Memories

 

In all the forty five plus years that DZ practiced as a doctor in the NHS, there is something that he never really fully noticed. Something that he pretty much took for granted without thinking about it.

And that is the respect with which I, and most of my colleagues were treated by the vast majority of our patients. And the value that was placed on our knowledge and advice, not only as individuals, but as a profession by society in general.

This was brought home to me yesterday when I read two articles about the fact that, in the USA our medical colleagues do not appear to be regarded so highly and their knowledge is increasingly being disregarded by the prevalence of what Asimov called “anti-intellectualism”. As an example, as many as 10% of the population are opposed to the practice of vaccination.

The consequences of these attitudes are well illustrated by this news article. “According to the Idaho Department of Health and Welfare, as reported by Idaho News 6, almost 60 people have gotten sick since May 19 after drinking raw milk. So far, 45 of those cases have tested positive for Campylobacteriosis,”

This is in spite of the fact that raw milk is described on the packaging as “not for human consumption”

But this lack of respect for the medical profession goes all the way to the top. This news illustrates that, even the most eminent of our colleagues are not immune from political oppression.

“At the 86th Scientific Sessions of the American Diabetes Association in New Orleans on June 5, 2026, police forcibly ejected five prominent obesity and diabetes researchers.

The researchers, including Steven Kahn (editor-in-chief of the ADA's flagship journal Diabetes Care) and pediatric obesity expert Justin Ryder, were removed from the Ernest N. Morial Convention Center by police after handing out copies of an editorial they authored criticising the Trump administration.”

Perhaps this is part of the chaotic insanity prevalent in the USA currently. Or perhaps the expense and, for many, inaccessibility, of medical care in the USA has resulted in a disillusion with the profession. A disillusion that has culminated in the murder of a CEO of a healthcare company. The victim had amassed a fortune of 43 million dollars, by running a health insurance company that had a reputation for reluctance to actually provide the care their customers had paid for.

DZ looks back at the interactions he enjoyed with his patients over the years with great satisfaction. Obviously there were a small number who caused a degree of irritation. But the vast majority were a pleasure, and some were truly delightful.

I have a small number of gifts I received from some of them. In accordance with GMC guidelines they are all low in monetary value. But I cherish them all. This is perhaps my favorite, from a lady now long passed but remembered fondly.

Injustice

 One of the first things DZ did when he retired was to deregister from the general Medical Council, and relinquish his license to practice. There were two reasons for this. Firstly, having retired already on two previous occasions I knew how easy it was to succumb to the temptation of going back to work. I burned my boats. Secondly I was glad to escape the tyranny of the GMC once and for all.

This process was not as straightforward as I had anticipated. Applicants to deregister are sent a form to fill in, fourteen pages long. This form requires the applicant to list full details of all the places worked over the previous five years, so that they can then contact your previous employers to, essentially, solicit complaints. A last frantic attempt to try and get you for something before you slip through their fingers.

If you have spent the last five years working through agencies the number of previous employers can be quite substantial, and compiling this list becomes quite onerous. At least these days they don't charge a fee. In the past a fee was payable, meaning that someone with an unblemished record would have to pay to deregister, something he'd get for nothing if they were struck off for being a naughty boy.

I declined to play their games, and simply cancelled my direct debit, confident that, in due course, I would be erased from the register for non payment of fees. Frankly I don't give a shit how I escape their clutches. I fact they backed down and gave me voluntary erasure without their precious form.  Tyrants and bullies always back off when faced with even the slightest defiance.

So, having escaped, I have had no interest in the machinations of the GMC. 

Until today, when I read this article.

So they still have the ability to enrage me. Their conduct against Dr Abu-Sittah is nothing short of abominable, disgusting and reprehensible. It smacks to me of racism. What a bunch of pigs!

Discrimination

 Yet more news from the asylum across the water with a lunatic in charge.

Trump has issued an order that medical staff in the veteran's administration, the government organisation that looks after ex servicemen, can deny treatment to any patient who supports the democratic party.

That would be like a British doctor being allowed to refuse treatment to a patient because they voted labour.

Where do I start? Trump obviously has no idea how the medical profession works. Most doctors would be bemused by the suggestion that we should even know a patient's political affiliation. In his entire career DZ never once asked a patient their political or religious views, and I don't suppose the vast majority of my colleagues would either.

I think Trump should be told "Hippocrates would like a word"

For all it's faults I can't imagine for a moment the GMC tolerating such a practice. Any doctor who did this would, rightly, find himself in hot water very quickly.

