! The case involves a Muslim patient with severe brain damage.

After many weeks the court has now ruled that the hospital trust in question can legally with hold life-saving treatment if his condition deteriorates. The decision was reached largely due to the unanimous medical opinion that resuscitation would not prolong life "in any meaningful way" and it is therefore not in the best interest of the patient to intervene should things deteriorate.

The case is understandably complex, such a decision is something no one would want to hear about a loved one, however there is added complexity in this case. As well as the family's wishes the patient is a Muslim and such an act would go against the Muslim faith. According to the family everything must be done to prolong life "until God takes it away." According to the Quran "Muslims cannot kill, or be complicit in the killing of another, except in the interests of justice."

However the Islamic code of medical ethics states that "..it is the process of life that the doctor aims to maintain and not the process of dying."

Does this mean doctors can stop attempting to prolong a patient's life if there is no hope of a cure?

Stoptober

Continuing with the trend,  this month, entitled "Stoptober" is a stop-smoking monthly campaign launched in England by the government.

The aim of the campaign is to encourage smokers to stop smoking for 28 days starting on the 1st October, as research has shown that those who can stop smoking for 28 days are five times more likely to stay smoke free!

This is the first time the government has launched a "mass quit attempt" and it will be supported by the media through the use of TV/radio advertising, a daily support messaging service and roadshows around the country. The NHS smoke free website can be found here. It is hoped that the extra support and group effort will help more individuals quit than if they were to try alone. An example of this group effort is the movement of a "Stoptober wheel" up and down the country which people can sign as a pledge to quit.

A representative for Cancer Research UK which is backing the campaign along with the British Heart Foundation said "smoking accounts for one in four cancer deaths and nearly a fifth of all cancer cases". Another telling statistic is that one in two long term smokers will die from a smoking related disease.

As well as the motivation and group support smokers who join the campaign are given free support to help them quit, another incentive to try and quit!

I think the campaign can only be seen as a good thing and the more people it helps the better! In terms of health care the statistics show that smoking causes or contributes to a large number of diseases, many of which cost the NHS time and money. In a sense the campaign is preventative treatment, prevent people acquiring these diseases by helping them to stop smoking. Consequently this will save the NHS time and money in the future.