How far up the chain of command in any organisation should the buck stop? Credit: Pixabay

Dr Peter Moore: Who carries the can when things go wrong?

Dr Peter Moore

A few years ago a GP colleague in Exeter had to face an NHS disciplinary panel over an alleged case of negligence.

His problem was that, at the time, he was on holiday in France.

Even though he was out of the country, the practice was still his responsibility.

Under the contract with the NHS, GPs were responsible for the practice 24 hours a day, 365 days a year.

The behaviour of the staff or locums must be set by the partners.

If he could show that the locum was on the local list of approved GPs and he had done everything to ensure the locum was competent then he could be in the clear but to say ‘no idea, I wasn’t there’ was not an excuse.

When I was working as a hospital doctor living in a suburb of Plymouth, there were two local practices.

The doctors in both practices were popular but one had delightful and helpful receptionists, the other one had difficult ‘dragons’.

My non-medical friends would comment that one practice was unlucky with their staff. I bit my tongue.

There’s no luck in it. The attitude of the receptionists is set by the partners.

When we had a vacancy we appointed a new receptionist who had glowing references. She had worked in a practice in the South East and they were sad to see her go her when she moved to Torquay.

Fairly soon we started receiving negative feedback. She was difficult to patients, asking too many questions and being generally obstructive. Away from the front desk she was friendly and fitted into our team well.

When we discussed the situation with her it became clear that she had been trained to limit the number of patients seeing the doctor.

This approach included too many questions and being generally obstructive.

We discussed our different philosophy but she felt that we were wrong. Allowing the patients easy access would lead to an abuse of the system.

She felt that patients needed to be treated like children who had to be ‘educated’ by strict rules.

She meant well and this is how she had been trained. It may have worked in her previous practice where she was obviously very popular with the GPs.

Our problem is that it did not fit in with our approach. She left on good terms still believing that we were wrong.

How far up the chain of command in any organisation should the buck stop?

If the quality of locums and receptionists is the responsibility of the GPs should this idea apply to other professions?

If a ship hits the rocks it is the captain who carries the blame, even if he was not on the bridge?

Should Cressida Dick, the commissioner of the Metropolitan Police have been forced to resign because some lower-ranking officers were appallingly misogynistic?

The idea of taking responsibility throughout an organisation is not universal.

Was ‘Yes Prime Minister’ an accurate satire of the civil service when Sir Humphry suggested that civil servants don’t resign. “That’s what ministers are for.”

When things go wrong it is easy to blame a junior member of staff but there needs to be other questions.

A newly qualified doctor who makes a mistake should not carry the can alone.

The organisation must ask why they were placed in that position. Where was the support?

Was there anyone the doctor could have contacted for advice?

It is unusual for mistakes to be the sole responsibility of an individual. Often it is the system which fails.

And sometimes the problem is even higher up the chain.

Is the organisation so underfunded that there was no one else to offer support?

Was the equipment poorly maintained? Were all the staff supportive and was morale too low?

When anything goes wrong the whole organisation needs to look at itself. It is no use saying ‘deputy heads will roll’.