The USA doesn't have an equivalent of the GMC, a nationwide regulatory body. Such regulation is devolved to individual states as "State Medical Boards." In normal times I'm sure that these boards would oppose this idea rigorously. 

But, in case you hadn't noticed, the times we are living in are far from normal, and full of surprises.

Out of touch

 A few weeks ago DZ highlighted the case of Dr Sarah Benn, a climate activist, and that the GMC had sanctioned her, in defiance of several articles of the Human Rights act.

Despite her having been retired for 2 years now they suspended her registration for five months. A totally vindictive, spiteful, and pointless act, but totally in character for the GMC and MPTS.

The reason that they ignored her very valid arguments was that they asserted that they knew better what the general public might consider unprofessional behaviour.

Enter the Doctors' Association UK, who decided to fact check this stance, by polling 2000 members of the general public. Only 3% of those polled agreed with the MPTS! A perfect illustration of how out of touch, patronising, arrogant and incompetent the GMC are.

I'm not sure why Dr Benn is still registered with the GMC at all. Taking voluntary erasure is an easy process and frees retired doctors completely from their malign attention. 

And using logical arguments in her defence was another waste of time. They're deaf and blind to anything but their own preconceptions. Why did she even bother turning up? What can they possibly do to a doctor no longer practising.

In her shoes I would have gone to the tribunal. And I would have relished the opportunity to express my opinion, and told them to fuck off!

Sisters

 DZ has been highly critical over the years about the GMC. But this article reveals that the General Nursing council is just as bad. Compare these two phrases;

“the council causes distress to doctors over trivial complaints while tolerating poor practice in other cases”. Sir Liam Donaldson.

"Good nurses find themselves investigated for years over minor issues, while some bad ones escape sanction."  Independent review.

In fact, reading the review you could be forgiven for thinking that it was about the GMC, with references to bullying, racism, and suicide among those being investigated.

The GMC, GNC, and all the other specific regulatory bodies should be abolished totally, and replaced with a proper, independent, professional body covering all health professions. Staffed by properly qualified people, instead of the incompetent amateurs we all have to put up with.

Tipped scales.

 DZ thought that he knew all of the machinations used by the GMC to make it easier to screw over doctors who come before a Medical Practitioners Tribunal.

Such as the original idea that the MPT should be independent of the GMC, which never happened.

Or the change in burden of proof from the criminal standard, (beyond reasonable doubt) to the civil, (balance of probabilities).

Or the fact that the only appeal against the penalty set by a fitness to practice hearing is to the High Court, an expensive, daunting and difficult path making appeal almost impossible for most doctors.

But what I didn't know was that, if the GMC themselves are dissatisfied with the judgement of a FPH and want a more severe punishment, then they themselves do have an appeal system for that. An appeal pathway not open to the accused doctor. And who gets to adjudicate this appeal of the GMC. Why the GMC themselves of course. 

The government noticed this and recommended abolition of this unfair practice over six years ago but nothing happened.

I din't know why the fuckers bother with a FPH at all. It's so biased against the doctor that it would be laughable if the consequences weren't so devastating

Earth Day

So yesterday, 22nd April, was "Earth Day". DZ is aware that various climate activist groups are not popular in the UK. But despite the disruption they undoubtedly cause, no-one can doubt their commitment, sincerity, and commitment to protest in a peaceful manner. Those familiar with DZ blog will know he is almost obsessive about the Human Rights Act 1998, and there are a number of articles of the act that protect those who wish to protest peacefully.

• Article 5: Right to liberty and security
• Article 6: Right to a fair trial
• Article 7: No punishment without law
• Article 8: Respect for your private and family life, home and correspondence
• Article 9: Freedom of thought, belief and religion
• Article 10: Freedom of expression
• Article 11: Freedom of assembly and association

All of the above are invoked to a greater or lesser degree by those who protest. The present government has demonstrated an antipathy to the act, and even suggested it's abolition. It's an ambition that, for the time being seems to be on the back burner. However two recent very disturbing  cases illustrate that it's observation seems to be under attack. 

The first is the case of Trudi Warner.

 who faced a charge of contempt of court for simply holding up a placard outside a court. Fortunately the high court judge threw the case out. What is really disturbing is that the high court judge drew attention to the actions of the Attorney General, and the Solicitor General, which were described as "significantly mischaracterising the evidence". Let's translate that. They lied! The most senior lawyers in government fucking lied to try and charge this lady for doing something she had every right to do!!!

