PTSD - A Psychodynamic Explanation

The Francis Report and General Practise

The Francis report published on 6^th February 2013 was an inquiry done by Sir Francis in Mid Staffordshire Foundation NHS trust into the role of commissioning survivors and regulatory bodies at the hospital. It follows on from two previous inquiries at the Mid Staffordshire Foundation trust which highlighted neglect in care, increased mortality rates and high level of complaints from relatives and patients. The report considered reasons for problems at the trust, why they weren’t identified and acted upon sooner. The report builds upon the original report published in 2010 and highlights suffering of patients and relatives failed by a system ignored values of true care and acted upon cooperate care interests above patient care. The report plays an important role in the improvement of healthcare services provided in the UK especially having serious implications upon nursing care through its 290 recommendations preaching a fundamental change in culture where patients are put first. However, the report states that responsibility of patient care is not dependent on the Trust alone but the whole healthcare service highlighting the importance of efficient teamwork within the multidisciplinary teams forming the healthcare service.

The following are some of the key recommendation of the Report:
 1. Duty of Candour – which states all NHS staff and directors should be honest and open with sharing of information i.e. mistakes, to perform service as best as possible.
2. Power of Suspension and Prosecution of boards/individuals – if minimum standards set by the Care Quality Commission(CQC) are not maintained
3. Registration in care – a registration system should be implemented to for staff and care workers that provide care in a hospital or care home environment; preventing unregistered personals providing care.
4.  GP’s and monitoring roles- GP’S need to undertake monitoring roles on behalf of patients undergoing care in a different environment to their treatment.

Effect on General Practise
Within the inquiry when analysing evidence of GP’s provided in the first original report, it was found that a great deal of concern was expressed from GP’s over the care of trust of patients. The inquiry states that it is unfortunate it didn’t occur to any of “them” – practising GP’s to report their concerns earlier, nevertheless these as it wasn’t directly expressed as their duty the report doesn’t criticise General Practitioners but concludes GP’s have an important role in monitoring care of patients who receive hospital or other speciality cares.

Implication of the report on GP’s duty include:
1. Responsibility for delivering of standards and quality of care – GP’s have an ongoing responsibility of care towards their patients that does not end to referral to further treatment/care e.g GP’s should check quality of care, have internal systems needed for “flagging” of areas of concern, keep themselves informed of care and care providers provided to the patient, be aware and main professionalism no taking advantage of their positions but ensure patient gets best possible safe and effective care.

2.  Continuity of Care – the report emphasis on transaction from hospital to a community and states GP’s and practises have an obligation towards their patients as part of their duty to check on patient treatment and check is treatment is satisfactory and monitor patterns of concern making them known to the CQC.

The Chair of the Royal College of General Practitioners Dr Clare Gereda responded to the Report by saying:  "Hospitals should be places where people feel safe and where they can trust the staff looking after them to deliver the care and kindness they deserve. They should not be institutions that strike fear and dread into the hearts of patients, in many cases even before they are admitted. "While the Francis report focuses on failings in secondary care, it has implications for the whole of the NHS, including general practice. At a time when the NHS is under greater than ever financial pressure, it is imperative that the needs of patients are put first, and that cuts are not made which could jeopardise the safety of patient care……"The NHS was set up 65 years ago to provide fair and effective healthcare and to protect patients. If it is to continue doing this, the Government and all of us working in the NHS must stop underestimating the importance of kindness and compassion, the fundamentals of good patient care that cannot be budgeted for."

Shared Culture: the Francis Report also pinpoints the fact that all NHS must adopt and practise the use of a shared culture in which patients are the main priority of care and everything done is for the benefit of their health.  It suggests that this requires core values and standards shared throughout the system alongside effective managemental leadership running through the NHS. Furthermore the inquiry also puts forward the conclusion the system should have applied values of transparency honesty and candour in order to achieve the underlining objective of the NHS and provide efficient safe and the best care to all patients.

We hope you have found this informative, and offers you of the changes that has happened within the healthcare system in order to provide you with better and safer care.
By Universal Medicine Team(Mathew George)