 

The second case is that of Dr Sarah Benn.

The Medical Practitioners Tribunal Service has ruled Dr Sarah Benn's fitness to practise was impaired and said it must consider whether a sanction should be imposed on her registration. For participating in a peaceful protest, in defiance of a court injunction.

Let's leave aside for a moment the idea that the human rights act can apparently be over-ridden by the courts, something I find highly questionable. What is astounding is that she could face suspension, or even erasure for "Obstructing a private road." The GMC, and the tribunal service have a long history of disdain for the human rights act, and seem to think it doesn't apply to them. Also these tribunals are usually made up of complete amateurs who know nothing about the law. And as well as their arogance, they are inconsistent. 

"In January 1999 the Standards Committee of the GMC met to consider issues involving the behaviour of doctors who comment in the media. It was their view that the GMC should not attempt to curtail doctors' rights to express their personal opinions. Doctors, like anyone else commenting in the media, are subject to the same constraints imposed by media regulatory bodies, and the libel laws. Furthermore, the committee considered that the professionals reputation depends principally on the standards of care and conduct provided by doctors to their patients, and not on personal opinions as put forward in published letters or articles. Whilst you may disagree with the comments Dr Y has made, we cannot take action against a doctor who is expressing a personal opinion".

Dr Benn's actions have absolutely nothing to do with the standards of care she provides to her patients. I anticipate that, in view of the publicity this case has attracted, and the involvement of the BMA, that the GMC will back off. I expect that they will offer Dr Benn a warning. Dr Benn should be made aware that has the right to refuse a warning. The GMC should be told to fuck off.

Excuses

 As a follow up to my last post, the (not a) doctor in question has now been sentenced to 7 years in prison.

As comment I'd like to quote from the article;

“That the degree certificate and supporting letter were accepted by the GMC represents an abject failure of scrutiny." (of the GMC)

“such clearly false documents” and why it took a journalist rather than a professional governing body (the GMC) to uncover the truth.

The GMC claimed in court that documents in the 1990s were not subject to the “rigorous scrutiny” now in place."

That does not fill me with confidence. The incompetence involved is staggering, and DZ sees no evidence to suggest that scrutiny is now more rigorous. Unless of course they are referring to the appraisal and revalidation process. A process that the lady in question successfully negotiated for years.

The GMC are ingrained with incompetence, ignorance, complacency, amateurism, rank stupidity and pomposity. They are utterly unfit for purpose, root and branch.

If our Health minister really wants to do something about the massive and manifest failings of the GMC it would not be enough to reform or tinker. Step one is to terminate it totally and start from scratch with a proper regulatory body, staffed by properly qualified people, rather than a bunch of aimless retirees wanting a hobby. And not one current employee of this failed organisation should have any involvement with the replacement.

It gets worse

 DZ has posted lots of instances of doctors who, despite being unfit to practice in one way or another, have no difficulty in getting regular satisfactory appraisals, revalidation and a licence to continue practicing.

But this case takes things even further. This individual obtained registration despite having no medical qualification! And then spent 20 years getting satisfactory appraisals and revalidation.

The fact that someone not even medically qualified can still pass annual appraisals is a further illustration of the fact that this entire process is not fit for purpose.

So what do you suppose will be the response of the GMC.

Ethics

The practice of medicine is full of moral and ethical conflicts. Although we have the GMC good practice guide there are many occasions where the advice in there will not cover a particular situation. Often there is no guidance anywhere for the doctors and other staff involved. A thankfully rare example is described here. DZ imagines that most woman carrying a wanted pregnancy would want all measures possible taken to preserve the life of her baby, even in the event of her own death. Few would argue against the expeditious delivery of a viable baby in a dying woman, and this is rare but well documented.

The case linked to above is a step further, and could be ethically justified.

But there is a step further that DZ thinks is a vile abomination. (1) (2) Who the fuck thought that was a good idea. Joseph Mengele?

More malice

 DZ has recently read an article about a Consultant Paediatrician who is being pursued by the GMC. There are two aspects to this case that I find disturbing.

Firstly the case at the centre of their action is 24 years old. If you check the GMC website you will see that they themselves have a "five year rule". They will not normally investigate cases older than 5 years. So they are acting contrary to their own guidelines.

Secondly, and far more disturbing. The doctor has decided to apply for voluntary erasure. This would terminate the action of the medical practitioners tribunal. Only back in June this year I posted on a similar case. In that case the GMC granted voluntary erasure, the MPT objected, and the case went to court where the legal precedent was set that a doctor can obtain voluntary erasure even if there was a tribunal in progress. On that occasion the GMC were actually the good guys. Which makes it all the more extraordinary that on this occasion the GMC are ignoring this precedent, and have rejected the application. So not only are they being malicious and vindictive, but grossly inconsistent too. One wonders what is their motivation here. 

Would it be too much to expect them to abide by their own rules, as well as the law, and be consistent?

Animosity

 DZ, like I suspect most doctors, has met colleagues he did not get on with. And I'm dead certain that some of my colleagues have not liked me very much either. Such is human nature. I have had one colleague threaten me with violence, and I've called one a "fucking idiot". I've even wished death upon one or two. But that's as far is it goes. 

Unlike this guy, who tried to burn his colleagues house down with him in it, and when discovered by his intended victim, stabbed him. 

I bet he doesn't put that in his appraisal form, though I suppose that's moot. I can't see him keeping his GMC registration for long. The GMC takes a dim view of doctors who try to murder their colleagues.

What surprises me the most is the vehicle on which he went to his victim's house, and on which I presume he intended to escape.

A "getaway" bicycle

I have it!

 

DZ has had a “Eureka” moment. It has come to him like a blinding flash what is at the top of the massive list of things that is wrong with appraisal. It’s so simple!

Imagine for a moment that in the recruitment process it was acceptable for candidates to write their own reference. I think most people can see what would be wrong with that.

So why is it considered OK that we fill in our own appraisal form? Just maybe there might be a little bias and exaggeration involved, and a little filtering possibly?

When it comes to colleague feedback might we just ask people we get on with, or have a little dirt on, and exclude that vascular surgeon you called a cunt.

And patient feedback. Might we just ask those we know like us? And exclude that guy whose young wife we comforted while he was in hospital?

And when it comes to the appraisal form itself do you suppose it’s possible that that too is bordering on a work of fiction? Is it possible that those patients you misdiagnosed, screwed up, swindled, fucked or killed don’t get a mention?

Surely not! Surely an organisation such as the GMC must have thought of that?

GMC appraisal dept.

Strike??

 

There is no doubt that over almost 20 years doctors’ pay has declined significantly, by a process of slow erosion. The same is true of other NHS staff, but I’m going to confine myself to talking about the medical profession. The BMA estimates the drop in real earnings to be 30% since 2006, a figure I can well believe. Coincidentally that also corresponds to the time period when doctors have been burdened with the extra workload of appraisal and mandatory training in most cases without any reduction in clinical workload.

The BMA are thumping their chests and demanding a pay rise of 30% in real terms over the next five years. And a national strike is threatened if they don’t get it.

Those of DZ age will know that, no matter how justified this might be, this is just not going to happen for a number of reasons.

Firstly a third of all doctors are not actually BMA members. They will not be balloted on strike action, and are unlikely to support it. The government know this

The BMA are “all mouth and no trousers”. They don’t have it in them to pursue their aims against a hostile and intransigent government. Nor will they support individual doctors who become targeted by employers and the GMC. The government know this.

Next, doctors have never felt easy with industrial action, for the simple reason that action which hurts their patients goes against the grain. Total support for strike action is unlikely, and support will fall if the action drags on. Both the BMA, and the government know this.

The GMC have in past disputes made veiled threats towards doctors who engage in such action.

Government will use the same tactics to screw us that have always worked before. Dig in their heels and wait. The BMA will not be able to sustain a prolonged campaign. Both the BMA and the government know this.

DZ addressed this the last time doctors engaged in industrial action and lost. He even made a suggestion that never occurred to the BMA, or perhaps it did and they decided it was too likely to shake up the government and the GMC, that the gongs that many BMA high ups aspire to might be at risk.

A form of industrial action that would be popular, sustainable indefinitely and not adversely affect a single patient.

Boycott all non clinical work.  Refuse en masse to engage in appraisal, revalidation, CME, audit, mandatory training, teaching etc. We could keep that up for years if necessary. And there’s fuck all they could do about it if we all stuck to it.

Appraisal causes disaster.

 

I’ve written repeatedly here about appraisal and revalidation, and vowed to myself on a number of occasions that I’ve now exhausted the subject, and I’ll put it to rest.

And then along comes another horror story.

This one concerns a doctor who started working in an NHS post in 1991 as a haematologist, who carried on working into his mid 80’s by simply informing his employers that he had made a mistake with his date of birth, and “updating”. He did this more than once until it was noticed that his latest update would have made him just 8 years old when he qualified from medical school.

He duly appeared in front of the GMC, was found guilty of dishonesty and his registration was suspended for twelve months, after which he was restored to the register.

Prior to his suspension he had accumulated a number of adverse incidents relating to his work, no doubt related in part to his advanced age. You would have thought that the Trust involved would have taken steps to ensure his retirement but no. Unbelievably they gave him his job back and he returned to work.

So let’s just summarise

He had a string of adverse incidents

He had a GMC conviction for dishonesty

He was 85 years old

And his Trust gave him his fucking job back!!! With the full acceptance of the GMC!!!

So what happened next should not surprise anyone.

A patient of this doctor required bone marrow sampling and he chose to obtain it by sternal puncture using the device featured in my recent mystery object post. This is a simple procedure and very safe if properly done. DZ himself performed it a number of times as a houseman in the 1970s. It requires some physical force to penetrate the front of the sternum and it is absolutely crucial that the adjustable collar on the needle is securely set at the correct distance from the tip to prevent the operator from “following through” and coming out of the back of the sternum. The correct distance is usually just a few millimetres.

Reading between the lines either, the collar was removed, the collar was not set at the correct distance, or it was not properly tightened. The result was that the doctor went through the sternum and penetrated the heart causing rapid death from haemopericardium and cardiac tamponade. The patient was in her 40s, and was accompanied by her husband, who witnessed the entire debacle.

Naturally the police were involved and the doctor found guilty of criminal negligence. He has been sentenced to three years in jail.

The GMC, and the Trust involved undoubtedly failed in their duty of care to the patient. But they also have a duty of care to the doctor. In restoring his registration, and reemploying him they clearly failed in that duty too. He should have been quietly and gently informed by both that he was being retired, not just for the benefit of his patients, but also his own. As a result of their abject failure a woman died, and the doctor will spend what is almost certainly the rest of his life in prison.

So where does appraisal and revalidation come in here. Well obviously he has successfully navigated these since 1991. Had he not he could not have been revalidated and reemployed. So this is not just yet another case of the process not working in weeding out an unfit doctor. It is far worse. This is a case in which the appraisal and revalidation process actually facilitated the return to work of someone unfit.

Nice one boys.

Appraisal reappraised

 

Back in May 2018, when we were blissfully unaware of what was around the corner I did a little exercise working out how much time the process of appraisal takes, and what this means in the broader view of impact on clinical services. I did the same, separately, for mandatory training.

Then Covid came along. With the workload clinicians were taking, and the stress we were under it became accepted, even by the GMC,  that a requirement for appraisal would be unnecessarily burdensome on hard pressed doctors. Trusts also felt the same about mandatory training. Tacit admissions that both appraisal and mandatory training can be shelved when it suits them.

Covid has not gone away! The UK seems to be in yet another wave, with 25,000 new cases on June 15 2022. In addition the waiting lists for treatment have ballooned. There are now 6.5 million people awaiting treatment. Also it is estimated that the UK is understrength by 10,000 doctors.

So I decided to recalculate, but combining both processes. I assumed, as before that appraisal takes 40 hours to prepare for and endure. And 20 hours mandatory training. I also assumed, as before that a doctor works 44 weeks of the year. In may 2018 there 240,000 fully registered medical practitioners. There are now 300,000.

I’m not going to go through the arithmetic. The bottom line is that, if appraisal, and mandatory training were abolished, and the time saved devoted to clinical work it would generate extra work equivalent to employing an extra 10227 full time doctors. At zero cost. That would address the shortfall at a stroke. I believe that the benefits would actually be greater. These calculations assume that doctors would be prepared to do an extra 15 sessions a year if the requirement for appraisal and mandatory training, both utterly worthless exercises, were lifted. I would be perfectly prepared to permanently change an SPA to a clinical session if this were offered, and I’ve no doubt many of my colleagues would feel the same. In addition we know that these processes are demoralising. They contribute to doctors emigrating and retiring early.

They are both, in the current circumstances, and for the foreseeable future, unwanted luxuries we can not afford.

Malice

 

I have often written on this blog about the tyranny and vindictiveness of the GMC, and of their arrogant view that the law somehow doesn’t apply to them. The GMC themselves are overseen and regulated by the Professional Standards Authority for Health and Social care. It is rare indeed for this body to take the GMC to task. The annual reports on GMC performance are little more than congratulatory whitewash exercises for their mates up the road. Even on those rare occasions when the high court finds against the GMC, this is not examined by the authority.

But when the opportunity arises to challenge the GMC in a way that enable the Authority to get the knife into an individual doctor they’re in there like a shot, showing a degree of malice and vindictiveness that makes the GMC look benign.

As in this case. A Belfast Neurologist was the subject of a GMC fitness to practice hearing. I don’t want to go into the allegations. They may be substantial, or the GMC may just be bullying, to which they’re not averse. The Doctor in question decided, understandably, to quit the profession entirely, and applied for voluntary erasure. Any registered medical professional has the right to do this. DZ looks forward to doing this in the near future. Once that happens I may reveal my identity. And then again I may not. Once erased the GMC have no more authority over the practitioner, who from then on has escaped their tyranny for ever. And to give the GMC their due they granted the request, erased the doctor, and the fitness to practice hearing then became moot, and was terminated. The Dr and the GMC went their separate ways. For once the GMC are not the villains of this peace.

The Professional Standards Authority weren’t happy with this. They went so far as to go to court to force the GMC to reregister the doctor, so that the fitness to practice hearing could proceed. Now, the ultimate sanction available to the GMC in a hearing is erasure. So the Authority wanted to  reinstate the doctor so that they could potentially erase him again. A case of. “You can’t quit, we want to fire you”. All it could possibly achieve was to subject the doctor to more stress, more humiliation, more harassment. An action so pointlessly vindictive and malicious you wonder what sort of vile cunts would want to do such a thing.

I’m pleased to say the judge told them to fuck off.

Whistleblowing and bullying

 

The NHS attitude to whistleblowing has never been cause for celebration. Going back to the Stafford Hospitals scandal it’s clear that problems had been endemic for some years, but those few staff who dared to raise concerns found themselves turned on by management, often with the collusion of the GMC. The message was quite clear. Keep your mouth shut.

And bullying of whistleblowers is not the whole story. Bullying is widespread throughout the entire NHS, and a recent report shows that things are not changing.

If you google “NHS bullying” you will find dozens of documents laying out the bullying policies of various Trusts. You might think that these indicate that the problem has been addressed but there is one flaw with that view. These policies and protocols are not worth the paper they were written on.

In the late 2000s a NHS Consultant initiated an industrial tribunal case against a former employer for bullying, harassment and constructive dismissal. The tribunal concluded that the Trust had indeed failed to follow it’s own policies and procedures, but they also stated, astonishingly, that these policies and procedures were “Not contractually binding”. So the guilty Trust won. I wonder how many NHS employees are aware that these policies are totally unenforceable.

And NHS trusts still continue to behave towards employees in a highly questionable manner. We all know now about the appalling behaviour of the Consultant Breast Surgeon Ian Paterson, who was jailed for 20 years for maiming and mutilating many of his patients. Paterson worked until 2007 despite the fact that a surgical colleague raised concerns as early as 2003. The management response was not only to ignore those concerns, but also to move the whistleblower to a different hospital. Paterson was enabled to go on maiming people for a further 4 years by the complacency of the Trust, and also Spire private hospital, where he also worked.

Things have not changed since A J Cronin wrote “The Citadel”

Another appraisal fail

 I see another very dodgy doctor has been caught up with, having slipped through the tattered net that is appraisal and revalidation. I wonder how many more there are out there. We'll never know. As I've said before, the GMC couldn't find their own arse, with both hands, in broad daylight.

Appraisal fails once more

 A little over a year ago DZ wrote about a surgeon who had successfully negotiated yearly appraisals  and periodic revalidation despite causing harm to hundreds of patients over many years. 

Well here is another. The emerging pattern is one of appraisal being no barrier to poor performance.

And yet DZ has seen instances where poor performance has not only been picked up, but also acted on. Not by the GMC, but, surprisingly, by private health insurance companies. On more than one occasion he has encountered practitioners who have been informed by insurance companies that they would no longer be reimbursed by those companies for certain specific procedures. Presumably the insurers audit practitioners and flag up instances where either a higher than expected proportion of patients receive a certain procedure, or there is a disproportionate incidence of complications

In those cases DZ has seen, no restrictions were placed on the doctor by their NHS employer.

So credit where it's due. The private sector has a system of identifying poorly performing doctors that actually works. Without making anyone go through the joke that is appraisal. The NHS & GMC don't. 

Well no shit Sherlock!